ACTA DE CONSTATACION

--- En Puno, siendo las _________horas del da______________ presente el Instructor, en la vivienda
sito en,___________________________________________________, de propiedad de
______________________________________________________, con _______ aos de edad, natural
de_____________________, de estado civil _________________, de
ocupacin____________________________, con instruccin ___________________, identificado con
DNI N_______________, domiciliado en
___________________________________________________; se procedi a realizar la presente
diligencia de Constatacin en presencia del RMP. Dr.
______________________________________________ procedindose a levantar la presente ACTA
DE CONSTATACION, verificando lo siguiente conforme se detalla a
continuacin:________________________________________________________________ ________
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--- La presente diligencia se da por concluida a las __________ horas del da de la fecha, firmando en
seal de conformidad el (la) testigo, en presencia del RMP y el Instructor que certifica.----------------------

EL INSTRUCTOR LA TESTIGO

R.M.P.