INFORMAÇÃO GERAL

NOME (S)__________________________________________________________________________________________________________________________________

APELIDO(S) ________________________________________________________________________________________________________________________________

IDATE ATUAL:___________________________________________ALTURA ACTUAL:____________________________________________________________________

ESTADO CIVIL:___________________________________________SEXO:_____________________________________________________________________________

E CASADO(A) EM: CONCERVATÔRIA (PREFECTURA) DE:__________________________________________________________________________________________

______________________________ AÑO ________________ NO ASSENTO_____________________________ PAIS_________________________________________

NOME COMPLETO DO ESPOSO (A)____________________________________________________________________________________________________________

PROFISSÀO ACTUAL:________________________________________________________________________________________________________________________

NATURALIDADE: FREGUESIA (PARROQUIA):____________________________________________________________________________________________________

CONCELHO(DISTRITO):___________________________________________________________________________________________________________

DISTRITO (ESTADO):_____________________________________________________________________________________________________________

DATA DE NASCIMIENTO _________________________________________ DATA ENTRADA N/PAIS_______________________________________________________

HORA NASCIMIENTO_________________________________

ULTIMA RESIDÊNCIA EM PORTUGAL:__________________________________________________________________________________________________________

RESIDENCIA COMPLETA NESTE PAIS:__________________________________________________________________________________________________________

_____________________________________________________________________________TLF:__________________________________________________________

NOME COMPLETO DO PAI:___________________________________________________________________________________________________________________

IDADE:____________________________

NATURALIDADE FREGUESIA_____________________________________________CONCELHO:__________________________________________________________

ESTADO CIVIL:_________________________________ RESIDENTE (FOI)EM:__________________________________________________________________________

NOME COMPLETO DA MÀE:___________________________________________________________________________________________________________________

IDADE:__________________________________

NATURALIDADE FREGUESIA:____________________________________________________ CONCELHO:__________________________________________________

ESTADO CIVIL:_______________________________________ RESIDENTE (FOI)EM:____________________________________________________________________

AVOS PATERNOS:___________________________________________________________________________________________________________________________

E:_________________________________________________________________________________________________________________________________________

AVOS MATERNOS:__________________________________________________________________________________________________________________________

E:_________________________________________________________________________________________________________________________________________

ENCONTRASSE INSCRITO EM CARACAS___________ MARACAIBO____________

VALENCIA:__________ OUTROS:__________________________________

BILHETE DE IDENTIDADE: NUMERO:_________________________________ EMITIDO AOS:__________________________________________

LOCAL EMISSÂO:_______________________ VALIDO ATE:_______________________________________________

EMISÂO BILHETE DE IDENTIDADE (X) PRIMERA VEZ:______________________ EXTRAVIADO:________________________________

DOCUMENTOS A EMITIR:___________________________________________________________________________________________________________________

OBSERVAÇÔES:__________________________________________________________________________________________________________________________

DATE EM:_________________________________________ AOS:________________ DE:____________________ DE:_____________________________________

PAI____________________________________

ASSINATURA

MAE________________________________________