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From: <segurabici@segurabici.es>
To: "enlacesegelevia" <enlacesegelevia@bmsgroup.com>
References: <c7f3sWqqTc4anQBDTpHWFbwrMYYvbzpHjUsi0Oz9N4@www.segurabici.es> <074601dd5c8a$b369cac0$1a3d6040$@segurabici.es> <09ca01dd5fdd$14b091b0$3e11b510$@segurabici.es> <MATPR09MB8533EE05B2D4CCD570E7DF30AF612@MATPR09MB8533.eurprd09.prod.outlook.com>
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Subject: S#2026006124#E-MAIL CIA SOL DOC
Date: Tue, 27 Oct 2026 14:10:03 +0100
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Email originated externally.

=20

=20

De: Siniestros Autos <siniestrosautos@divinapastora.com>=20
Enviado el: lunes, 26 de octubre de 2026 16:36
Para: segurabici@segurabici.es
Asunto: SB01 2026/374 SINIESTRO 2026006124

=20

Buenas tardes:

=20

=20

Ruego nos remitan certificado bancario de titularidad de cuenta corriente y
copia DNI para poder realizar el pago de las facturas m=E9dicas

=20

=20

Saludos.

=20

=20

=20

Tramitaci=F3n Da=F1o Corporal
Departamento de Siniestros Autos

=20



  Antes de imprimir este mensaje, aseg=FArese de que es necesario. El medio
ambiente est=E1 en nuestra mano.=20

Este mensaje se dirige exclusivamente a su destinatario, pudiendo contener
informaci=F3n confidencial sometida a secreto profesional o cuya divulgaci=
=F3n
est=E1 prohibida por la ley. Si ha recibido este mensaje por error, le roga=
mos
nos lo comunique inmediatamente por esta misma v=EDa y proceda a su
destrucci=F3n. Asimismo, le recordamos que la lectura, uso, impresi=F3n, co=
pia
eo difusi=F3n del mismo sin autorizaci=F3n est=E1 prohibido. El correo elec=
tr=F3nico
v=EDa Internet no permite asegurar la confidencialidad de los mensajes
transmitidos ni su correcta recepci=F3n e integridad. La Entidad no asume
responsabilidad legal por tales circunstancias ni por el contenido de este
mensaje.

  _____ =20

De: segurabici@segurabici.es <mailto:segurabici@segurabici.es>
<segurabici@segurabici.es <mailto:segurabici@segurabici.es> >
Enviado: lunes, 19 de octubre de 2026 17:18
Para: Siniestros Autos <siniestrosautos@divinapastora.com
<mailto:siniestrosautos@divinapastora.com> >
Asunto: REF SB01 2026/374 SINIESTRO 2026006124=20

=20

Buenas tardes, remito documentaci=F3n sobre el siniestro.

=20

Un saludo.

=20





=20

De: segurabici@segurabici.es <mailto:segurabici@segurabici.es>
<segurabici@segurabici.es <mailto:segurabici@segurabici.es> >=20
Enviado el: jueves, 15 de octubre de 2026 11:48
Para: 'DIVINA PASTORA' <siniestrosautos@divinaseguros.com
<mailto:siniestrosautos@divinaseguros.com> >
Asunto: ENVIO STRO.2026006124=20
Importancia: Alta

=20

Buenos d=EDas, el asegurado nos indica que quiere acudir a la cl=EDnica
concertada.

=20

Ruego su gesti=F3n lo antes posible.

=20

Un saludo.

=20



=20


BMS MEDIACI=D3N IBERIA, CORRED. SEG.


PASEO DE LA CASTELLANA, 28 ENTREPLANTA


28046 MADRID


Tel:  (91) 419 76 40        Fax:


e-mail:  <mailto:%7b%5bCOR.COR_eMail%5d%7d> =20

Siniestro          2026006124


Compa=F1=EDa:

LIONS GATE IBERIA CONSULTING SERVICES S.L.U.

Referencia:

=09

P=F3liza: =20

181016712887

=20

=20


F.Efecto:

12/02/2026

Forma de Pago:

  Anual


Informe Siniestro tipo  Culpa


F.Ocurrencia:

09/10/2026

F.Comunicaci=F3n:

09/10/2026


Lugar:

BARX - VALENCIA


Descripci=F3n:

EL ASEG. SE TROPIEZA CON UNA PIEDRA QUE LE CAUSA LA CAIDA Y SE GOLPEA EL
HOMBRO


TOMADOR

=20


Nombre:

ENRIQUE BORONAT CASANOVA


NIF:

20011512-V


Direcci=F3n:

CALLE PERE MARC, 48  46701  GANDIA (VALENCIA)=20


ASEGURADO

=20

=09=09

PERJUDICADO

=20



CONTRARIO


Nombre:

=09Tel=E9fono:=20

=09

Direcci=F3n:

=20


CP:

=09Localidad:

=20

=09=09=09=09=09=09

VEH=CDCULO


Modelo:

=20

Matr=EDcula:

=09

COMPA=D1=CDA


Nombre:

=09

P=F3liza:

 =20

Ref.C=EDa.:

=20


Tramitador:

 =20

Tel=E9fono:

  =20

OBSERVACIONES

=09

PERITAJE

=20


=09=09=09

OBSERVACIONES  GASTOS MEDICOS

=09
=09=09=09=09=09=09=09=09=09

=20

=20





=20


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<div class=3D"WordSection1"><div><div><div><div><div><div><div><div><div><d=
iv><div><div><p class=3D"MsoNormal"><span style=3D"mso-ligatures:standardco=
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s=3D"MsoNormal"><b><span style=3D"font-size:11.0pt;font-family:&quot;Calibr=
i&quot;,sans-serif">De:</span></b><span style=3D"font-size:11.0pt;font-fami=
ly:&quot;Calibri&quot;,sans-serif"> Siniestros Autos &lt;siniestrosautos@di=
vinapastora.com&gt; <br><b>Enviado el:</b> lunes, 26 de octubre de 2026 16:=
36<br><b>Para:</b> segurabici@segurabici.es<br><b>Asunto:</b> SB01 2026/374=
 SINIESTRO 2026006124<o:p></o:p></span></p></div></div><p class=3D"MsoNorma=
l"><o:p>&nbsp;</o:p></p><p class=3D"MsoNormal"><span style=3D"font-size:10.=
0pt;font-family:&quot;Arial&quot;,sans-serif;color:black">Buenas tardes:<o:=
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ont-family:&quot;Arial&quot;,sans-serif;color:black"><o:p>&nbsp;</o:p></spa=
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s=3D"MsoNormal"><span style=3D"font-size:10.0pt;font-family:&quot;Arial&quo=
t;,sans-serif;color:black">Ruego nos remitan certificado bancario de titula=
ridad de cuenta corriente y copia DNI para poder realizar el pago de las fa=
cturas m=E9dicas<o:p></o:p></span></p><div id=3D"Signature"><p class=3D"Mso=
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font-family:&quot;Times&quot;,serif;color:black;background:white">Saludos.<=
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"><hr size=3D"2" width=3D"98%" align=3D"center"></div><div id=3D"divRplyFwd=
Msg"><p class=3D"MsoNormal"><b><span style=3D"font-size:11.0pt;font-family:=
&quot;Calibri&quot;,sans-serif;color:black">De:</span></b><span style=3D"fo=
nt-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif;color:black"> <a =
href=3D"mailto:segurabici@segurabici.es">segurabici@segurabici.es</a> &lt;<=
a href=3D"mailto:segurabici@segurabici.es">segurabici@segurabici.es</a>&gt;=
<br><b>Enviado:</b> lunes, 19 de octubre de 2026 17:18<br><b>Para:</b> Sini=
estros Autos &lt;<a href=3D"mailto:siniestrosautos@divinapastora.com">sinie=
strosautos@divinapastora.com</a>&gt;<br><b>Asunto:</b> REF SB01 2026/374 SI=
NIESTRO 2026006124</span> <o:p></o:p></p><p class=3D"MsoNormal">&nbsp;<o:p>=
</o:p></p></div><div><p class=3D"xmsonormal">Buenas tardes, remito document=
aci=F3n sobre el siniestro.<o:p></o:p></p><p class=3D"xmsonormal">&nbsp;<o:=
p></o:p></p><p class=3D"xmsonormal">Un saludo.<o:p></o:p></p><p class=3D"xm=
sonormal">&nbsp;<o:p></o:p></p><p class=3D"xmsonormal"><img border=3D"0" wi=
dth=3D"589" height=3D"102" style=3D"width:6.1333in;height:1.0583in" id=3D"x=
_Imagen_x0020_1743047953" src=3D"cid:image002.png@01DD5C9A.64425290"><o:p><=
/o:p></p><p class=3D"xmsonormal"><span style=3D"font-size:9.0pt;font-family=
:&quot;Arial&quot;,sans-serif;color:black"><img border=3D"0" width=3D"590" =
height=3D"101" style=3D"width:6.15in;height:1.05in" id=3D"x__x005f_x0000_i1=
028" src=3D"cid:image003.png@01DD5C9A.64425290"></span><o:p></o:p></p><p cl=
ass=3D"xmsonormal">&nbsp;<o:p></o:p></p><div style=3D"border:none;border-to=
p:solid #E1E1E1 1.0pt;padding:3.0pt 0cm 0cm 0cm"><p class=3D"xmsonormal"><b=
><span style=3D"font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif=
">De:</span></b><span style=3D"font-size:11.0pt;font-family:&quot;Calibri&q=
uot;,sans-serif"> <a href=3D"mailto:segurabici@segurabici.es">segurabici@se=
gurabici.es</a> &lt;<a href=3D"mailto:segurabici@segurabici.es">segurabici@=
segurabici.es</a>&gt; <br><b>Enviado el:</b> jueves, 15 de octubre de 2026 =
11:48<br><b>Para:</b> 'DIVINA PASTORA' &lt;<a href=3D"mailto:siniestrosauto=
s@divinaseguros.com">siniestrosautos@divinaseguros.com</a>&gt;<br><b>Asunto=
:</b> ENVIO STRO.2026006124 <br><b>Importancia:</b> Alta</span><o:p></o:p><=
/p></div><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p><p class=3D"xmsonorma=
l">Buenos d=EDas, el asegurado nos indica que quiere acudir a la cl=EDnica =
concertada.<o:p></o:p></p><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p><p c=
lass=3D"xmsonormal">Ruego su gesti=F3n lo antes posible.<o:p></o:p></p><p c=
lass=3D"xmsonormal">&nbsp;<o:p></o:p></p><p class=3D"xmsonormal">Un saludo.=
<o:p></o:p></p><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p><p class=3D"xms=
onormal"><img border=3D"0" width=3D"142" height=3D"62" style=3D"width:1.475=
in;height:.6416in" id=3D"x_Imagen_x0020_1" src=3D"cid:image001.png@01DD5C9A=
.64425290"><o:p></o:p></p><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p><tab=
le class=3D"MsoNormalTable" border=3D"0" cellspacing=3D"0" cellpadding=3D"0=
" style=3D"border-collapse:collapse"><tr><td valign=3D"top" style=3D"paddin=
g:0cm 3.5pt 0cm 3.5pt"><p class=3D"xmsonormal"><b>BMS MEDIACI=D3N IBERIA, C=
ORRED. SEG.</b><o:p></o:p></p></td></tr><tr><td valign=3D"top" style=3D"pad=
ding:0cm 3.5pt 0cm 3.5pt"><p class=3D"xmsonormal">PASEO DE LA CASTELLANA, 2=
8 ENTREPLANTA<o:p></o:p></p></td></tr><tr><td valign=3D"top" style=3D"paddi=
ng:0cm 3.5pt 0cm 3.5pt"><p class=3D"xmsonormal">28046 MADRID<o:p></o:p></p>=
</td></tr><tr><td valign=3D"top" style=3D"padding:0cm 3.5pt 0cm 3.5pt"><p c=
lass=3D"xmsonormal">Tel:&nbsp; (91) 419 76 40&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp; Fax:<o:p></o:p></p></td></tr><tr><td valign=3D"top" style=3D"p=
adding:0cm 3.5pt 0cm 3.5pt"><p class=3D"xmsonormal"><span lang=3D"EN-GB">e-=
mail: </span><a href=3D"mailto:%7b%5bCOR.COR_eMail%5d%7d"><span lang=3D"EN-=
GB">&nbsp;</span></a><o:p></o:p></p></td></tr></table><p class=3D"xmsonorma=
l"><b><u>Siniestro</u>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
; </b>2026006124<o:p></o:p></p><table class=3D"MsoNormalTable" border=3D"1"=
 cellspacing=3D"0" cellpadding=3D"0" width=3D"633" style=3D"width:474.75pt;=
border-collapse:collapse"><tr><td width=3D"20%" colspan=3D"3" valign=3D"top=
" style=3D"width:20.0%;border:none;border-top:double windowtext 1.5pt;paddi=
ng:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Compa=F1=EDa:</i><o:=
p></o:p></p></td><td width=3D"32%" colspan=3D"4" valign=3D"top" style=3D"wi=
dth:32.0%;border:none;border-top:double windowtext 1.5pt;padding:3.0pt 3.0p=
t 3.0pt 3.0pt"><p class=3D"xmsonormal"><span lang=3D"EN-US">LIONS GATE IBER=
IA CONSULTING SERVICES S.L.U.</span><o:p></o:p></p></td><td width=3D"16%" v=
align=3D"top" style=3D"width:16.0%;border:none;border-top:double windowtext=
 1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Referenc=
ia:</i><o:p></o:p></p></td><td width=3D"29%" valign=3D"top" style=3D"width:=
29.0%;border:none;border-top:double windowtext 1.5pt;padding:3.0pt 3.0pt 3.=
0pt 3.0pt"></td></tr><tr><td width=3D"20%" colspan=3D"3" valign=3D"top" sty=
le=3D"width:20.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"=
xmsonormal"><i>P=F3liza:</i>&nbsp;&nbsp;<o:p></o:p></p></td><td width=3D"32=
%" colspan=3D"4" valign=3D"top" style=3D"width:32.0%;border:none;padding:3.=
0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">181016712887<o:p></o:p></p><=
/td><td width=3D"16%" valign=3D"top" style=3D"width:16.0%;border:none;paddi=
ng:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p></=
td><td width=3D"29%" valign=3D"top" style=3D"width:29.0%;border:none;paddin=
g:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p></t=
d></tr><tr><td width=3D"20%" colspan=3D"3" valign=3D"top" style=3D"width:20=
.0%;border:none;border-bottom:double windowtext 1.5pt;padding:3.0pt 3.0pt 3=
.0pt 3.0pt"><p class=3D"xmsonormal"><i>F.Efecto:</i><o:p></o:p></p></td><td=
 width=3D"32%" colspan=3D"4" valign=3D"top" style=3D"width:32.0%;border:non=
e;border-bottom:double windowtext 1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p=
 class=3D"xmsonormal">12/02/2026<o:p></o:p></p></td><td width=3D"16%" valig=
n=3D"top" style=3D"width:16.0%;border:none;border-bottom:double windowtext =
1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Forma de =
Pago:</i><o:p></o:p></p></td><td width=3D"29%" valign=3D"top" style=3D"widt=
h:29.0%;border:none;border-bottom:double windowtext 1.5pt;padding:3.0pt 3.0=
pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp; Anual<o:p></o:p></p></td></t=
r><tr><td width=3D"99%" colspan=3D"9" valign=3D"top" style=3D"width:99.0%;p=
adding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Informe Siniestr=
o tipo</i>&nbsp; <b>Culpa</b><o:p></o:p></p></td></tr><tr><td width=3D"20%"=
 colspan=3D"3" valign=3D"top" style=3D"width:20.0%;border:none;padding:3.0p=
t 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>F.Ocurrencia:</i><o:p></o:p=
></p></td><td width=3D"32%" colspan=3D"4" valign=3D"top" style=3D"width:32.=
0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">09/=
10/2026<o:p></o:p></p></td><td width=3D"16%" valign=3D"top" style=3D"width:=
16.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">=
<i>F.Comunicaci=F3n:</i><o:p></o:p></p></td><td width=3D"29%" valign=3D"top=
" style=3D"width:29.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p clas=
s=3D"xmsonormal">09/10/2026<o:p></o:p></p></td></tr><tr><td width=3D"29%" c=
olspan=3D"4" valign=3D"top" style=3D"width:29.0%;border:none;padding:3.0pt =
3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Lugar:</i><o:p></o:p></p></td=
><td width=3D"70%" colspan=3D"5" valign=3D"top" style=3D"width:70.0%;border=
:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">BARX - VALEN=
CIA<o:p></o:p></p></td></tr><tr><td width=3D"29%" colspan=3D"4" valign=3D"t=
op" style=3D"width:29.0%;border:none;border-bottom:double windowtext 1.5pt;=
padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Descripci=F3n:<=
/i><o:p></o:p></p></td><td width=3D"70%" colspan=3D"5" valign=3D"top" style=
=3D"width:70.0%;border:none;border-bottom:double windowtext 1.5pt;padding:3=
.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">EL ASEG. SE TROPIEZA CON UN=
A PIEDRA QUE LE CAUSA LA CAIDA Y SE GOLPEA EL HOMBRO<o:p></o:p></p></td></t=
r><tr><td width=3D"11%" valign=3D"top" style=3D"width:11.0%;border:none;pad=
ding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><b><i><u>TOMADOR</u><=
/i></b><o:p></o:p></p></td><td width=3D"88%" colspan=3D"8" valign=3D"top" s=
tyle=3D"width:88.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=
=3D"xmsonormal">&nbsp;<o:p></o:p></p></td></tr><tr><td width=3D"11%" valign=
=3D"top" style=3D"width:11.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt">=
<p class=3D"xmsonormal"><i>Nombre:</i><o:p></o:p></p></td><td width=3D"88%"=
 colspan=3D"8" valign=3D"top" style=3D"width:88.0%;border:none;padding:3.0p=
t 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">ENRIQUE BORONAT CASANOVA<o:p><=
/o:p></p></td></tr><tr><td width=3D"15%" colspan=3D"2" valign=3D"top" style=
=3D"width:15.0%;border:none;border-bottom:inset 1.0pt;padding:3.0pt 3.0pt 3=
.0pt 3.0pt"><p class=3D"xmsonormal"><i>NIF:</i><o:p></o:p></p></td><td widt=
h=3D"84%" colspan=3D"7" valign=3D"top" style=3D"width:84.0%;border:none;bor=
der-bottom:inset 1.0pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonor=
mal">20011512-V<o:p></o:p></p></td></tr><tr><td width=3D"11%" valign=3D"top=
" style=3D"width:11.0%;border:none;border-bottom:double windowtext 1.5pt;pa=
dding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Direcci=F3n:</i><=
o:p></o:p></p></td><td width=3D"88%" colspan=3D"8" valign=3D"top" style=3D"=
width:88.0%;border:none;border-bottom:double windowtext 1.5pt;padding:3.0pt=
 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">CALLE PERE MARC, 48&nbsp; 46701=
&nbsp; GANDIA (VALENCIA)&nbsp;<o:p></o:p></p></td></tr><tr><td width=3D"49%=
" colspan=3D"6" valign=3D"top" style=3D"width:49.0%;border:none;padding:3.0=
pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><b><i><u>ASEGURADO</u></i></b=
><o:p></o:p></p></td><td width=3D"50%" colspan=3D"3" valign=3D"top" style=
=3D"width:50.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xm=
sonormal">&nbsp;<o:p></o:p></p></td></tr><tr><td width=3D"49%" colspan=3D"6=
" valign=3D"top" style=3D"width:49.0%;border:none;border-bottom:double wind=
owtext 1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td><td width=3D"50%" colspa=
n=3D"3" valign=3D"top" style=3D"width:50.0%;border:none;border-bottom:doubl=
e windowtext 1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td></tr><tr><td width=
=3D"36%" colspan=3D"5" valign=3D"top" style=3D"width:36.0%;border:none;padd=
ing:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><b><i><u>PERJUDICADO</=
u></i></b><o:p></o:p></p></td><td width=3D"62%" colspan=3D"4" valign=3D"top=
" style=3D"width:62.0%;border:none;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p clas=
s=3D"xmsonormal">&nbsp;<o:p></o:p></p></td></tr><tr><td width=3D"99%" colsp=
an=3D"9" valign=3D"top" style=3D"width:99.0%;border:none;border-top:double =
windowtext 1.5pt;padding:3.0pt 3.0pt 3.0pt 3.0pt"><table class=3D"MsoNormal=
Table" border=3D"0" cellspacing=3D"0" cellpadding=3D"0" style=3D"border-col=
lapse:collapse"><tr><td width=3D"618" valign=3D"top" style=3D"width:463.15p=
t;padding:0cm 3.5pt 0cm 3.5pt"><p class=3D"xmsonormal"><i>CONTRARIO</i><o:p=
></o:p></p><table class=3D"MsoNormalTable" border=3D"1" cellspacing=3D"0" c=
ellpadding=3D"0" width=3D"632" style=3D"width:474.0pt;border-collapse:colla=
pse"><tr><td width=3D"14%" style=3D"width:14.0%;padding:3.0pt 3.0pt 3.0pt 3=
.0pt"><p class=3D"xmsonormal"><i>Nombre:</i><o:p></o:p></p></td><td width=
=3D"57%" colspan=3D"3" style=3D"width:57.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt=
"></td><td width=3D"14%" style=3D"width:14.0%;padding:3.0pt 3.0pt 3.0pt 3.0=
pt"><p class=3D"xmsonormal"><i>Tel=E9fono:&nbsp;</i><o:p></o:p></p></td><td=
 width=3D"14%" style=3D"width:14.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td><=
/tr><tr><td width=3D"14%" style=3D"width:14.0%;padding:3.0pt 3.0pt 3.0pt 3.=
0pt"><p class=3D"xmsonormal"><i>Direcci=F3n:</i><o:p></o:p></p></td><td wid=
th=3D"86%" colspan=3D"5" style=3D"width:86.0%;padding:3.0pt 3.0pt 3.0pt 3.0=
pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p></td></tr><tr><td width=3D=
"14%" style=3D"width:14.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xms=
onormal"><i>CP:</i><o:p></o:p></p></td><td width=3D"14%" style=3D"width:14.=
0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td><td width=3D"14%" style=3D"width:1=
4.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Localidad:=
</i><o:p></o:p></p></td><td width=3D"57%" colspan=3D"3" style=3D"width:57.0=
%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p=
></p></td></tr><tr><td width=3D"89" style=3D"width:66.75pt;border:none;padd=
ing:0cm 0cm 0cm 0cm"></td><td width=3D"89" style=3D"width:66.75pt;border:no=
ne;padding:0cm 0cm 0cm 0cm"></td><td width=3D"88" style=3D"width:66.0pt;bor=
der:none;padding:0cm 0cm 0cm 0cm"></td><td width=3D"182" style=3D"width:136=
.5pt;border:none;padding:0cm 0cm 0cm 0cm"></td><td width=3D"88" style=3D"wi=
dth:66.0pt;border:none;padding:0cm 0cm 0cm 0cm"></td><td width=3D"95" style=
=3D"width:71.25pt;border:none;padding:0cm 0cm 0cm 0cm"></td></tr></table><p=
 class=3D"xmsonormal"><i>VEH=CDCULO</i><o:p></o:p></p><table class=3D"MsoNo=
rmalTable" border=3D"1" cellspacing=3D"0" cellpadding=3D"0" width=3D"632" s=
tyle=3D"width:474.0pt;border-collapse:collapse"><tr><td width=3D"15%" style=
=3D"width:15.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i=
>Modelo:</i><o:p></o:p></p></td><td width=3D"42%" style=3D"width:42.0%;padd=
ing:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p><=
/td><td width=3D"18%" style=3D"width:18.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"=
><p class=3D"xmsonormal"><i>Matr=EDcula:</i><o:p></o:p></p></td><td width=
=3D"25%" style=3D"width:25.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td></tr></=
table><p class=3D"xmsonormal"><i>COMPA=D1=CDA</i><o:p></o:p></p><table clas=
s=3D"MsoNormalTable" border=3D"1" cellspacing=3D"0" cellpadding=3D"0" width=
=3D"632" style=3D"width:474.0pt;border-collapse:collapse"><tr><td width=3D"=
17%" style=3D"width:17.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmso=
normal"><i>Nombre:</i><o:p></o:p></p></td><td width=3D"83%" colspan=3D"3" s=
tyle=3D"width:83.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"></td></tr><tr><td widt=
h=3D"17%" style=3D"width:17.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D=
"xmsonormal"><i>P=F3liza:</i><o:p></o:p></p></td><td width=3D"50%" style=3D=
"width:50.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&nbsp=
;&nbsp;<o:p></o:p></p></td><td width=3D"17%" style=3D"width:17.0%;padding:3=
.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Ref.C=EDa.:</i><o:p></o:=
p></p></td><td width=3D"17%" style=3D"width:17.0%;padding:3.0pt 3.0pt 3.0pt=
 3.0pt"><p class=3D"xmsonormal">&nbsp;<o:p></o:p></p></td></tr><tr><td widt=
h=3D"17%" style=3D"width:17.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D=
"xmsonormal"><i>Tramitador:</i><o:p></o:p></p></td><td width=3D"50%" style=
=3D"width:50.0%;padding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal">&n=
bsp;&nbsp;<o:p></o:p></p></td><td width=3D"17%" style=3D"width:17.0%;paddin=
g:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><i>Tel=E9fono:</i><o:p><=
/o:p></p></td><td width=3D"17%" style=3D"width:17.0%;padding:3.0pt 3.0pt 3.=
0pt 3.0pt"><p class=3D"xmsonormal">&nbsp; &nbsp;<o:p></o:p></p></td></tr></=
table><p class=3D"xmsonormal"><i>OBSERVACIONES</i><o:p></o:p></p><table cla=
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dding:3.0pt 3.0pt 3.0pt 3.0pt"><p class=3D"xmsonormal"><b><i><u>OBSERVACION=
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m 0cm"></td><td width=3D"26" style=3D"width:19.5pt;border:none;padding:0cm =
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