Benefactor in Kind

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Date of inscription

Type of inscription (legal/natural)

Name of the company (information of the company/entity)

RUC

Address (Company)

Country (Empresa)

City (company)

Phone office

Phone office 2

Email (company)

Web page

Name (information of the legal representative)

Last name (representative)

Address (representative)

County (representative)

City (representative)

Nationality

Date of birth

ID No.

Type of document

Home number

Cellphone

E-mail

Type of contribution.

Aporte en efectivo

Aporte en especie

Aporte en servicio profesional

Amount / Values

Program

Details

Comments

Signature