Section 1 of 3
FICHA DE REEMBOLSO/ Final LINAME 2024
FINAL LINAME PLAYA TEMPORADA 2024 /
NOMBRES y APELLIDOS
( Jugador(a )
NOMBRES y APELLIDOS
( Jugador(a )
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RUT (11.111.111-1)
(Jugador(a)
RUT (11.111.111-1)
(Jugador(a)
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TELÉFONO CELULAR (
Jugador(a)
TELÉFONO CELULAR (
Jugador(a)
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CORREO ELECTRÓNICO
CORREO ELECTRÓNICO
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NOMBRES y APELLIDOS
( APODERADO )
NOMBRES y APELLIDOS
( APODERADO )
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RUT (11.111.111-1) (Apoderado(a)
RUT (11.111.111-1) (Apoderado(a)
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CORREO ELECTRÓNICO (Apoderado(a)
CORREO ELECTRÓNICO (Apoderado(a)
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Section 2 of 3
Datos bancarios
(De quien recibe el Reembolso)
NOMBRE Y APELLIDO
NOMBRE Y APELLIDO
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RUT (11.111.111-1)
RUT (11.111.111-1)
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Datos bancarios
Datos bancarios
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CUENTA CORRIENTE
CUENTA AHORROS
CUENTA VISTA
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or
add "Other"
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Nombre del Banco
Nombre del Banco
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Nª DE CUENTA
Nª DE CUENTA
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Section 3 of 3
Adjuntar respaldo de gasto
comprobante de pago
comprobante de pago
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Add file
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1
5
10
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Ticket de vuelo
Ticket de vuelo
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