{"id":20058,"date":"2023-03-24T01:33:35","date_gmt":"2023-03-24T06:33:35","guid":{"rendered":"https:\/\/rcgroup.com.pa\/services\/rc-lawyers\/digital-forms\/due-diligence-form-legal-entity\/"},"modified":"2025-03-13T23:15:08","modified_gmt":"2025-03-14T04:15:08","slug":"due-diligence-form-legal-entity-client","status":"publish","type":"page","link":"https:\/\/rcgroup.com.pa\/en\/services\/rc-lawyers\/digital-forms\/due-diligence-form-legal-entity-client\/","title":{"rendered":"Due Diligence Form (Legal Entity Client)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"20058\" class=\"elementor elementor-20058 elementor-4503\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-71bfaec elementor-section-stretched elementor-section-height-min-height elementor-section-full_width elementor-section-height-default elementor-section-items-middle\" data-id=\"71bfaec\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"aux-parallax-section elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-48d136e\" data-id=\"48d136e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5ff2cec elementor-widget__width-initial elementor-widget-tablet__width-initial elementor-widget elementor-widget-heading\" data-id=\"5ff2cec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">CUSTOMER DUE DILIGENCE FORM - LEGAL PERSON<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b5df5f4 elementor-widget elementor-widget-heading\" data-id=\"b5df5f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">DUE DILIGENCE FORM FOR LEGAL ENTITY<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-76d90eb3 elementor-section-content-top elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"76d90eb3\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"aux-parallax-section elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-65ff365f\" data-id=\"65ff365f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-64f0297 elementor-widget elementor-widget-text-editor\" data-id=\"64f0297\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<link rel='stylesheet' id='formidable-css' href='https:\/\/rcgroup.com.pa\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=3181438' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_13_container\" data-token=\"7f8bc0d4b19fcd2d2915d960f0c0a302\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_formulariodiligenciapersonajuridica\" data-token=\"7f8bc0d4b19fcd2d2915d960f0c0a302\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Formulario de Debida Diligencia (Cliente Persona Jur\u00eddica)<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"13\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_13\" id=\"frm_hide_fields_13\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"formulariodiligenciapersonajuridica\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_13\" name=\"frm_submit_entry_13\" value=\"d65279c355\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/20058\" \/><div id=\"frm_field_878_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">I. DATOS GENERALES \/ GENERAL INFORMATION<\/h3>\r\n\r\n\r\n<div id=\"frm_field_879_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_7pj43542\" id=\"field_7pj43542_label\" class=\"frm_primary_label\">Nombre de la Compa\u00f1\u00eda \/ Company Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7pj43542\" name=\"item_meta[879]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Campo Obligatorio\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_880_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_b1crr42\" id=\"field_b1crr42_label\" class=\"frm_primary_label\">Nombre Comercial \/ Business Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_b1crr42\" name=\"item_meta[880]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Campo Obligatorio\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_886_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_k5l9i2\" id=\"field_k5l9i2_label\" class=\"frm_primary_label\">Pa\u00eds de Constituci\u00f3n \/ Country of Jurisdiction\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[886]\" id=\"field_k5l9i2\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Pa\u00eds de Constituci\u00f3n \/ Country of Jurisdiction is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_951_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_ns802\" id=\"field_ns802_label\" class=\"frm_primary_label\">Fecha de Constituci\u00f3n \/ Incorporation Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ns802\" name=\"item_meta[951]\" value=\"\"  data-sectionid=\"878\"  maxlength=\"10\" data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_881_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_c7uvk432\" id=\"field_c7uvk432_label\" class=\"frm_primary_label\">No. de Registro \/ Registry Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_c7uvk432\" name=\"item_meta[881]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Campo Obligatorio\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_882_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_uv69a3\" id=\"field_uv69a3_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n Fiscal \/ Tax Identification Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_uv69a3\" name=\"item_meta[882]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Campo Obligatorio\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_883_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_fd5rv3\" id=\"field_fd5rv3_label\" class=\"frm_primary_label\">Tel\u00e9fono \/ Telephone Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_fd5rv3\" name=\"item_meta[883]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Campo Obligatorio\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_885_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_ogdii2\" id=\"field_ogdii2_label\" class=\"frm_primary_label\">Fax \/ Fax Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ogdii2\" name=\"item_meta[885]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_887_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_7ov292\" id=\"field_7ov292_label\" class=\"frm_primary_label\">P\u00e1gina Web \/ Web Page\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7ov292\" name=\"item_meta[887]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_888_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_5udvn2\" id=\"field_5udvn2_label\" class=\"frm_primary_label\">Correo Electr\u00f3nico \/ E-mail Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5udvn2\" name=\"item_meta[888]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_891_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_kbygn2\" id=\"field_kbygn2_label\" class=\"frm_primary_label\">Direcci\u00f3n F\u00edsica \/ Physical Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kbygn2\" name=\"item_meta[891]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_952_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_c9rls\" id=\"field_c9rls_label\" class=\"frm_primary_label\">Descripci\u00f3n detallada de la actividad comercial o de negocios de la compa\u00f1\u00eda \/ Please provide a detailed description of the company\u2019s business activity\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_c9rls\" name=\"item_meta[952]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_953_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_g3dv\" id=\"field_g3dv_label\" class=\"frm_primary_label\">Pa\u00eds donde realiza la actividad \/ Country where the business activity is carried out\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[953]\" id=\"field_g3dv\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Pa\u00eds donde realiza la actividad \/ Country where the business activity is carried out is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_954_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ucnzk\" id=\"field_ucnzk_label\" class=\"frm_primary_label\">Direcci\u00f3n Postal \/ P.O. Box Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ucnzk\" name=\"item_meta[954]\" value=\"\"  data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_919_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_qbswk2_label\" class=\"frm_primary_label\">\u00bfCotiza en Mercado de Valores? \/ Are you listed on a recognized stock exchange?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qbswk2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_919-878-0\">\t\t\t<label  for=\"field_qbswk2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[919]\" id=\"field_qbswk2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfCotiza en Mercado de Valores? \/ Are you listed on a recognized stock exchange? is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_919-878-1\">\t\t\t<label  for=\"field_qbswk2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[919]\" id=\"field_qbswk2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfCotiza en Mercado de Valores? \/ Are you listed on a recognized stock exchange? is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_958_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5yabj\" id=\"field_5yabj_label\" class=\"frm_primary_label\">En caso afirmativo, favor indique cu\u00e1l \/ If yes, please indicate which one\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5yabj\" name=\"item_meta[958]\" value=\"\"  data-sectionid=\"878\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_959_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_1waht_label\" class=\"frm_primary_label\">\u00bfEs su actividad regulada en materia de prevenci\u00f3n de blanqueo de capitales y financiamiento del terrorismo? \/ Is your activity regulated by law on the prevention of money laundering and terrorist financing? \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1waht_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_959-878-0\">\t\t\t<label  for=\"field_1waht-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[959]\" id=\"field_1waht-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfEs su actividad regulada en materia de prevenci\u00f3n de blanqueo de capitales y financiamiento del terrorismo? \/ Is your activity regulated by law on the prevention of money laundering and terrorist financing?  is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_959-878-1\">\t\t\t<label  for=\"field_1waht-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[959]\" id=\"field_1waht-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfEs su actividad regulada en materia de prevenci\u00f3n de blanqueo de capitales y financiamiento del terrorismo? \/ Is your activity regulated by law on the prevention of money laundering and terrorist financing?  is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_960_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_f2vv3\" id=\"field_f2vv3_label\" class=\"frm_primary_label\">Si su respuesta es afirmativa, favor indique el ente supervisor \/ Is your answer is affirmative, please provide the name of the supervisory body\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_f2vv3\" name=\"item_meta[960]\" value=\"\"  data-sectionid=\"878\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_957_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_wcw5g_label\" class=\"frm_primary_label\">\u00bfRealiza negocios con el gobierno? \/ Do you do business with the government?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wcw5g_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_957-878-0\">\t\t\t<label  for=\"field_wcw5g-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[957]\" id=\"field_wcw5g-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfRealiza negocios con el gobierno? \/ Do you do business with the government? is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_957-878-1\">\t\t\t<label  for=\"field_wcw5g-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[957]\" id=\"field_wcw5g-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"878\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"\u00bfRealiza negocios con el gobierno? \/ Do you do business with the government? is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_920_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_t7f132\" id=\"field_t7f132_label\" class=\"frm_primary_label\">En caso afirmativo, indique nombre de entidad y pa\u00eds \/ If yes, please indicate name of the entity and country\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_t7f132\" name=\"item_meta[920]\" value=\"\"  data-sectionid=\"878\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_906_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">II. INFORMACI\u00d3N COMPLEMENTARIA \/ ADDITIONAL INFORMATION<\/h3>\r\n\r\n\r\n<div id=\"frm_field_907_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_oqosd2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfRealiza la entidad jur\u00eddica negocios en moneda virtual? \/  Do you conduct business using virtual currency?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_oqosd2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_907-906-0\">\t\t\t<label  for=\"field_oqosd2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[907]\" id=\"field_oqosd2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfRealiza la entidad jur\u00eddica negocios en moneda virtual? \/  Do you conduct business using virtual currency?&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_907-906-1\">\t\t\t<label  for=\"field_oqosd2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[907]\" id=\"field_oqosd2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfRealiza la entidad jur\u00eddica negocios en moneda virtual? \/  Do you conduct business using virtual currency?&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_908_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_3djft2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfHa sido parte la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de procesos civiles, judiciales, fiscales o penales en calidad de demandado, acusado, investigado, imputado o c\u00f3mplice en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been involved in any civil, judicial, criminal, or fiscal proceedings as defendant, accused, investigated, imputed or accomplice in the last five (5) years?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_3djft2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_908-906-0\">\t\t\t<label  for=\"field_3djft2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[908]\" id=\"field_3djft2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfHa sido parte la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de procesos civiles, judiciales, fiscales o penales en calidad de demandado, acusado, investigado, imputado o c\u00f3mplice en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been involved in any civil, judicial, criminal, or fiscal proceedings as defendant, accused, investigated, imputed or accomplice in the last five (5) years?&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_908-906-1\">\t\t\t<label  for=\"field_3djft2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[908]\" id=\"field_3djft2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfHa sido parte la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de procesos civiles, judiciales, fiscales o penales en calidad de demandado, acusado, investigado, imputado o c\u00f3mplice en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been involved in any civil, judicial, criminal, or fiscal proceedings as defendant, accused, investigated, imputed or accomplice in the last five (5) years?&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_909_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_t9w6a2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfHa sido la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de objeto de investigaci\u00f3n o proceso, en calidad de imputado, c\u00f3mplice o cualquier calidad, ya sea a nivel administrativo o judicial, por motivos de blanqueo de capitales, financiamiento de terrorismo, financiamiento de armas de destrucci\u00f3n masiva o cualquier delito conexo o derivado en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been the object of any investigation or proceedings, as an accused party, accomplice or any other capacity, at an administrative or judicial level due to money laundering, terrorist financing, weapon of mass destruction or anu crime ancillary or connected thereto in the last five (5) years?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_t9w6a2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_909-906-0\">\t\t\t<label  for=\"field_t9w6a2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[909]\" id=\"field_t9w6a2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfHa sido la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de objeto de investigaci\u00f3n o proceso, en calidad de imputado, c\u00f3mplice o cualquier calidad, ya sea a nivel administrativo o judicial, por motivos de blanqueo de capitales, financiamiento de terrorismo, financiamiento de armas de destrucci\u00f3n masiva o cualquier delito conexo o derivado en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been the object of any investigation or proceedings, as an accused party, accomplice or any other capacity, at an administrative or judicial level due to money laundering, terrorist financing, weapon of mass destruction or anu crime ancillary or connected thereto in the last five (5) years?&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_909-906-1\">\t\t\t<label  for=\"field_t9w6a2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[909]\" id=\"field_t9w6a2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfHa sido la entidad jur\u00eddica, o alguno de sus beneficiarios, directores, dignatarios, representante legal o apoderados, de objeto de investigaci\u00f3n o proceso, en calidad de imputado, c\u00f3mplice o cualquier calidad, ya sea a nivel administrativo o judicial, por motivos de blanqueo de capitales, financiamiento de terrorismo, financiamiento de armas de destrucci\u00f3n masiva o cualquier delito conexo o derivado en los \u00faltimos cinco (5) a\u00f1os? \/ Has the legal entity or any of its beneficiaries, directors, officers, legal representative, attorneys, been the object of any investigation or proceedings, as an accused party, accomplice or any other capacity, at an administrative or judicial level due to money laundering, terrorist financing, weapon of mass destruction or anu crime ancillary or connected thereto in the last five (5) years?&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_910_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_aexcj2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfLa (s) compa\u00f1\u00eda (s) para la (s) cual (es) R&#038;C LAWYERS presta sus servicios son para su uso propio o ser\u00e1n utilizadas para sus clientes subyacentes en cuyo nombre est\u00e1 actuando? \/ Are the company (ies) for which R&#038;C LAWYERS provide services for your own use under the activity declared above or the company (ies) will be used by your underlying customers on whose behalf you are acting?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_aexcj2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_910-906-0\">\t\t\t<label  for=\"field_aexcj2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[910]\" id=\"field_aexcj2-0\" value=\"Para uso propio \/ For own use\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfLa (s) compa\u00f1\u00eda (s) para la (s) cual (es) R&amp;C LAWYERS presta sus servicios son para su uso propio o ser\u00e1n utilizadas para sus clientes subyacentes en cuyo nombre est\u00e1 actuando? \/ Are the company (ies) for which R&amp;C LAWYERS provide services for your own use under the activity declared above or the company (ies) will be used by your underlying customers on whose behalf you are acting?&lt;\/p&gt; is invalid\"   \/> Para uso propio \/ For own use<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_910-906-1\">\t\t\t<label  for=\"field_aexcj2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[910]\" id=\"field_aexcj2-1\" value=\"Para clientes subyacentes \/ For underlying customers\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfLa (s) compa\u00f1\u00eda (s) para la (s) cual (es) R&amp;C LAWYERS presta sus servicios son para su uso propio o ser\u00e1n utilizadas para sus clientes subyacentes en cuyo nombre est\u00e1 actuando? \/ Are the company (ies) for which R&amp;C LAWYERS provide services for your own use under the activity declared above or the company (ies) will be used by your underlying customers on whose behalf you are acting?&lt;\/p&gt; is invalid\"   \/> Para clientes subyacentes \/ For underlying customers<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_911_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_7w6mz2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfEst\u00e1 su actividad regulada, supervisada y monitoreada por leyes consistentes con las Recomendaciones de GAFI, en temas relacionados con la identificaci\u00f3n y prevenci\u00f3n del blanqueo de capitales y financiamiento del terrorismo? \/ Is your business activity regulated, supervised and monitored by laws in respect of the detection and prevention of money laundering and terrorism financing, consistent with the FAFT Recommendations?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_7w6mz2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_911-906-0\">\t\t\t<label  for=\"field_7w6mz2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[911]\" id=\"field_7w6mz2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEst\u00e1 su actividad regulada, supervisada y monitoreada por leyes consistentes con las Recomendaciones de GAFI, en temas relacionados con la identificaci\u00f3n y prevenci\u00f3n del blanqueo de capitales y financiamiento del terrorismo? \/ Is your business activity regulated, supervised and monitored by laws in respect of the detection and prevention of money laundering and terrorism financing, consistent with the FAFT Recommendations?&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_911-906-1\">\t\t\t<label  for=\"field_7w6mz2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[911]\" id=\"field_7w6mz2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"906\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEst\u00e1 su actividad regulada, supervisada y monitoreada por leyes consistentes con las Recomendaciones de GAFI, en temas relacionados con la identificaci\u00f3n y prevenci\u00f3n del blanqueo de capitales y financiamiento del terrorismo? \/ Is your business activity regulated, supervised and monitored by laws in respect of the detection and prevention of money laundering and terrorism financing, consistent with the FAFT Recommendations?&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_912_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\"><strong>Si la respuesta es afirmativa, indique el nombre de la autoridad u organismo profesional que ejerce las funciones de regulaci\u00f3n, supervisi\u00f3n o control de su actividad.<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>If he answer is yes, please provide the name of the authority or professional body which exercises the regulatory, supervisory or monitory functions of your activity<\/em><\/p>\n<\/div>\n<div id=\"frm_field_913_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_bu9cd2\" id=\"field_bu9cd2_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_bu9cd2\" name=\"item_meta[913]\" value=\"\"  data-sectionid=\"906\"  placeholder=\"1.\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_914_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_35b7y2\" id=\"field_35b7y2_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_35b7y2\" name=\"item_meta[914]\" value=\"\"  data-sectionid=\"906\"  placeholder=\"2.\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_915_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gu04u2\" id=\"field_gu04u2_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_gu04u2\" name=\"item_meta[915]\" value=\"\"  data-sectionid=\"906\"  placeholder=\"3.\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_963_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">III. JUNTA DIRECTIVA\/REPRESENTANTE LEGAL\/APODERADOS\/OTROS \/ BOARD OF DIRECTORS, LEGAL REPRESENTATIVE, ATTORNEYS\/OTHERS<\/h3>\r\n\r\n\r\n<div id=\"frm_field_965_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_k7w5a\" id=\"field_k7w5a_label\" class=\"frm_primary_label\">Nombre Completo (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_k7w5a\" name=\"item_meta[965]\" value=\"\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_966_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_jkww0\" id=\"field_jkww0_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jkww0\" name=\"item_meta[966]\" value=\"\"  data-sectionid=\"963\"  maxlength=\"10\" data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_967_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_yxwei\" id=\"field_yxwei_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[967]\" id=\"field_yxwei\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nacionalidad \/ Nationality (1) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_968_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_bu0z\" id=\"field_bu0z_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_bu0z\" name=\"item_meta[968]\" value=\"\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_969_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_jcr63\" id=\"field_jcr63_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_jcr63\" name=\"item_meta[969]\" value=\"\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_971_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_wssry\" id=\"field_wssry_label\" class=\"frm_primary_label\">Cargo \/ Office (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_wssry\" name=\"item_meta[971]\" value=\"\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_970_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_6cg78\" id=\"field_6cg78_label\" class=\"frm_primary_label\">Domicilio \/ Domicile (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6cg78\" name=\"item_meta[970]\" value=\"\"  data-sectionid=\"963\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_982_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ybspa\" id=\"field_ybspa_label\" class=\"frm_primary_label\">Nombre Completo (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ybspa\" name=\"item_meta[982]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_983_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_r4mwu\" id=\"field_r4mwu_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r4mwu\" name=\"item_meta[983]\" value=\"\"  data-sectionid=\"963\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_984_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_8vsp6\" id=\"field_8vsp6_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[984]\" id=\"field_8vsp6\"  data-sectionid=\"963\"  data-invmsg=\"Nacionalidad \/ Nationality (2) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_985_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_qt3l7\" id=\"field_qt3l7_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qt3l7\" name=\"item_meta[985]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_986_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_6echw\" id=\"field_6echw_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6echw\" name=\"item_meta[986]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_988_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_b9n4m\" id=\"field_b9n4m_label\" class=\"frm_primary_label\">Cargo \/ Office (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_b9n4m\" name=\"item_meta[988]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_987_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_1vzi6\" id=\"field_1vzi6_label\" class=\"frm_primary_label\">Domicilio \/ Domicile (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1vzi6\" name=\"item_meta[987]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_991_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_5tfzb\" id=\"field_5tfzb_label\" class=\"frm_primary_label\">Nombre Completo (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5tfzb\" name=\"item_meta[991]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_992_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_xefhy\" id=\"field_xefhy_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xefhy\" name=\"item_meta[992]\" value=\"\"  data-sectionid=\"963\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_993_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_13ad2\" id=\"field_13ad2_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[993]\" id=\"field_13ad2\"  data-sectionid=\"963\"  data-invmsg=\"Nacionalidad \/ Nationality (3) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_994_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_trkzp\" id=\"field_trkzp_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_trkzp\" name=\"item_meta[994]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_995_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_9zoyu\" id=\"field_9zoyu_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_9zoyu\" name=\"item_meta[995]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_997_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_vybg6\" id=\"field_vybg6_label\" class=\"frm_primary_label\">Cargo \/ Office (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_vybg6\" name=\"item_meta[997]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_996_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_jpfuy\" id=\"field_jpfuy_label\" class=\"frm_primary_label\">Domicilio \/ Domicile (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_jpfuy\" name=\"item_meta[996]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_998_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_vco4j\" id=\"field_vco4j_label\" class=\"frm_primary_label\">Nombre Completo (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_vco4j\" name=\"item_meta[998]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_999_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_sfpeq\" id=\"field_sfpeq_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_sfpeq\" name=\"item_meta[999]\" value=\"\"  data-sectionid=\"963\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1000_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_oemp6\" id=\"field_oemp6_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1000]\" id=\"field_oemp6\"  data-sectionid=\"963\"  data-invmsg=\"Nacionalidad \/ Nationality (4) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1001_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_4bohi\" id=\"field_4bohi_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4bohi\" name=\"item_meta[1001]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1002_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_y7xut\" id=\"field_y7xut_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_y7xut\" name=\"item_meta[1002]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1004_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_eculq\" id=\"field_eculq_label\" class=\"frm_primary_label\">Cargo \/ Office (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_eculq\" name=\"item_meta[1004]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1003_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_68305a\" id=\"field_68305a_label\" class=\"frm_primary_label\">Domicilio \/ Domicile (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_68305a\" name=\"item_meta[1003]\" value=\"\"  data-sectionid=\"963\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1006_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">IV. BENEFICIARIOS FINALES DE LAS ACCIONES DE LA COMPA\u00d1\u00cdA \/ FINAL BENEFICIARIES HOLDING THE SHARES OF THE COMPANY<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1007_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_smwp3\" id=\"field_smwp3_label\" class=\"frm_primary_label\">Nombre Completo (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_smwp3\" name=\"item_meta[1007]\" value=\"\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1008_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_4k35j\" id=\"field_4k35j_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4k35j\" name=\"item_meta[1008]\" value=\"\"  data-sectionid=\"1006\"  maxlength=\"10\" data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1009_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_zbgar\" id=\"field_zbgar_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1009]\" id=\"field_zbgar\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nacionalidad \/ Nationality (1) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1010_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_b8nmb\" id=\"field_b8nmb_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_b8nmb\" name=\"item_meta[1010]\" value=\"\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1011_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_890c9\" id=\"field_890c9_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_890c9\" name=\"item_meta[1011]\" value=\"\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1013_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_48i2r\" id=\"field_48i2r_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of  Shares (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_48i2r\" name=\"item_meta[1013]\" value=\"\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1012_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_j6njr\" id=\"field_j6njr_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_j6njr\" name=\"item_meta[1012]\" value=\"\"  data-sectionid=\"1006\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1014_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_zqv74\" id=\"field_zqv74_label\" class=\"frm_primary_label\">Nombre Completo (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_zqv74\" name=\"item_meta[1014]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1015_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_3wmtt\" id=\"field_3wmtt_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3wmtt\" name=\"item_meta[1015]\" value=\"\"  data-sectionid=\"1006\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1016_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_6jyxk\" id=\"field_6jyxk_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1016]\" id=\"field_6jyxk\"  data-sectionid=\"1006\"  data-invmsg=\"Nacionalidad \/ Nationality (2) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1017_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_jbc6w\" id=\"field_jbc6w_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_jbc6w\" name=\"item_meta[1017]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1018_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ssup7\" id=\"field_ssup7_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ssup7\" name=\"item_meta[1018]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1020_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_mvabn\" id=\"field_mvabn_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of  Shares (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_mvabn\" name=\"item_meta[1020]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1019_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_f26e\" id=\"field_f26e_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_f26e\" name=\"item_meta[1019]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1021_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nis97\" id=\"field_nis97_label\" class=\"frm_primary_label\">Nombre Completo (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nis97\" name=\"item_meta[1021]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1022_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_1jqj4\" id=\"field_1jqj4_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1jqj4\" name=\"item_meta[1022]\" value=\"\"  data-sectionid=\"1006\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1023_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_qz2ds\" id=\"field_qz2ds_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1023]\" id=\"field_qz2ds\"  data-sectionid=\"1006\"  data-invmsg=\"Nacionalidad \/ Nationality (3) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1024_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_o540o\" id=\"field_o540o_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_o540o\" name=\"item_meta[1024]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1025_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_5gmby\" id=\"field_5gmby_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5gmby\" name=\"item_meta[1025]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1027_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_v5kp1\" id=\"field_v5kp1_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of  Shares (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_v5kp1\" name=\"item_meta[1027]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1026_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_k56dr\" id=\"field_k56dr_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_k56dr\" name=\"item_meta[1026]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1028_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_es6ki\" id=\"field_es6ki_label\" class=\"frm_primary_label\">Nombre Completo (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_es6ki\" name=\"item_meta[1028]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1029_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_hw224\" id=\"field_hw224_label\" class=\"frm_primary_label\">Fecha de Nacimiento \/ Date of Birth (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hw224\" name=\"item_meta[1029]\" value=\"\"  data-sectionid=\"1006\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1030_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_2y372\" id=\"field_2y372_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1030]\" id=\"field_2y372\"  data-sectionid=\"1006\"  data-invmsg=\"Nacionalidad \/ Nationality (4) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1031_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_hckcq\" id=\"field_hckcq_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o pasaporte \/ ID number or passport (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hckcq\" name=\"item_meta[1031]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1032_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_6wuw6\" id=\"field_6wuw6_label\" class=\"frm_primary_label\">Profesi\u00f3n u ocupaci\u00f3n \/ Profession or occupation (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6wuw6\" name=\"item_meta[1032]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1034_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_5mv86\" id=\"field_5mv86_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of  Shares (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5mv86\" name=\"item_meta[1034]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1033_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_pe97u\" id=\"field_pe97u_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_pe97u\" name=\"item_meta[1033]\" value=\"\"  data-sectionid=\"1006\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1036_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\"><strong>En los casos que el beneficiario final sea una sociedad, se deber\u00e1 identificar como beneficiario final a la persona natural que ejerza control efectivo sobre la sociedad.<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>In cases where the beneficial owner is a corporation, the natural person exercising effective control over the corporation must be identified as the beneficial owner.<\/em><\/p>\n<\/div>\n<\/div>\n<div id=\"frm_field_917_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">V.  PERSONAS EXPUESTAS POL\u00cdTICAMENTE (PEP) \/ POLITICALLY EXPOSED PERSONS (PEP)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_918_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\"><strong>*Definiciones seg\u00fan Art\u00edculo 4 de la Ley 23 de 27 de abril de 2015.<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Personas expuestas pol\u00edticamente PEP<\/strong>: Personas nacionales o extranjeras que cumplen funciones p\u00fablicas destacadas de alto nivel o con mando y jurisdicci\u00f3n en un Estado, como (pero sin limitarse) los jefes de Estados o de un gobierno, los pol\u00edticos de alto perfil, los funcionarios gubernamentales, judiciales o militares de alta jerarqu\u00eda, los altos ejecutivos de empresas o corporaciones estatales, los funcionarios p\u00fablicos que ocupen cargos de elecci\u00f3n popular, entre otros que ejerzan la toma de decisiones en entidades p\u00fablicas; personas que cumplen o a quienes se les han confiado funciones importantes por una organizaci\u00f3n internacional, como los miembros de la alta gerencia, es decir, directores, subdirectores y miembros de la junta directiva o funciones equivalentes.<\/p>\n<p style=\"text-align: justify;\"><strong>Familiares cercanos:<\/strong> \u00danicamente, el c\u00f3nyuge, los padres, los hermanos y los hijos de la persona expuesta pol\u00edticamente.<\/p>\n<p style=\"text-align: justify;\"><strong>Estrecho colaborador:<\/strong> Persona conocida por su \u00edntima relaci\u00f3n con respecto a la persona expuesta pol\u00edticamente, esto incluye a quienes est\u00e1n en posici\u00f3n de realizar transacciones financieras, comerciales o de cualquier naturaleza, ya sean locales e internacionales, en nombre de la persona expuesta pol\u00edticamente.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Definitions according to Article 4 of Law 23 of April 27, 2015.<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Politically exposed person: <\/strong>National or foreign individual who holds any high level public office, with authority and jurisdiction within a State, such as (but not limited to) heads of State or government, high profile politicians, government officials, high ranking judicial or military officers, senior government company or corporation executives, publically elected officials among others, with decision making power, individuals who perform for or have been entrusted by an international organization with important duties, such as members of senior management, namley, directors, deputy directors and board members, or the like.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Close relatives<\/em><\/strong><em>: Only the spouse, parents, siblings and children of a politically exposed person.<\/em><\/p>\n<p style=\"text-align: justify;\"><strong>Close associate:<\/strong> Person known for having a close relationship with a politically exposed person including individuals who have been in a position to make financial, commercial or other transactions, either domestic or international, on behalf of that politically exposed person.<\/p>\n<\/div>\n<div id=\"frm_field_955_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_wmmlb_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Indique si alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda ha desempe\u00f1ado o desempe\u00f1a alg\u00fan cargo p\u00fablico que lo catalogue actualmente como persona expuesta pol\u00edticamente (PEP). Please indicate whether the beneficiaries, directors, officers, legal representative or attorneys of the company have held or hold any public office that currently classifies you as a politically exposed person (PEP)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wmmlb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_955-917-0\">\t\t\t<label  for=\"field_wmmlb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[955]\" id=\"field_wmmlb-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Indique si alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda ha desempe\u00f1ado o desempe\u00f1a alg\u00fan cargo p\u00fablico que lo catalogue actualmente como persona expuesta pol\u00edticamente (PEP). Please indicate whether the beneficiaries, directors, officers, legal representative or attorneys of the company have held or hold any public office that currently classifies you as a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_955-917-1\">\t\t\t<label  for=\"field_wmmlb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[955]\" id=\"field_wmmlb-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Indique si alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda ha desempe\u00f1ado o desempe\u00f1a alg\u00fan cargo p\u00fablico que lo catalogue actualmente como persona expuesta pol\u00edticamente (PEP). Please indicate whether the beneficiaries, directors, officers, legal representative or attorneys of the company have held or hold any public office that currently classifies you as a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_956_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_g6feu\" id=\"field_g6feu_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Si la respuesta es S\u00ed, indique el cargo y rango de fecha en que ha desempe\u00f1ado o desempe\u00f1a dicho cargo. \/  If the answer is Yes, please indicate the position and date range in which you have held that position<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_g6feu\" name=\"item_meta[956]\" value=\"\"  data-sectionid=\"917\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_921_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_oa48k2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, familiar cercano (c\u00f3nyuge, padre, madre, hermano (a) o hijo (a)) de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close relative (spouse, father, mother, brother, sister, son, daughter) of a politically exposed person (PEP)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_oa48k2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_921-917-0\">\t\t\t<label  for=\"field_oa48k2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[921]\" id=\"field_oa48k2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, familiar cercano (c\u00f3nyuge, padre, madre, hermano (a) o hijo (a)) de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close relative (spouse, father, mother, brother, sister, son, daughter) of a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_921-917-1\">\t\t\t<label  for=\"field_oa48k2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[921]\" id=\"field_oa48k2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, familiar cercano (c\u00f3nyuge, padre, madre, hermano (a) o hijo (a)) de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close relative (spouse, father, mother, brother, sister, son, daughter) of a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_922_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6pqif2\" id=\"field_6pqif2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Si la respuesta es S\u00ed, indique el parentesco y cargo de esta persona. \/ If the answer is Yes, please inform the family relationship and office of this person<\/p>.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6pqif2\" name=\"item_meta[922]\" value=\"\"  data-sectionid=\"917\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_923_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_yci2s2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, estrecho colaborador de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close associate of a politically exposed person (PEP)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_yci2s2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_923-917-0\">\t\t\t<label  for=\"field_yci2s2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[923]\" id=\"field_yci2s2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, estrecho colaborador de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close associate of a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_923-917-1\">\t\t\t<label  for=\"field_yci2s2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[923]\" id=\"field_yci2s2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfEs alguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda, estrecho colaborador de una persona catalogada actualmente como PEP? Are any of the beneficiaries, directors, officers, legal representative or attorneys of the company a close associate of a politically exposed person (PEP)&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_924_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pfob82\" id=\"field_pfob82_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Si la respuesta es S\u00ed, indique la relaci\u00f3n y cargo de esta persona. \/ If the answer is Yes, please inform the relationship and office of this person.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_pfob82\" name=\"item_meta[924]\" value=\"\"  data-sectionid=\"917\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_925_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_4lpst2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">\u00bfAlguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda participa o realiza negocios con entidades gubernamentales? Does any of the beneficiaries, directors, officers, legal representative or attorneys of the company participate in or conduct business with government entities?<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4lpst2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_925-917-0\">\t\t\t<label  for=\"field_4lpst2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[925]\" id=\"field_4lpst2-0\" value=\"SI \/ YES\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfAlguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda participa o realiza negocios con entidades gubernamentales? Does any of the beneficiaries, directors, officers, legal representative or attorneys of the company participate in or conduct business with government entities?&lt;\/p&gt; is invalid\"   \/> SI \/ YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_925-917-1\">\t\t\t<label  for=\"field_4lpst2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[925]\" id=\"field_4lpst2-1\" value=\"NO \/ NO\"\n\t\t data-sectionid=\"917\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"&lt;p style=&quot;text-align: justify;&quot;&gt;\u00bfAlguno de los beneficiarios, directores, dignatarios, representante legal o apoderado de la compa\u00f1\u00eda participa o realiza negocios con entidades gubernamentales? Does any of the beneficiaries, directors, officers, legal representative or attorneys of the company participate in or conduct business with government entities?&lt;\/p&gt; is invalid\"   \/> NO \/ NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_926_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_o5n1q2\" id=\"field_o5n1q2_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Si la respuesta es S\u00ed, indique el nombre y pa\u00eds de la entidad gubernamental. \/ If the answer is Yes, please provide the name and country of the government entity.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_o5n1q2\" name=\"item_meta[926]\" value=\"\"  data-sectionid=\"917\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_928_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">VI. PERFIL FINANCIERO Y TRANSACCIONAL \/ FINANCIAL AND TRANSACTIONAL PROFILE<\/h3>\r\n\r\n\r\n<div id=\"frm_field_929_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_other_container\">\r\n    <div  id=\"field_xt7l02_label\" class=\"frm_primary_label\">1 Pa\u00edses de origen o procedencia de los fondos \/ Country of origin\/Source of Funds or Resources\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_xt7l02_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_929-928-0\">\t\t\t<label  for=\"field_xt7l02-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[929][]\" id=\"field_xt7l02-0\" value=\"Panam\u00e1 \/ Panama\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1 Pa\u00edses de origen o procedencia de los fondos \/ Country of origin\/Source of Funds or Resources is invalid\"   aria-required=\"true\"  \/> Panam\u00e1 \/ Panama<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_929-928-1\">\t\t\t<label  for=\"field_xt7l02-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[929][]\" id=\"field_xt7l02-1\" value=\"Internacional \/ International\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1 Pa\u00edses de origen o procedencia de los fondos \/ Country of origin\/Source of Funds or Resources is invalid\"   \/> Internacional \/ International<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_929-928-other_2\">\t\t\t<label  for=\"field_xt7l02-other_2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[929][other_2]\" id=\"field_xt7l02-other_2\" value=\"Indique el pa\u00eds \/ Please confirm the country\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1 Pa\u00edses de origen o procedencia de los fondos \/ Country of origin\/Source of Funds or Resources is invalid\"   \/> Indique el pa\u00eds \/ Please confirm the country<\/label><label for=\"field_xt7l02-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Indique el pa\u00eds \/ Please confirm the country<\/label><input type=\"text\" id=\"field_xt7l02-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][929][other_2]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_930_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_8kd7y2_label\" class=\"frm_primary_label\">2. Forma de Pago \/ Payment Method\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8kd7y2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_930-928-0\">\t\t\t<label  for=\"field_8kd7y2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[930][]\" id=\"field_8kd7y2-0\" value=\"Cheque \/ Check\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"2. Forma de Pago \/ Payment Method is invalid\"   aria-required=\"true\"  \/> Cheque \/ Check<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_930-928-1\">\t\t\t<label  for=\"field_8kd7y2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[930][]\" id=\"field_8kd7y2-1\" value=\"Tarjeta de Cr\u00e9dito \/ Credit Card\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"2. Forma de Pago \/ Payment Method is invalid\"   \/> Tarjeta de Cr\u00e9dito \/ Credit Card<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_930-928-2\">\t\t\t<label  for=\"field_8kd7y2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[930][]\" id=\"field_8kd7y2-2\" value=\"Transferencia Bancaria \/ Wire Transfer\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"2. Forma de Pago \/ Payment Method is invalid\"   \/> Transferencia Bancaria \/ Wire Transfer<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_930-928-3\">\t\t\t<label  for=\"field_8kd7y2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[930][]\" id=\"field_8kd7y2-3\" value=\"Pago en L\u00ednea \/ Online Payment\"  data-sectionid=\"928\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"2. Forma de Pago \/ Payment Method is invalid\"   \/> Pago en L\u00ednea \/ Online Payment<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_932_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">VII. DECLARACI\u00d3N Y FIRMA \/ DECLARATION AND SIGNATURE<\/h3>\r\n\r\n\r\n<div id=\"frm_field_933_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_fffi32\" id=\"field_fffi32_label\" class=\"frm_primary_label\">Yo \/ I\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_fffi32\" name=\"item_meta[933]\" value=\"\"  data-sectionid=\"932\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1037_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_rzp0d\" id=\"field_rzp0d_label\" class=\"frm_primary_label\">en calidad de Representante Legal de \/ acting as Legal Representative of \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_rzp0d\" name=\"item_meta[1037]\" value=\"\"  data-sectionid=\"932\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_934_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\">declaro bajo gravedad de juramento que \/ declare under oath that:<\/p>\n<ol>\n<li style=\"text-align: justify;\">Estoy debidamente autorizado para completar el presente formulario \/ <em>I am duly authorized to complete this form.<\/em><\/li>\n<li style=\"text-align: justify;\">Me comprometo a cubrir los honorarios profesionales y gastos que su firma incurra en la asignaci\u00f3n solicitada o cualquier otra asignaci\u00f3n que solicitara en el futuro incluyendo los gastos de debida diligencia \/ <em>I undertake to settle all professional fees and expenses incurred by your law firm for the services requested, or any other service that may be requested in the future including due diligence fees.<\/em><\/li>\n<li style=\"text-align: justify;\">La compa\u00f1\u00eda se encuentra en cumplimiento tributario en el pa\u00eds o pa\u00edses donde tiene obligaciones fiscales \/ <em>The company is<\/em><em> in tax compliance in the country or countries where it has tax obligations.<\/em><\/li>\n<li style=\"text-align: justify;\">La informaci\u00f3n proporcionada en este documento es verdadera y correcta \/ <em>The<\/em><em> information provided in this document is true and correct.<\/em><\/li>\n<li style=\"text-align: justify;\">Todas las actividades que ejerce la compa\u00f1\u00eda se encuentran dentro de las normas legales y que los recursos utilizados para el pago de \u00e9sta provienen de fondos de origen l\u00edcito \/ <em>All the activities carried out by the company are within the legal regulations and that the <\/em><em>resources used for the payment thereof come from funds of lawful origin.<\/em><\/li>\n<li style=\"text-align: justify;\">Me comprometo a informar a R&#038;C LAWYERS de cualquier cambio en la informaci\u00f3n aqu\u00ed suministrada \/ <em>I undertake to inform R&#038;C LAWYERS of any change in the information sated herein.<\/em><\/li>\n<li style=\"text-align: justify;\">Declaro que ni la compa\u00f1\u00eda ni sus beneficiarios, directores, dignatarios, representante legal, apoderados, est\u00e1n listados por la oficina de control de activos extranjeros del tesoro de los Estados Unidos de Am\u00e9rica y me comprometo a notificar a R&#038;C LAWYERS si tengo conocimiento de ello \/ <em>I declare that neither the company nor its beneficiaries, directors, officers, legal representative, attorneys, are listed by the office of foreign assets control (OFAC) of the United States treasury department and undertake to notify R&#038;C LAWYERS should I become aware of it. <\/em><a href=\"http:\/\/www.ustreas.gov\/offices\/enforcement\/ofac\/\" target=\"_blank\" rel=\"noopener\"><em>http:\/\/www.ustreas.gov\/offices\/enforcement\/ofac\/<\/em><\/a><em>).<\/em><\/li>\n<li style=\"text-align: justify;\">Confirmo que la compa\u00f1\u00eda no est\u00e1 sujeta a tributos en los Estados Unidos de Am\u00e9rica \/ <em>I confirm that the company is not subject to taxes in the United States of America.<\/em><\/li>\n<li style=\"text-align: justify;\">Declaro que la compa\u00f1\u00eda ha buscado asesor\u00eda de un abogado en el (los) pa\u00eds (es) de domicilio con respecto a los servicios que brindar\u00e1 R&#038;C LAWYERS en relaci\u00f3n con la formaci\u00f3n y administraci\u00f3n de veh\u00edculos corporativos y fiduciarios \/ <em>I declare that the company has sought the advice of counsel in the country (ies) where of its domicile, the services to be provided to it from R&#038;C LAWYERS in connection with the formatino and administration of corporate and fiduciary services.<\/em><\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div id=\"frm_field_936_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Firma Digital \/ Digital Signature<\/h3>\r\n\r\n\r\n<div id=\"frm_field_937_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_s5g0r742\" id=\"field_s5g0r742_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_s5g0r742\" name=\"item_meta[937]\" value=\"\"  data-sectionid=\"936\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_938_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_mx3nn742\" id=\"field_mx3nn742_label\" class=\"frm_primary_label\">Firma \/ Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad938' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[938][typed]\" class=\"name\" id=\"field_mx3nn742\" autocomplete=\"off\" value=\"\"  data-sectionid=\"936\"  style=\"width:400px\" maxlength=\"150\" data-reqmsg=\"Firma Obligatoria\" aria-required=\"true\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"938\" data-fieldname=\"item_meta[938]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[938][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    <div class=\"frm_description\" id=\"frm_desc_field_mx3nn742\">(Por favor firmar igual que en su c\u00e9dula de identidad personal\/pasaporte)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_939_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_c779r742\" id=\"field_c779r742_label\" class=\"frm_primary_label\">Fecha \/ Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c779r742\" name=\"item_meta[939]\" value=\"04\/28\/2026\"  readonly=\"readonly\"  data-sectionid=\"936\"  maxlength=\"10\" data-frmval=\"04\/28\/2026\" data-invmsg=\"Fecha no es v\u00e1lido\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_942_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">LISTA DE VERIFICACI\u00d3N \u2013 DOCUMENTACI\u00d3N REQUERIDA \/ CHECK LIST \u2013 REQUIRED DOCUMENTATION<\/h3>\r\n<div id=\"frm_desc_field_ma9fl2\" class=\"frm_description frm_section_spacing\">Tipos de archivos permitidos \/ Allowed file types (.jpg, .png, .pdf, .doc, docx)<\/div>\r\n\r\n<div id=\"frm_field_1102_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first\">\r\n    <label for=\"field_bpail\" id=\"field_bpail_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia de Certificado de Registro P\u00fablico de la Compa\u00f1\u00eda o su equivalente \/ Copy of a Good Standing Certificate of the Company or its equivalent.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1102]\"  data-reqmsg=\"Este campo no puede estar en blanco.\"  value=\"\" data-frmfile=\"1102\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1102_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1102\" id=\"field_bpail\"\n\t\t\t data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia de Certificado de Registro P\u00fablico de la Compa\u00f1\u00eda o su equivalente \/ Copy of a Good Standing Certificate of the Company or its equivalent.&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia de Certificado de Registro P\u00fablico de la Compa\u00f1\u00eda o su equivalente \/ Copy of a Good Standing Certificate of the Company or its equivalent.&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1103_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first\">\r\n    <label for=\"field_urwpu\" id=\"field_urwpu_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia del Pacto Social o su equivalente \/Copy of the Articles of Incorporation or its equivalent.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1103]\"  data-reqmsg=\"Este campo no puede estar en blanco.\"  value=\"\" data-frmfile=\"1103\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1103_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1103\" id=\"field_urwpu\"\n\t\t\t data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Pacto Social o su equivalente \/Copy of the Articles of Incorporation or its equivalent.&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Pacto Social o su equivalente \/Copy of the Articles of Incorporation or its equivalent.&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1104_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_oke1e\" id=\"field_oke1e_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia del Aviso de Operaci\u00f3n (si aplica) \/ Copy of the Notice of Operation (if applicable).<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1104]\"  value=\"\" data-frmfile=\"1104\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1104_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1104\" id=\"field_oke1e\"\n\t\t\t data-sectionid=\"942\"  data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Aviso de Operaci\u00f3n (si aplica) \/ Copy of the Notice of Operation (if applicable).&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Aviso de Operaci\u00f3n (si aplica) \/ Copy of the Notice of Operation (if applicable).&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1105_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_91ti3\" id=\"field_91ti3_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia del pasaporte (si es extranjero) o c\u00e9dula (si es paname\u00f1o) vigente de los directores, dignatarios, accionistas, firmante o apoderado. En el caso de los Apoderados, adjuntar copia del Poder \/ Copy of valid passport (for foreigners) or copy of the personal identity document (for Panamanians) of the Board of Directors, Officers, Legal Representatives, Shareholders, signatories, or attorneys. In the case of the Attorneys, please attach copy of the Power of Attorney.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1105]\"  data-reqmsg=\"Este campo no puede estar en blanco.\"  value=\"\" data-frmfile=\"1105\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1105_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1105\" id=\"field_91ti3\"\n\t\t\t data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del pasaporte (si es extranjero) o c\u00e9dula (si es paname\u00f1o) vigente de los directores, dignatarios, accionistas, firmante o apoderado. En el caso de los Apoderados, adjuntar copia del Poder \/ Copy of valid passport (for foreigners) or copy of the personal identity document (for Panamanians) of the Board of Directors, Officers, Legal Representatives, Shareholders, signatories, or attorneys. In the case of the Attorneys, please attach copy of the Power of Attorney.&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del pasaporte (si es extranjero) o c\u00e9dula (si es paname\u00f1o) vigente de los directores, dignatarios, accionistas, firmante o apoderado. En el caso de los Apoderados, adjuntar copia del Poder \/ Copy of valid passport (for foreigners) or copy of the personal identity document (for Panamanians) of the Board of Directors, Officers, Legal Representatives, Shareholders, signatories, or attorneys. In the case of the Attorneys, please attach copy of the Power of Attorney.&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1106_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_odbbt\" id=\"field_odbbt_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia de comprobante de domicilio vigente (de no m\u00e1s de 3 meses) de la Compa\u00f1\u00eda con una traducci\u00f3n oficial al ingl\u00e9s cuando sea necesario \/ Copy of a recent proof of address (not older than 3 months) of the Company with an official translation into English, where the document is provided in any language other than English.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1106]\"  data-reqmsg=\"Este campo no puede estar en blanco.\"  value=\"\" data-frmfile=\"1106\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1106_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1106\" id=\"field_odbbt\"\n\t\t\t data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia de comprobante de domicilio vigente (de no m\u00e1s de 3 meses) de la Compa\u00f1\u00eda con una traducci\u00f3n oficial al ingl\u00e9s cuando sea necesario \/ Copy of a recent proof of address (not older than 3 months) of the Company with an official translation into English, where the document is provided in any language other than English.&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia de comprobante de domicilio vigente (de no m\u00e1s de 3 meses) de la Compa\u00f1\u00eda con una traducci\u00f3n oficial al ingl\u00e9s cuando sea necesario \/ Copy of a recent proof of address (not older than 3 months) of the Company with an official translation into English, where the document is provided in any language other than English.&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1107_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_7xh31\" id=\"field_7xh31_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Copia del Registro de Acciones de la compa\u00f1\u00eda o Copia de los Certificados de Acciones \/ Copy of the company\u2019s Share Register or copy of the Certificates of Shares.<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1107]\"  data-reqmsg=\"Este campo no puede estar en blanco.\"  value=\"\" data-frmfile=\"1107\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1107_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1107\" id=\"field_7xh31\"\n\t\t\t data-sectionid=\"942\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Registro de Acciones de la compa\u00f1\u00eda o Copia de los Certificados de Acciones \/ Copy of the company\u2019s Share Register or copy of the Certificates of Shares.&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Copia del Registro de Acciones de la compa\u00f1\u00eda o Copia de los Certificados de Acciones \/ Copy of the company\u2019s Share Register or copy of the Certificates of Shares.&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1108_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5fra9\" id=\"field_5fra9_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Declaraci\u00f3n de Indemnizaci\u00f3n (en caso de requerir servicio de directores nominales) \/ Declaration and Indemnity Form (if non-executive director services are provided).<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"942\"  data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[1108]\"  value=\"\" data-frmfile=\"1108\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1108_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1108\" id=\"field_5fra9\"\n\t\t\t data-sectionid=\"942\"  data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Declaraci\u00f3n de Indemnizaci\u00f3n (en caso de requerir servicio de directores nominales) \/ Declaration and Indemnity Form (if non-executive director services are provided).&lt;\/p&gt;. Drop a file here or click to upload. Maximum file size: 5MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"&lt;p style=&quot;text-align: justify;&quot;&gt;Declaraci\u00f3n de Indemnizaci\u00f3n (en caso de requerir servicio de directores nominales) \/ Declaration and Indemnity Form (if non-executive director services are provided).&lt;\/p&gt;. Choose File. Maximum file size: 5MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_945_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">S\u00d3LO PARA USO DE R&#038;C LAWYERS \/ FOR R&#038;C LAWYERS USE ONLY<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1038_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: left;\"><strong>Datos del colaborador (quien declara haber revisado la informaci\u00f3n suministrada por el cliente)<\/strong><\/p>\n<p style=\"text-align: left;\"><strong><em>Employees&#8217;s data (who declares to have reviewed the information provided by the client).<\/em><\/strong><\/p>\n<\/div>\n<div id=\"frm_field_1100_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_1v1iw\" id=\"field_1v1iw_label\" class=\"frm_primary_label\">Revisado por \/ Revised by\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1v1iw\" name=\"item_meta[1100]\" value=\"\"  readonly=\"readonly\"  data-sectionid=\"945\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_947_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_hin6w2\" id=\"field_hin6w2_label\" class=\"frm_primary_label\">Cargo \/ Ocupaci\u00f3n (Position \/ Occupation)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hin6w2\" name=\"item_meta[947]\" value=\"\"  readonly=\"readonly\"  data-sectionid=\"945\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1099_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_icn40\" id=\"field_icn40_label\" class=\"frm_primary_label\">Firma \/ Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad1099' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1099][typed]\" class=\"name\" id=\"field_icn40\" autocomplete=\"off\" value=\"\"  data-sectionid=\"945\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"1099\" data-fieldname=\"item_meta[1099]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[1099][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    <div class=\"frm_description\" id=\"frm_desc_field_icn40\">(Por favor firmar igual que en su c\u00e9dula de identidad personal\/pasaporte)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_949_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_qkp3k2\" id=\"field_qkp3k2_label\" class=\"frm_primary_label\">Fecha \/ Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qkp3k2\" name=\"item_meta[949]\" value=\"04\/28\/2026\"  readonly=\"readonly\"  data-sectionid=\"945\"  maxlength=\"10\" data-frmval=\"04\/28\/2026\" data-invmsg=\"Fecha no es v\u00e1lido\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1040_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">ANEXO 1 \/ ANNEX 1<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1042_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\"><strong>Declaraci\u00f3n Jurada de Identificaci\u00f3n del Beneficiario Final<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong><em>Affidavit of Final Beneficiary Identification<\/em><\/strong><\/p>\n<\/div>\n<div id=\"frm_field_1043_container\" class=\"frm_form_field  frm_html_container form-field\">\n<ol>\n<li style=\"text-align: justify;\">A fin de cumplir con las normas legales dirigidas a: (i) la identificaci\u00f3n del\/los \u00faltimo (s) beneficiario (s); y (ii) prevenir el blanqueo de capitales y el financiamiento del terrorismo, \/ <em>In order to comply with the legal regulations aimed to: (i) identify of the final beneficiary (ies); and (ii) prevent money laundering and terrorist financing<\/em><\/li>\n<\/ol>\n<\/div>\n<div id=\"frm_field_1044_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9c2kh\" id=\"field_9c2kh_label\" class=\"frm_primary_label\">Yo \/ I\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_9c2kh\" name=\"item_meta[1044]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1045_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_other_container\">\r\n    <div  id=\"field_qlwta_label\" class=\"frm_primary_label\">g\u00e9nero \/ gender\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qlwta_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1045-1040-0\">\t\t\t<label  for=\"field_qlwta-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1045]\" id=\"field_qlwta-0\" value=\"Hombre \/ Male\"\n\t\t data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"g\u00e9nero \/ gender is invalid\"   \/> Hombre \/ Male<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1045-1040-1\">\t\t\t<label  for=\"field_qlwta-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1045]\" id=\"field_qlwta-1\" value=\"Mujer \/ Female\"\n\t\t data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"g\u00e9nero \/ gender is invalid\"   \/> Mujer \/ Female<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1045-1040-other_2\">\t\t\t<label  for=\"field_qlwta-other_2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1045]\" id=\"field_qlwta-other_2\" value=\"Otro \/ Other\"\n\t\t data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"g\u00e9nero \/ gender is invalid\"   \/> Otro \/ Other<\/label><label for=\"field_qlwta-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Otro \/ Other<\/label><input type=\"text\" id=\"field_qlwta-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][1045]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1046_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_skv32\" id=\"field_skv32_label\" class=\"frm_primary_label\">de nacionalidad \/ of nationality\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1046]\" id=\"field_skv32\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"de nacionalidad \/ of nationality is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1047_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ukha\" id=\"field_ukha_label\" class=\"frm_primary_label\">con (pasaporte o c\u00e9dula de identidad) \/ with (passport or identity card)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ukha\" name=\"item_meta[1047]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1048_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_eniyg\" id=\"field_eniyg_label\" class=\"frm_primary_label\">actuando  en nombre y representaci\u00f3n de \/ acting for and on behalf of\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_eniyg\" name=\"item_meta[1048]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1049_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_jjrht\" id=\"field_jjrht_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">declaro bajo gravedad de juramento que los beneficiarios finales de las acciones emitidas y en circulaci\u00f3n de la Compa\u00f1\u00eda \/ declare under penalty of perjury that the final beneficiaries of the Company<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_jjrht\" name=\"item_meta[1049]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1050_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>son los siguientes \/ <em>are as follows<\/em><\/p>\n<\/div>\n<div id=\"frm_field_1054_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_eoysr\" id=\"field_eoysr_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_eoysr\" name=\"item_meta[1054]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1056_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_jc58n\" id=\"field_jc58n_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1056]\" id=\"field_jc58n\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nacionalidad \/ Nationality (1) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1057_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_2dxvm\" id=\"field_2dxvm_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o Pasaporte \/ Identification or  Passport No. (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_2dxvm\" name=\"item_meta[1057]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1059_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_uhfy6\" id=\"field_uhfy6_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of Shares (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_uhfy6\" name=\"item_meta[1059]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1058_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_dgr35\" id=\"field_dgr35_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (1)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dgr35\" name=\"item_meta[1058]\" value=\"\"  data-sectionid=\"1040\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1060_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_fxh6h\" id=\"field_fxh6h_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Fecha en la que adquiri\u00f3 la condici\u00f3n de Beneficiario Final \/ Date on which the final beneficiary status was acquired (1)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fxh6h\" name=\"item_meta[1060]\" value=\"\"  data-sectionid=\"1040\"  maxlength=\"10\" data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1062_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_39fzi\" id=\"field_39fzi_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_39fzi\" name=\"item_meta[1062]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1063_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_i2uoz\" id=\"field_i2uoz_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1063]\" id=\"field_i2uoz\"  data-sectionid=\"1040\"  data-invmsg=\"Nacionalidad \/ Nationality (2) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1064_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_3lnrm\" id=\"field_3lnrm_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o Pasaporte \/ Identification or  Passport No. (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3lnrm\" name=\"item_meta[1064]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1066_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_82une\" id=\"field_82une_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of Shares (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_82une\" name=\"item_meta[1066]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1065_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_tbzax\" id=\"field_tbzax_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (2)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_tbzax\" name=\"item_meta[1065]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1067_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_thl25\" id=\"field_thl25_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Fecha en la que adquiri\u00f3 la condici\u00f3n de Beneficiario Final \/ Date on which the final beneficiary status was acquired (2)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_thl25\" name=\"item_meta[1067]\" value=\"\"  data-sectionid=\"1040\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1070_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_4t2xx\" id=\"field_4t2xx_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4t2xx\" name=\"item_meta[1070]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1071_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_psk6j\" id=\"field_psk6j_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1071]\" id=\"field_psk6j\"  data-sectionid=\"1040\"  data-invmsg=\"Nacionalidad \/ Nationality (3) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1072_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_qp3ku\" id=\"field_qp3ku_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o Pasaporte \/ Identification or  Passport No. (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qp3ku\" name=\"item_meta[1072]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1074_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_cndx3\" id=\"field_cndx3_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of Shares (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_cndx3\" name=\"item_meta[1074]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1073_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_caafs\" id=\"field_caafs_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (3)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_caafs\" name=\"item_meta[1073]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1075_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_q7teg\" id=\"field_q7teg_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Fecha en la que adquiri\u00f3 la condici\u00f3n de Beneficiario Final \/ Date on which the final beneficiary status was acquired (3)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_q7teg\" name=\"item_meta[1075]\" value=\"\"  data-sectionid=\"1040\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1076_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_vceq2\" id=\"field_vceq2_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_vceq2\" name=\"item_meta[1076]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1077_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_vwqma\" id=\"field_vwqma_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1077]\" id=\"field_vwqma\"  data-sectionid=\"1040\"  data-invmsg=\"Nacionalidad \/ Nationality (4) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1078_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_fprjj\" id=\"field_fprjj_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o Pasaporte \/ Identification or  Passport No. (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_fprjj\" name=\"item_meta[1078]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1080_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_2u2h3\" id=\"field_2u2h3_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of Shares (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_2u2h3\" name=\"item_meta[1080]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1079_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_1vl0x\" id=\"field_1vl0x_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (4)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1vl0x\" name=\"item_meta[1079]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1081_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_v0qrk\" id=\"field_v0qrk_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Fecha en la que adquiri\u00f3 la condici\u00f3n de Beneficiario Final \/ Date on which the final beneficiary status was acquired (4)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_v0qrk\" name=\"item_meta[1081]\" value=\"\"  data-sectionid=\"1040\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1084_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_4spjh\" id=\"field_4spjh_label\" class=\"frm_primary_label\">Nombre Completo \/ Complete Name (5)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4spjh\" name=\"item_meta[1084]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1085_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_lhtcy\" id=\"field_lhtcy_label\" class=\"frm_primary_label\">Nacionalidad \/ Nationality (5)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1085]\" id=\"field_lhtcy\"  data-sectionid=\"1040\"  data-invmsg=\"Nacionalidad \/ Nationality (5) is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda\">Nueva Zelanda<\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica\">Rep\u00fablica Central de \u00c1frica<\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas\">San Vicente y las Granadinas<\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1086_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_8inds\" id=\"field_8inds_label\" class=\"frm_primary_label\">No. de Identificaci\u00f3n o Pasaporte \/ Identification or  Passport No. (5)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_8inds\" name=\"item_meta[1086]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1088_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_frizu\" id=\"field_frizu_label\" class=\"frm_primary_label\">Porcentaje de Acciones \/ Percentage of Shares (5)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_frizu\" name=\"item_meta[1088]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1087_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_fi53q\" id=\"field_fi53q_label\" class=\"frm_primary_label\">Direcci\u00f3n \/ Address (5)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_fi53q\" name=\"item_meta[1087]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1089_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_wu9p9\" id=\"field_wu9p9_label\" class=\"frm_primary_label\"><p style=\"text-align: justify;\">Fecha en la que adquiri\u00f3 la condici\u00f3n de Beneficiario Final \/ Date on which the final beneficiary status was acquired (5)<\/p>\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wu9p9\" name=\"item_meta[1089]\" value=\"\"  data-sectionid=\"1040\"  maxlength=\"10\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1097_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: justify;\">Que las personas arriba indicadas son los beneficiarios finales, due\u00f1os o controladores de las acciones emitidas, y que no existen otros accionistas o beneficiarios que los declarados.<\/p>\n<p style=\"text-align: justify;\"><em>That the persons indicated above are the final beneficiaries, owners or controllers of the shares issued, and that there are no other shareholders or beneficiaries other than those declared.<\/em><\/p>\n<\/div>\n<div id=\"frm_field_1098_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_xcga1\" id=\"field_xcga1_label\" class=\"frm_primary_label\">Fecha \/ Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xcga1\" name=\"item_meta[1098]\" value=\"04\/28\/2026\"  readonly=\"readonly\"  data-sectionid=\"1040\"  maxlength=\"10\" data-frmval=\"04\/28\/2026\" data-invmsg=\"Fecha no es v\u00e1lido\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_948_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_eb9j32\" id=\"field_eb9j32_label\" class=\"frm_primary_label\">Firma \/ Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad948' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[948][typed]\" class=\"name\" id=\"field_eb9j32\" autocomplete=\"off\" value=\"\"  data-sectionid=\"1040\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"948\" data-fieldname=\"item_meta[948]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[948][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    <div class=\"frm_description\" id=\"frm_desc_field_eb9j32\">(Por favor firmar igual que en su c\u00e9dula de identidad personal\/pasaporte)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_946_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_4cb372\" id=\"field_4cb372_label\" class=\"frm_primary_label\">Nombre \/ Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4cb372\" name=\"item_meta[946]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1101_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_half\">\r\n    <label for=\"field_hquaz\" id=\"field_hquaz_label\" class=\"frm_primary_label\">Cargo \/ Title\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hquaz\" name=\"item_meta[1101]\" value=\"\"  data-sectionid=\"1040\"  data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_940_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_8c3zu742_label\" class=\"frm_primary_label\">\u00bfEres humano? \/ Are you human?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_8c3zu742\" class=\"frm-g-recaptcha\" data-sitekey=\"6LfMeEElAAAAAHbYPyhee2qD1DE3Y74Xn9xEyYm3\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_1119_container\">\n\t\t\t<label for=\"field_filtb\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_filtb\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[1119]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"y7CTR79on9yYZZrDIw5qjJtKUKFdPv+krYTnUETX6zC\/\/BJAzCfD3d0iu9kHhbXe\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Enviar Datos<\/button>\r\n\r\n<a href=\"#\" tabindex=\"0\" class=\"frm_start_over\" >Empezar nuevamente<\/a>\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-9b26e34 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9b26e34\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"aux-parallax-section elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-292d0e1\" data-id=\"292d0e1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3e643d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"b3e643d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5fb2930 elementor-widget elementor-widget-text-editor\" data-id=\"5fb2930\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Entity regulated and supervised by the Superintendency of Non-Financial Institutions.<\/p><p><em>Entity regulated and supervised by the Superintendency of Non-Financial Entities.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>CUSTOMER DUE DILIGENCE FORM &#8211; LEGAL PERSON DUE DILIGENCE FORM FOR LEGAL ENTITY Entity regulated and supervised by the Superintendency of Non-Financial Institutions. Entity regulated and supervised by the Superintendency of Non-Financial Entities.<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":20036,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_joinchat":[],"footnotes":""},"class_list":["post-20058","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/pages\/20058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/comments?post=20058"}],"version-history":[{"count":2,"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/pages\/20058\/revisions"}],"predecessor-version":[{"id":20203,"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/pages\/20058\/revisions\/20203"}],"up":[{"embeddable":true,"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/pages\/20036"}],"wp:attachment":[{"href":"https:\/\/rcgroup.com.pa\/en\/wp-json\/wp\/v2\/media?parent=20058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}