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Seguro de Vida
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Nombre completo
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Your answer
Teléfono
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Fecha de nacimiento
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MM
/
DD
/
YYYY
¿Cual será el principal propósito del seguro?
Protección
Ahorro
Cesión bancaria (Requisito de banco)
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Indique el monto solicitado para la cobertura del seguro de vida
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¿Usted o el solicitante del seguro fuma?
Sí
No
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