<table border="1" cellspacing="0" style="width:281pt"> <tbody> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap; width:124pt"> </td> <td style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap; width:157pt">3.</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Nombres y Apellidos Completos</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">DANIEL MONDAQUE AYALA</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt"># Dorsal o Polera</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">1</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">FECHA DE NACIMIENTO</td> <td style="height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">01/07/1994</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">Edad</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">28</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">Carnet de Identidad</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">11386254</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Categoría</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">-</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Nombre de Misión Completa</td> <td style="height:14.4pt; text-align:left; vertical-align:bottom; white-space:nowrap">Bolivia - Cochabamba</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">Año Inicio </td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">2015</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Barrio</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">El Dorado</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Estaca</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">La Pampa</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:nowrap">Equipo Anterior</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">Junior´s</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">Seguro de Univida </td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">Si</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">Fotocopia C.I.</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">Si</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">VACUNA</td> <td style="height:14.4pt; text-align:center; vertical-align:bottom; white-space:nowrap">Si</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">DOSIS</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">SINOPHARN</td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">CANTIDAD DE DOSIS</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">2DA DOSIS</td> </tr> <tr> <td colspan="2" style="background-color:yellow; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">No CELULAR</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap">75693276</td> </tr> <tr> <td colspan="2" style="background-color:yellow; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">CORREO ELECTRONICO GMAIL</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap"><a href="mailto:danielmondaque77@gmail.com">danielmondaque77@gmail.com</a></td> </tr> <tr> <td colspan="2" style="background-color:#ededed; height:14.4pt; text-align:center; vertical-align:middle; white-space:normal; width:124pt">COMENTARIOS</td> <td style="height:14.4pt; vertical-align:bottom; white-space:nowrap"> </td> </tr> </tbody> </table>