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[]
[null,null,null,null,null,null,null,null,null,"AYTO CAMPOS DEL PARAISO"]
[]
["SOLICITUD SERVICIO DE COMIDA A DOMICILIO"]
[]
["FECHA:"]
[]
["NOMBRE DEL CENTRO:",null,null,null,null,null,null,"RESIDENCIA DE MAYORES SAN JOAQUÍN Y SANTA ANA"]
[]
[]
[]
["1.-DATOS PERSONALES DEL USUARIO/A"]
[]
[null,"PRIMER APELLIDO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SEGUNDO APELLIDO"]
[]
[]
[]
[null,"NOMBRE",null,null,null,null,null,null,null,null,null,null,"D.N.I./N.I.F.",null,null,null,null,null,null,null,"FECHA DE NACIMIENTO"]
[]
[]
[]
[null,"DOMICILIO FAMILIAR, CALLE, PLAZA, NÚMERO"]
[]
[]
[]
[null,"LOCALIDAD"]
[]
[]
[]
[null,"CÓDIGO POSTAL",null,null,null,null,null,null,null,"PROVINCIA",null,null,null,null,null,null,null,null,null,null,"TELÉFONO"]
[]
[]
[]
[null,"Persona de referencia:"]
[]
[null,"Telefonos de contacto persona de referencia:"]
[]
[]
[null,"IMPORTANTE: A EFECTOS DE ACREDITACIÓN DE LOS DATOS ECONÓMICOS"]
[null,"si",null,"AUTORIZO AL AYUNTAMIENTO DE CAMPOS DEL PARAÍSO PARA QUE SOLICITE LA DOCUMENTACIÓN QUE PRECISE A LOS ORGANISMOS PERTINENTES O SI ESTO NO FUERA POSIBLE A LOS PROPIOS SOLICITANTES. "]
[]
[]
[]
[null,"Autorizo que los recibos de comida a domicilio, sean cargados en la siguiente cuenta:"]
[]
[null,"ENTIDAD BANCARIA:"]
[]
[]
[null,"TITULAR DE LA CUENTA:"]
[]
[]
[null,"Nº CUENTA:",null,null,null,"E","S"]
[]
[null,null,"En  Carrascosa del Campo, a  ",null,null,null,null,null,null,null,null,null,null,"de",null,null,null,null,null,null,null,null,null,"de"]
[]
[]
[]
[]
[null,"Vº Bº Director del centro     ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Fdo."]
[null,"Fernando Blanco Manzano"]
["La prestación de este servicio, queda sujeto a las subvenciones recibidas para su ejecución, además de los convenios de colaboración"]
["establecidos entre los diferentes Ayuntamientos."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"AYTO CAMPOS DEL PARAISO"]
[]
[null,"SOLICITUD SERVICIO DE COMIDA A DOMICILIO"]
[]
[]
[]
[]
[null,"D.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"con DNI "]
[]
[null,"que habiendo solicitado el servico de comidas domiciliarias a este Ayuntamiento, con fecha"]
[]
[null,"INFORMO QUE:",null,null,null,null,"( marque con una X lo que proceda)"]
[]
[null,null,null,null,"Si sufro  alergias o intolerancias alimenticias"]
[]
[null,null,null,null,"NO sufro alergias o intolerancias alimenticias"]
[]
[]
[null,null,"En caso de haber marcado SI, especifiquenos cual y acompañe esta solicitud con un informe médico."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"MUY IMPORTANTE : EL SERVICIO NO COMENZARÁ HASTA QUE NO SE PRESENTEN LOS "]
[null,null,"INFORMES MÉDICOS CORRESPONDIENTES SI EL SOLICITANTE ES ALERGICO O INTOLERANTE "]
[null,null,"A ALGÚN TIPO DE ALIMENTO."]
[]
[]
[]
[]
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[null,null,"Fdo. ",null,null,null,null,null,null,null,null,null,null,null,null,null,"V.B. Director Residencia "]
[null,null,"Interesado o tutor legal",null,null,null,null,null,null,null,null,null,null,null,null,null,"Fernando Blanco Manzano"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"Carrascosa del Campo a, ",null,null,null,null,null,null,null,null,null,"de",null,null,null,null,null,null,null," ","de",20]