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{"sheet":"Hoja1","index":0,"n_rows":69,"n_cols":31,"rows_kept":69,"cut":false,"hidden":false,"merged":[[61,30,66,30],[62,1,62,21],[62,22,62,27],[62,28,62,29],[59,22,59,27],[59,1,59,21],[59,28,59,29],[60,1,60,21],[60,22,60,27],[60,28,60,29],[61,1,61,21],[61,22,61,27],[61,28,61,29],[64,19,64,21],[64,22,64,24],[63,1,63,29],[65,22,65,24],[65,25,65,29],[64,1,64,3],[64,4,64,6],[64,7,64,18],[53,1,53,29],[50,1,50,3],[51,1,51,3],[52,1,52,3],[48,27,48,29],[49,1,49,3],[46,25,46,26],[47,25,47,26],[36,20,36,29],[41,24,41,28],[38,21,38,29],[44,19,44,29],[40,7,40,16],[48,14,48,15],[49,14,49,15],[50,14,50,15],[51,14,51,15],[52,14,52,15],[46,1,47,3],[46,4,46,12],[47,4,47,12],[46,14,46,18],[47,14,47,15],[46,27,46,29],[4,1,4,29],[6,1,6,29],[8,24,8,29],[10,1,10,29],[12,1,12,29],[14,24,14,29],[16,1,16,29],[17,1,17,4],[17,5,17,17],[17,18,17,20],[17,21,17,29],[8,18,8,23],[18,8,18,13],[18,15,18,20],[18,21,18,22],[18,23,18,29],[20,1,20,3],[20,8,20,9],[20,4,20,5],[20,12,20,13],[20,16,20,18],[20,21,20,23],[18,2,18,4],[18,5,18,7],[22,5,22,11],[22,12,22,13],[22,25,22,26],[21,25,21,26],[26,2,27,8],[28,2,29,8],[24,1,24,29],[22,1,22,4],[27,11,27,15],[29,11,29,15],[31,21,31,22],[40,1,40,6],[44,2,44,5],[43,1,43,5],[43,8,43,12],[44,9,44,12],[40,17,40,25],[41,17,41,23],[32,2,33,8],[34,2,35,8],[36,2,38,8],[30,2,31,8],[32,17,32,20],[43,17,43,20],[43,22,43,23],[43,25,43,26],[32,21,32,22],[32,26,32,27],[31,11,31,15],[33,11,33,15],[35,11,35,15],[37,11,37,15],[47,27,47,29],[46,19,47,21],[46,22,47,24],[48,1,48,3],[48,4,48,12],[48,19,48,21],[48,22,48,24],[48,25,48,26],[50,19,50,21],[49,4,49,12],[50,4,50,12],[48,17,48,18],[49,17,49,18],[50,17,50,18],[47,17,47,18],[51,17,51,18],[52,17,52,18],[51,4,51,12],[52,4,52,12],[52,25,52,26],[49,27,49,29],[50,27,50,29],[51,27,51,29],[52,27,52,29],[49,19,49,21],[51,19,51,21],[52,19,52,21],[49,22,49,24],[50,22,50,24],[51,22,51,24],[52,22,52,24],[67,1,67,29],[68,1,68,29],[2,23,2,25],[2,26,2,29],[5,1,5,29],[8,3,8,17],[11,1,11,29],[14,3,14,17],[66,1,66,3],[66,4,66,6],[66,7,66,18],[66,19,66,21],[66,22,66,24],[66,25,66,29],[64,25,64,29],[65,1,65,3],[65,4,65,6],[65,7,65,18],[65,19,65,21],[54,1,58,29],[41,7,41,16],[49,25,49,26],[50,25,50,26],[51,25,51,26]]}
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No. De Solicitud"]
[]
[null,"Contratante (Nombre completo o razón social; solo llenar si es diferente al del solicitante)."]
[]
[null,"(Apellido paterno - Apellido materno - Nombre(s) o razón social )"]
[]
[null,"RFC",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Relación con el solicitante"]
[]
[null,"Solicitante"]
[]
[null,"(Apellido paterno - Apellido materno - Nombre(s) o razón social )"]
[]
[null,"RFC",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Relación con el solicitante"]
[]
[null,"Datos personales"]
[null,"Domicilio: Calle y No.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Col. o Pob."]
[null,"C.P.",null,null,null,"Población",null,null,null,null,null,null,null,null,"Edo.",null,null,null,null,null,null,"Teléfono"]
[]
[null,"Estado Civil",null,null,"Soltero",null,null,null,"Casado",null,null,null,"Viudo",null,null,null,"Divorciado",null,null,null,null,"Unión libre"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Año",null,"Mes","Día"]
[null,"Lugar de nacimiento:",null,null,null,null,null,null,null,null,null,null,"Sexo:",null,"Mas",null,null,"Fem",null,null,"Fecha de nacimiento"]
[]
[null,"Seguro solicitado"]
[]
[null,null,"Seguro de Accidentes Personales Anual",null,null,null,null,null,null,null,null,"Suma Asegurada",null,null,null,null,null,null,"Escala para perdidas orgánicas:",null,null,null,null,null,null,"A",null,"B"]
[null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,"Seguro total de Accidentes Personales en viajes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Frecuencia de pago de primas:"]
[null,null,null,null,null,null,null,null,null,null,"$",null,null,null,null,null,null,null,"Anual",null,null,null,"Semestral",null,null,null,null,"Trimestral"]
[null,null,"Seguro de Accidentes Personales en Viajes aéreos"]
[null,null,null,null,null,null,null,null,null,null,"$",null,null,null,null,null,null,null,null,null,null,"Año",null,"Mes","Día",null,"Año",null,"Mes","Día"]
[null,null,"Seguro de Accidentes personales Familiar",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Vigencia desde",null,null,null,null,null,null,null,"Hasta"]
[null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,"Seguro de Accidentes Personales Junior",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Motivo del seguro:"]
[null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,"Seguro de Accidentes Personales Larga Dependencia",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Viajes de recreo, estudios, congresos o convenciones"]
[null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Otro"]
[]
[null,"Reembolso de Gastos Médicos",null,null,null,null,null,"Indemnización diaria",null,null,null,null,null,null,null,null,null,"Información sobre viajes durante"]
[null,null,null,null,null,null,null,"(solo opera para Accidentes Personales Anual)",null,null,null,null,null,null,null,null,null,"el periodo contratado.",null,null,null,null,null,null,"No. De viajes a realizar"]
[null,"Si",null,null,"No",null,null,null,"Si",null,null,"No",null,null,null,null,null,"Medios de transporte que utiliza:"]
[null,"Suma asegurada",null,null,null,null,null,null,"Suma asegurada",null,null,null,null,null,null,null,null,"Avión línea regular",null,null,null,null,"Automóvil",null,null,"Autobús",null,null,"Tren"]
[null,"$",null,null,null,null,null,null,"$",null,null,null,null,null,null,null,null,"Otros:"]
[]
[null,"No.  De Solicitante",null,null,"Nombre completo",null,null,null,null,null,null,null,null,"Sexo","Fecha de nacimiento",null,null,null,null,"Parentesco",null,null,"Ocupación",null,null,"Estatura",null,"Peso"]
[null,null,null,null,"(Apellido paterno, materno, nombre(s))",null,null,null,null,null,null,null,null,"M / F","Año",null,"Mes","Día",null,null,null,null,null,null,null,"Mts",null,"Kgs"]
[]
[]
[]
[]
[]
[null,"Beneficiarios Designados"]
[null,"Advertencia: En el caso de que desee nombrar beneficiarios a menores de edad, no se debe señalar a un mayor de edad como representante de los menores para efecto de que, en su representación cobre la indemnización. Lo anterior porque las legislaciones civiles previenen la forma en que deben designarse tutores, albaceas, representantes de herederos u otros cargos similares y no consideran al contrato de seguro como el instrumento adecuado para tales designaciones. La designación que se hiciera de un mayor de edad como representante de menores beneficiarios, durante la minoría de edad de ellos, legalmente puede implicar que se nombra beneficiario al mayor de edad, quien en todo caso sólo tendría una obligación moral, pues la designación que se hace de beneficiarios en un contrato de seguro le concede el derecho incondicionado de disponer de la suma asegurada"]
[]
[]
[]
[]
[null,"(Apellido paterno -- materno -- nombre(s))",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Parentesco",null,null,null,null,null,"%"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AI-115-7"]
[]
[null,"Datos del agente"]
[null,"No. Agente",null,null,"No. Promotor",null,null,"Nombre Agente",null,null,null,null,null,null,null,null,null,null,null,"Participación",null,null,"C. de utilidad",null,null,"Promotoria"]
[]
[]
[null,"AXA Seguros, S.A. de C.V. - Periférico Sur 3325 Piso 11, San Jerónimo Aculco 10400 México, D.F."]
[null,"Tels. 5169 1000 • 5169 2500 • 01 800 900 1AXA • www.axa.com.mx"]

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[]
[null,"Información sobre ocupación (Solicitante Titular)"]
[]
[null,"Nombre de la empresa",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Teléfono"]
[null,"Giro",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Población y Edo."]
[null,"Ocupación"]
[null,"Ingresos anuales del solicitante     $",null,null,null,null,null,null,null,null,null,null,null,null,null,"Ingresos anuales del contratante   $"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(Solo cuanto el contratante es diferente al solicitante)"]
[]
[null,"El siguiente cuestionario no es requerido en solicitudes para cubrir viajes de recreo, estudios, congresos o convenciones."]
[]
[null,"Lugar de trabajo:",null,null,"Oficina",null,null,"Fabrica",null,null,"Taller",null,null,"Calle",null,null,"Tienda / Comercio",null,null,null,null,"Consultorio / Despacho",null,null,null,null,null,"Otro"]
[]
[null,"1) ¿Trabaja Ud. en horario nocturno? ",null,null,null,null,null,null,null,null,null,"Si",null,"No",null,null,"9) ¿Conduce Ud. algún tipo de vehículo? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Detalle tipo de vehículo, uso y carga"]
[null,"2) ¿Usa Ud. armas de fuego, punzocortantes o herramientas peligrosas?",null,null,null,null,null,null,null,null,null,"Si",null,"No",null,null,"(excluya auto de uso particular)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"10) ¿Pilotea o forma parte de la tripulación en algún tipo de aeronave? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"3) ¿Trabaja Ud. con o en lugares donde se maneja fuego, alta tensión, productos químicos, radioactivos, inflamables, explosivos, tóxicos o peligrosos?",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"11) ¿Realiza Ud. actividades submarinas, marinas, subterráneas, aéreas o en techos, azoteas o en alturas peligrosas o en plataformas marítimas? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[]
[null,"4) ¿Trabaja Ud. con animales sean o no domésticos? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"5) ¿Trabaja Ud. en lugares donde se expendan bebidas alcohólicas? ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"12) ¿Realiza Ud. actividades artísticas, de modelaje o deportivas en forma profesional? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"6) ¿Realiza Ud. trabajos de mantenimiento a algún tipo de aparato, maquinaria o equipo? ",null,null,null,null,null,null,null,null,null,"Si",null,"No",null,null,"13) ¿Realiza Ud. investigaciones o maneja información que pueda poner en peligro su integridad física? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[]
[null,"7) ¿Trabaja Ud. o maneja algún tipo de maquinaria industrial o pesada? ",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"14) ¿Alguna otra ocupación o fuente de ingresos adicional? (No incluir rentas o inversiones)",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"8) ¿Supervisa Ud. procesos de manufactura o de construcción?",null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[]
[null,"Hábitos"]
[]
[null,"¿Haces uso de bebidas alcohólicas?",null,null,null,null,null,null,"Si",null,"No"]
[null,"Cual (es):",null,null,null,null,null,null,null,null,null,null,"Frecuencia:",null,null,null,null,null,null,null,null,"Cantidad:"]
[null,null,null,null,"(Ron, Brandy, whisky, etc.)",null,null,null,null,null,null,null,null,null,null,"(Diaria, semanal, quincenal, etc.)",null,null,null,null,null,null,null,"(3, 4, 5 o mas copas)"]
[null,"Cuestionario médico"]
[null,"1) ¿Han padecido los padres o hermanos (del titular y/o cónyuge) de insufi ciencia renal, afecciones cardiacas, hipertensión arterial, diabetes, epilepsia, cáncer, afecciones congénitas, afección reumática, afección coronaria, demencia, esquizofrenia o trastornos mentales?  "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"2) ¿Estuvo, o está sujeto algún tratamiento médico, intervención quirúrgica u hospitalizado?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"3) ¿Ha padecido molestias del corazón, presión alta, anemia o alguna enfermedad del sistema circulatorio? ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"4) ¿Padece o ha padecido de reumatismo, alguna anomalía del sistema óseo, alguna deformidad o alguna pérdida transitoria o no transitoria de algún movimiento?  "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"5) ¿Le falta algún miembro o parte de él, tiene alguna anomalía de la vista, auditiva o del sistema respiratorio? ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"6) ¿Ha tenido enfermedades del aparato digestivo, intestino delgado, hígado, colón, páncreas o vesícula biliar?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"7)¿Padece o ha padecido enfermedad del sistema nervioso locomotor, cuadros de ansiedad, depresión o alguna enfermedad mental?  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"8) ¿Padece o ha padecido enfermedad vascular cerebral (embolia, trombosis, etc.), diabetes mellitus, cáncer o tumores de cualquier tipo y en cualquier parte del cuerpo?  "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"9) ¿Ha padecido enfermedades transmisibles (Incluyendo hepatitis o infecciones de transmisión sexual)?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"10) ¿Se le ha practicado pruebas especiales de laboratorio para diagnosticar alguna enfermedad específica (como SIDA, diabetes, etc.)? ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[null,"Especifique:"]
[null,"En caso de alguna respuesta afirmativa, favor de ampliar la información "]
[null,"No. Pregunta",null,null,null,"Detalle"]

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[]
[]
[null,"Actividades, aficiones, deportes"]
[null,"Este seguro no cubre accidentes ocasionados por alguna de las siguientes actividades. Si Ud. Desea cubrirlas en forma especial, favor de indicarlo."]
[null,"Actividad  ",null,null,null,null,null,"Marque si desea cubrir el riesgo",null,null,null,"Actividad  ",null,null,null,null,null,"Marque si desea cubrir el riesgo",null,null,null,"Actividad  ",null,null,null,null,null,"Marque si desea cubrir el riesgo"]
[]
[null,"Carrera de autos",null,null,null,null,null,null,null,null,null,"Tiro al blanco",null,null,null,null,null,null,null,null,null,"Vuelo en aviones que no sean de línea regular"]
[null,"Artes marciales, box o lucha",null,null,null,null,null,null,null,null,null,"Ski"]
[null,"Alpinismo",null,null,null,null,null,null,null,null,null,"Charrería o equitación ",null,null,null,null,null,null,null,null,null,"Deportes aéreos (paracaidismo, vuelo delta, planeador etc.) "]
[null,"Uso de motocicleta",null,null,null,null,null,null,null,null,null,"Buceo"]
[null,"Motonáutica",null,null,null,null,null,null,null,null,null,"Caza",null,null,null,null,null,null,null,null,null,"Pruebas o contiendas de velocidad, resistencia o seguridad en algún tipo de vehículo"]
[null,"Juegos de azar y/o apuestas "]
[null,"Si Ud. Ha marcado alguna de las actividades, favor de indicar:"]
[null,"1) Actividad: ",null,null,"Amateur",null,null,null,"Profesional"]
[null,"2) Nivel: ",null,null,"Nacional",null,null,null,"Internacional"]
[null,"3) Tipo o especialidad:"]
[]
[null,"4) Practica",null,null,"Solo",null,null,null,"En grupo"]
[null,"5) Frecuencia:"]
[null,"6) Lugares:"]
[null,"7) Equipo o vehículos utilizados:"]
[null,"8) Características del motor (en caso de vehículos):"]
[null,"9) Otros detalles de la actividad (profundidad, altura, suertes que practica, piezas que cobra, etc.)"]
[]
[]
[]
[null,"Otros seguros Si Ud. Ha sido rechazado o extraprimado al solicitar algún seguro, sírvase a indicar"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Fecha"]
[null,"Compañía",null,null,null,null,null,null,null,null,null,null,null,null,"Tipo de seguro",null,null,null,"Año","Mes","Día","Suma Asegurada"]
[]
[]
[]
[null,"Si Ud. Tiene algún otro seguro de accidentes personales, sírvase indicar: (no incluya seguros de grupo o colectivos)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Fecha"]
[null,"Compañía",null,null,null,null,null,null,null,null,null,null,null,null,"Tipo de seguro",null,null,null,"Año","Mes","Día","Suma Asegurada"]
[]
[]
[]
[null,"Observaciones"]
[]
[]
[]
[]
[]
[null,"Referencias del contratante (deberá llenarse en todos los casos)"]
[null,"(Datos de tres personas, no familiares, que le conozcan). Si es persona moral, dar referencias del solicitante"]
[null,"Nombre",null,null,null,null,null,null,null,null,"Domicilio",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Teléfono"]

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[]
[]
[null,"Nota importante (debe leerlo antes de firmar)"]
[null,"Se previene al contratante y al solicitante que conforme a la ley sobre el contrato de seguro, deben declarar todos los hechos importantes para la apreciación del riesgo a que se refiere esta solicitud, tal y como los conozcan o deban conocer en el momento de firmar la solicitud, en la inteligencia de que la no declaración o la inexacta o falsa declaración de un hecho de los mencionados podría originar la pérdida del derecho del asegurado o del beneficiario en su caso."]
[]
[]
[]
[null,"El contrato de seguro, empezará a surtir efecto en el momento en que el contratante y solicitante tengan conocimiento de que, AXA Seguros, S.A. de C.V. aceptó el riesgo y no al momento de la firma de esta solicitud."]
[]
[null,"Si la póliza de seguros que se está contratando por medio de esta solicitud se encuentra dentro de las condiciones a que se refieren las distintas disposiciones de carácter fiscal para efectos de deducibilidad o acredita miento de impuestos, y el contratante desea sujetarse a lo que indican dichos ordenamientos, deberá proporcionar su clave de Registro Federal de Contribuyentes anexando a la presente para el efecto copia de la Cédula de Verificación Fiscal."]
[]
[]
[]
[null,"Enterado de lo que antecede y para efecto de esta solicitud de seguro, declaro estar dispuesto, si fuera necesario, a pasar un examen médico por cuenta de la Compañía, si ésta lo estima conveniente. Además autorizo con la mayor amplitud a los médicos o instituciones de médicos que me atiendan o me hayan atendido, para que participen a AXA Seguros, S.A. de C.V. todos mis antecedentes patológicos y los libero expresamente de cualquier responsabilidad. Asimismo autorizo a las compañías de seguros en las cuales he solicitado póliza para proporcionar la información de su conocimiento, útil en la evaluación de esta solicitud."]
[]
[]
[]
[]
[null,"Para los efectos que pueda tener esta solicitud, ratifico que todas las respuestas a las preguntas contenidas en la misma, las he dado personalmente, que son verídicas y están completas y convengo asimismo en que todas las declaraciones y respuestas que aparecen en esta solicitud se considerarán como necesarias al contrato de seguro solicitado y constituyen la base sobre la que se celebre dicho contrato."]
[]
[]
[null,"La firma del solicitante y/o contratante al calce, indican su conformidad con las respuestas a los cuestionarios que anteceden."]
[]
[null,"\"Este documento sólo constituye una solicitud de seguro y, por tanto, no representa garantía alguna de que la misma será aceptada por la empresa de seguros, ni de que, en caso de aceptarse, la aceptación concuerde totalmente con los términos de la solicitud\"."]
[]
[]
[]
[]
[null,"Firma del solicitante",null,null,null,null,null,null,null,null,null,"Firma del contratante",null,null,null,null,null,null,null,null,null,"Lugar y fecha"]
[null,null,null,null,null,null,null,null,null,null,null,"(sólo si es diferente al solicitante)"]
[]
[null,"Informe completo del agente (deberá llenarse en todos los casos)"]
[]
[null,"¿Cuánto tiempo hace que conoce al solicitante?"]
[null,"¿En cuánto estima Ud. los ingresos anuales de su cliente? ",null,null,null,null,null,null,null,null,null,null,null,"$"]
[]
[null,"¿Le consta que su cliente firmó esta solicitud? ",null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[]
[null,"¿Recomienda Ud. a su cliente por su moralidad, reputación y ocupación?",null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No"]
[]
[null,"¿Conoce algún hecho en contradicción con las respuestas del solicitante?",null,null,null,null,null,null,null,null,null,null,null,null,null,"Si",null,"No",null,null,null,"¿Cual?"]
[]
[]
[]
[]
[null,"Firma del agente ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Lugar y fecha"]
[null,"de conformidad de las respuestas que anteceden."]
[]
[]
[null,"Para uso exclusivo de AXA Seguros, S.A. de C.V."]
[null,"Dictamen"]
[null,{"$f":"Hoja6!B21","v":0}]
[]
[]
[]
[]
[]
[null,"Registrado ante la Comisión Nacional de Seguros y Fianzas Of. No. 06-367-ll.1.1/21905 Exp. 732.2 (S-3)/1 del 28 de agosto de 1998."]

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[]
[]
[]
[]
[null,"Información Adicional de Art. 140 "]
[null,"Contratante:"]
[null,"Fecha de Nacimiento y/o contitución de la empresa",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Pais de Nacimiento"]
[null,"Nacionalidad",null,null,null,null,null,null,null,null,"Ocupación, Profesión, Actividad o Giro "]
[null,"Domicilio Particular "]
[null,"Teléfono ",null,null,null,null,null,null,null,"Folio Mercantil",null,null,null,null,null,null,null,null,"CURP"]
[null,"Correo Electrónico",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FIEL"]
[null,"Nombre del Representante Legal"]
[null,"Solicitante:"]
[null,"Nacionalidad",null,null,null,null,null,null,null,null,null,null,null,null,null,"CURP"]
[null,"Correo Electrónico",null,null,null,null,null,null,null,null,null,null,null,null,null,"RFC"]
[null,"FIEL"]
[]
[]
[]
[null,"Observaciones"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"AXA Seguros, S.A. de C.V. Xola 535, piso 27, Del Valle, 03100, México, D.F.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," Tels. 5169 1000 • 01 800 900 1292 • axa.mx"]

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["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Contratante",{"$f":"Hoja1!B6","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico"]
["RFC",{"$f":"Hoja1!D9","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico",null,null,"Nombre del Solicitante:",{"$f":"Hoja1!B12","v":0}]
["Relacion con el solicitante",{"$f":"Hoja1!Y9","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico",null,null,"Días en el que se le puede contactar:"]
["Solicitante",{"$f":"Hoja1!B12","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico",null,null,"Lunes"]
["RFC",{"$f":"Hoja1!D15","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico",null,null,"Martes"]
["Relacion con el solicitante",{"$f":"Hoja1!Y15","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico",null,null,"Miercoles"]
["Domicilio: Calle y No.",{"$f":"Hoja1!F18","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico",null,null,"Jueves"]
["Col. O Pob",{"$f":"Hoja1!V18","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico",null,null,"Viernes"]
["CP",{"$f":"Hoja1!C19","v":0},null,null,null,null,null,null,"Obligatorio","Numerico",null,null,"Horario:"]
["Poblacion",{"$f":"Hoja1!I19","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico","",null,"Comentarios:"]
["Estado",{"$f":"Hoja1!P19","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico",null,null,"Telefono Particular:"]
["Telefono",{"$f":"Hoja1!X19","v":0},null,null,null,null,null,null,"Opcional","Numerico",null,null,"Telefono de Oficina:"]
["Estado Civil",{"$f":"x","v":0},{"$f":"Hoja1!K21","v":0},{"$f":"Hoja1!O21","v":0},{"$f":"Hoja1!T21","v":0},{"$f":"Hoja1!Y21","v":0},null,null,"Opcional","Variable","",null,"Telefono Movil:"]
["Lugar de Nacimiento",{"$f":"Hoja1!F23","v":0},null,null,null,null,null,null,"Opcional","Alfanumerico",null,null,"Correo electrónico:"]
["Sexo",{"$f":"Hoja1!P23","v":0},{"$f":"Hoja1!S23","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["Fecha de Nacimiento"]
["Dia",{"$f":"Hoja1!AC23","v":0},null,null,null,null,null,null,"Obligatorio","4 Digitos"]
["Mes",{"$f":"Hoja1!AB23","v":0},null,null,null,null,null,null,"Obligatorio","2 Digitos"]
["Año",{"$f":"Hoja1!Z23","v":0},null,null,null,null,null,null,"Obligatorio","2 Digitos"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Seguro solicitado",{"$f":"Hoja1!B27","v":0},{"$f":"Hoja1!B29","v":0},{"$f":"Hoja1!B31","v":0},{"$f":"Hoja1!B33","v":0},{"$f":"Hoja1!B35","v":0},{"$f":"Hoja1!B37","v":0},null,"Obligatorio","Variable"]
["Suma asegurada",{"$f":"Hoja1!L28","v":0},{"$f":"Hoja1!L30","v":0},{"$f":"Hoja1!L32","v":0},{"$f":"Hoja1!L34","v":0},{"$f":"Hoja1!L36","v":0},{"$f":"Hoja1!L38","v":0},null,"Obligatorio","Numerico"]
["Reembolsos de gastos medicos",{"$f":"Hoja1!C43","v":0},{"$f":"Hoja1!F43","v":0},{"$f":"Hoja1!C45","v":0},null,null,null,null,"Obligatorio","Variable"]
["Indemnizacion diaria",{"$f":"Hoja1!J43","v":0},{"$f":"Hoja1!M43","v":0},{"$f":"Hoja1!J45","v":0},null,null,null,null,"Condicional","Variable"]
["Escala de perdidas organicas",{"$f":"Hoja1!AA27","v":0},{"$f":"Hoja1!AC27","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["Frecuencia de Pago",{"$f":"Hoja1!U30","v":0},{"$f":"Hoja1!Z30","v":0},{"$f":"Hoja1!AD30","v":0},null,null,null,null,"Obligatorio","Variable"]
["Vigencia"]
["Dia ",{"$f":"Hoja1!Y33","v":0},{"$f":"Hoja1!AD33","v":0},null,null,null,null,null,"Obligatorio","2 Digitos"]
["Mes",{"$f":"Hoja1!X33","v":0},{"$f":"Hoja1!AC33","v":0},null,null,null,null,null,"Obligatorio","2 Digitos"]
["Año",{"$f":"Hoja1!V33","v":0},{"$f":"Hoja1!AA33","v":0},null,null,null,null,null,"Obligatorio","4 Digitos"]
["Motivo del seguro",{"$f":"Hoja1!T37","v":0},{"$f":"Hoja1!T39","v":0},{"$f":"Hoja1!V39","v":0},null,null,null,null,"Condicional","Variable"]
["Informacion sobre viajes",{"$f":"Hoja1!AD42","v":0},{"$f":"Hoja1!V44","v":0},{"$f":"Hoja1!Y44","v":0},{"$f":"Hoja1!AB44","v":0},{"$f":"Hoja1!AD44","v":0},{"$f":"Hoja1!T45","v":0},null,"Condicional","Variable"]
["Dependientes",null,null,null,null,null,null,null,"Condicional","Variable"]
["No. Solicitante",{"$f":"Hoja1!B49","v":0},{"$f":"Hoja1!B50","v":0},{"$f":"Hoja1!B51","v":0},{"$f":"Hoja1!B52","v":0},{"$f":"Hoja1!B53","v":0},null,null,"Obligatorio","Variable"]
["Nombre",{"$f":"Hoja1!E49","v":0},{"$f":"Hoja1!E50","v":0},{"$f":"Hoja1!E51","v":0},{"$f":"Hoja1!E52","v":0},{"$f":"Hoja1!E53","v":0},null,null,"Obligatorio","Variable"]
["Sexo",{"$f":"Hoja1!N49","v":0},{"$f":"Hoja1!N50","v":0},{"$f":"Hoja1!N51","v":0},{"$f":"Hoja1!N52","v":0},{"$f":"Hoja1!N53","v":0},null,null,"Obligatorio","Variable"]
["Fecha de Nacimiento"]
["Dia",{"$f":"Hoja1!R49","v":0},{"$f":"Hoja1!R50","v":0},{"$f":"Hoja1!R51","v":0},{"$f":"Hoja1!R52","v":0},{"$f":"Hoja1!R53","v":0},null,null,"Obligatorio","Variable"]
["Mes",{"$f":"Hoja1!Q49","v":0},{"$f":"Hoja1!Q50","v":0},{"$f":"Hoja1!Q51","v":0},{"$f":"Hoja1!Q52","v":0},{"$f":"Hoja1!Q53","v":0},null,null,"Obligatorio","Variable"]
["Año",{"$f":"Hoja1!O49","v":0},{"$f":"Hoja1!O50","v":0},{"$f":"Hoja1!O51","v":0},{"$f":"Hoja1!O52","v":0},{"$f":"Hoja1!O53","v":0},null,null,"Obligatorio","Variable"]
["Parentesco ",{"$f":"Hoja1!T49","v":0},{"$f":"Hoja1!T50","v":0},{"$f":"Hoja1!T51","v":0},{"$f":"Hoja1!T52","v":0},{"$f":"Hoja1!T53","v":0},null,null,"Obligatorio","Variable"]
["Ocupacion",{"$f":"Hoja1!W49","v":0},{"$f":"Hoja1!W50","v":0},{"$f":"Hoja1!W51","v":0},{"$f":"Hoja1!W52","v":0},{"$f":"Hoja1!W53","v":0},null,null,"Obligatorio","Variable"]
["Estatura",{"$f":"Hoja1!Z49","v":0},{"$f":"Hoja1!Z50","v":0},{"$f":"Hoja1!Z51","v":0},{"$f":"Hoja1!Z52","v":0},{"$f":"Hoja1!Z53","v":0},null,null,"Obligatorio","Variable"]
["Peso",{"$f":"Hoja1!AB49","v":0},{"$f":"Hoja1!AB50","v":0},{"$f":"Hoja1!AB51","v":0},{"$f":"Hoja1!AB52","v":0},{"$f":"Hoja1!AB53","v":0},null,null,"Obligatorio","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Beneficiarios",{"$f":"Hoja1!B61","v":0},{"$f":"Hoja1!W61","v":0},{"$f":"Hoja1!AC61","v":0},null,null,null,null,"Opcional","Variable"]
["Beneficiarios 2",{"$f":"Hoja1!B62","v":0},{"$f":"Hoja1!W62","v":0},{"$f":"Hoja1!AC62","v":0},null,null,null,null,"Opcional","Variable"]
["Beneficiarios 3",{"$f":"Hoja1!B63","v":0},{"$f":"Hoja1!W63","v":0},{"$f":"Hoja1!AC63","v":0},null,null,null,null,"Opcional","Variable"]
["Datos del agente",{"$f":"Hoja1!B66","v":0},{"$f":"Hoja1!E66","v":0},{"$f":"Hoja1!H66","v":0},{"$f":"Hoja1!T66","v":0},{"$f":"Hoja1!W66","v":0},{"$f":"Hoja1!Z66","v":0},null,"Obligatorio","Variable"]
["Datos del agente 2",{"$f":"Hoja1!B67","v":0},{"$f":"Hoja1!E67","v":0},{"$f":"Hoja1!H67","v":0},{"$f":"Hoja1!T67","v":0},{"$f":"Hoja1!W67","v":0},{"$f":"Hoja1!Z67","v":0},null,"Obligatorio","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Nombre de la empresa",{"$f":"Hoja2!G4","v":0},null,null,null,null,null,null,"Obligatorio","Alfanumerico"]
["Telefono",{"$f":"Hoja2!W4","v":0},null,null,null,null,null,null,"Obligatorio","Numerico"]
["Giro",{"$f":"Hoja2!C5","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico"]
["Poblacion",{"$f":"Hoja2!W5","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico"]
["Ocupacion",{"$f":"Hoja2!E6","v":0},null,null,null,null,null,null,"Obligatorio","Alfabetico"]
["Ingresos anuales solicitantes",{"$f":"Hoja2!I7","v":0},null,null,null,null,null,null,"Obligatorio","Numerico"]
["Ingresos anuales contratante",{"$f":"Hoja2!W7","v":0},null,null,null,null,null,null,"Opcional","Numerico"]
["Lugar de trabajo",{"$f":"Hoja2!G12","v":0},{"$f":"Hoja2!J12","v":0},{"$f":"Hoja2!M12","v":0},{"$f":"Hoja2!P12","v":0},{"$f":"Hoja2!U12","v":0},{"$f":"Hoja2!AA12","v":0},{"$f":"Hoja2!AC12","v":0},"Obligatorio","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
[1,{"$f":"Hoja2!M14","v":0},{"$f":"Hoja2!O14","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[2,{"$f":"Hoja2!M16","v":0},{"$f":"Hoja2!O16","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[3,{"$f":"Hoja2!M18","v":0},{"$f":"Hoja2!O18","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[4,{"$f":"Hoja2!M21","v":0},{"$f":"Hoja2!O21","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[5,{"$f":"Hoja2!M23","v":0},{"$f":"Hoja2!O23","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[6,{"$f":"Hoja2!M24","v":0},{"$f":"Hoja2!O24","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[7,{"$f":"Hoja2!M26","v":0},{"$f":"Hoja2!O26","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[8,{"$f":"Hoja2!M28","v":0},{"$f":"Hoja2!O28","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[9,{"$f":"Hoja2!AB14","v":0},{"$f":"Hoja2!AD14","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[10,{"$f":"Hoja2!AB17","v":0},{"$f":"Hoja2!AD17","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[11,{"$f":"Hoja2!AB19","v":0},{"$f":"Hoja2!AD19","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[12,{"$f":"Hoja2!AB22","v":0},{"$f":"Hoja2!AD22","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[13,{"$f":"Hoja2!AB24","v":0},{"$f":"Hoja2!AD24","v":0},null,null,null,null,null,"Obligatorio","Variable"]
[14,{"$f":"Hoja2!AB27","v":0},{"$f":"Hoja2!AD27","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Habitos",{"$f":"Hoja2!J32","v":0},{"$f":"Hoja2!L32","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["ciales",{"$f":"Hoja2!D33","v":0},null,null,null,null,null,null,"Condicional","Alfabetico"]
["Frecuencia  ",{"$f":"Hoja2!P33","v":0},null,null,null,null,null,null,"Condicional","Alfabetico"]
["Cantidad",{"$f":"Hoja2!X33","v":0},null,null,null,null,null,null,"Condicional","Alfanumerico"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
[1,{"$f":"Hoja2!AB38","v":0},{"$f":"Hoja2!AD38","v":0},{"$f":"Hoja2!E39","v":0},null,null,null,null,"Obligatorio","Variable"]
[2,{"$f":"Hoja2!AB40","v":0},{"$f":"Hoja2!AD40","v":0},{"$f":"Hoja2!E41","v":0},null,null,null,null,"Obligatorio","Variable"]
[3,{"$f":"Hoja2!AB42","v":0},{"$f":"Hoja2!AD42","v":0},{"$f":"Hoja2!E43","v":0},null,null,null,null,"Obligatorio","Variable"]
[4,{"$f":"Hoja2!AB45","v":0},{"$f":"Hoja2!AD45","v":0},{"$f":"Hoja2!E46","v":0},null,null,null,null,"Obligatorio","Variable"]
[5,{"$f":"Hoja2!AB47","v":0},{"$f":"Hoja2!AD47","v":0},{"$f":"Hoja2!E48","v":0},null,null,null,null,"Obligatorio","Variable"]
[6,{"$f":"Hoja2!AB49","v":0},{"$f":"Hoja2!AD49","v":0},{"$f":"Hoja2!E50","v":0},null,null,null,null,"Obligatorio","Variable"]
[7,{"$f":"Hoja2!AB51","v":0},{"$f":"Hoja2!AD51","v":0},{"$f":"Hoja2!E52","v":0},null,null,null,null,"Obligatorio","Variable"]
[8,{"$f":"Hoja2!AB54","v":0},{"$f":"Hoja2!AD54","v":0},{"$f":"Hoja2!E55","v":0},null,null,null,null,"Obligatorio","Variable"]
[9,{"$f":"Hoja2!AB56","v":0},{"$f":"Hoja2!AD56","v":0},{"$f":"Hoja2!E57","v":0},null,null,null,null,"Obligatorio","Variable"]
[10,{"$f":"Hoja2!AB58","v":0},{"$f":"Hoja2!AD58","v":0},{"$f":"Hoja2!E59","v":0},null,null,null,null,"Obligatorio","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Compañía",{"$f":"Hoja3!B30","v":0},{"$f":"Hoja3!B31","v":0},{"$f":"Hoja3!B36","v":0},{"$f":"Hoja3!B37","v":0},null,null,null,"Opcional","Variable"]
["Tipo Seguro",{"$f":"Hoja3!O30","v":0},{"$f":"Hoja3!O31","v":0},{"$f":"Hoja3!O36","v":0},{"$f":"Hoja3!O37","v":0},null,null,null,"Opcional","Variable"]
["Dia",{"$f":"Hoja3!U30","v":0},{"$f":"Hoja3!U31","v":0},{"$f":"Hoja3!U36","v":0},{"$f":"Hoja3!U37","v":0},null,null,null,"Opcional","Variable"]
["Mes",{"$f":"Hoja3!T30","v":0},{"$f":"Hoja3!T31","v":0},{"$f":"Hoja3!T36","v":0},{"$f":"Hoja3!T37","v":0},null,null,null,"Opcional","Variable"]
["Año",{"$f":"Hoja3!S30","v":0},{"$f":"Hoja3!S31","v":0},{"$f":"Hoja3!S36","v":0},{"$f":"Hoja3!S37","v":0},null,null,null,"Opcional","Variable"]
["Suma asegurada",{"$f":"Hoja3!V30","v":0},{"$f":"Hoja3!V31","v":0},{"$f":"Hoja3!V36","v":0},{"$f":"Hoja3!V37","v":0},null,null,null,"Opcional","Variable"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Nombre",{"$f":"Hoja3!B48","v":0},{"$f":"Hoja3!B49","v":0},{"$f":"Hoja3!B50","v":0},null,null,null,null,"Obligatorio","Alfanumerico"]
["Domicilio  ",{"$f":"Hoja3!K48","v":0},{"$f":"Hoja3!K49","v":0},{"$f":"Hoja3!K50","v":0},null,null,null,null,"Obligatorio","Alfanumerico"]
["Telefono",{"$f":"Hoja3!AA48","v":0},{"$f":"Hoja3!AA49","v":0},{"$f":"Hoja3!AA50","v":0},null,null,null,null,"Obligatorio","Alfanumerico"]
["Campo","dato1","dato2","dato3","dato4","dato5","dato6","dato7","Validacion","Tipo de dato"]
["Tiempo",{"$f":"Hoja4!O34","v":0},null,null,null,null,null,null,"Obligatorio","Variable"]
["Estimacion",{"$f":"Hoja4!O35","v":0},null,null,null,null,null,null,"Obligatorio","Variable"]
["Firmo",{"$f":"Hoja4!Q37","v":0},{"$f":"Hoja4!S37","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["Recomienda",{"$f":"Hoja4!Q39","v":0},{"$f":"Hoja4!S39","v":0},null,null,null,null,null,"Obligatorio","Variable"]
["Contradiccion",{"$f":"Hoja4!Q41","v":0},{"$f":"Hoja4!S41","v":0},{"$f":"Hoja4!X41","v":0},null,null,null,null,"Obligatorio","Variable"]