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Name(s)
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Weight (Kilos)
Hight (centimeters)
Property Value (in Pesos currency)
Credit amount requested (in pesos currency)
Place Born
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Message
Business industry of the company you work for, or your own business
Term of desired credit
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Destino del Crédito
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Years in current address
Type of home
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How many dependents you have
Wok phone #
1 Personal Reference (family member)
1 Personal Reference ( NOT a family member)
Have you had variations in blood pressure?
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Do you suffer or have you suffered from any heart condition? (Heart attacks, angina pectoris, cardiac arrhythmias, coronary insufficiency)
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Do you suffer or have you suffered from diseases of the liver, kidneys, gallbladder or pancreas? (Dyspepsia, hepatitis B, C, liver cirrhosis, kidney failure)
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Do you have or have you had cancer or tumors of any type?
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Do you suffer or have you suffered from diabetes mellitus?
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Estado Civil
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