REGISTRO NACIONAL DE IDENTIFICACION Y ESTADO CIVIL

PIRU MARKAT" JAQ ILLT'AYNUSHTAK RIJISTRU - ISTATU SIWILI

ACTA DE NACIMIENTO REGISTRO NACIONAL DE IDENTIFICACION Y ESTADO CIVIL

REPUBLICA DEL PERU YURIT QAYLLAT" AKTA

PIRU MARKA

CUI / JIQ Nº
FECHA DE NACIMIENTO HORA
AYKAP"AS YURIWI QUSURA
:
Acta Nº 00000000

DIA / URU MES / PAJSHI AÑO / WATA AM / PM

LUGAR DE OCURRENCIA
QAWNA
1: Hospital / 1: Uspitalna 2: Clínica / Klinikna 3: Centro de Salud - Posta / 3: Sintru Salutna - Pustna 4: Domicilio / Utna 5: Otros / Yaqp”a

UBG. DEPARTAMENTO / TIPARTAMINTU UBG. PROVINCIA / PRUWINHSYA

UBG. DISTRITO / TISTRITU UBG. CENT. POBLADO / COM. NATIVA O CAMPESINA

UJTXITX MARKA / INTIJIN KUMUNIRARI - KAMPISIN KUMUNIRARI
SEXO / QUWAS QAYLLA 1: Masculino / Lluqalla 2: Femenino / Wallmichi

ECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECR
RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENI
ECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

ECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENI RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRE
RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECR
ECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRE

TITULAR / QAYLLIN SHUTXI

1 Prenombres / Shutxi
(Muestra de Criptograma y Dígito Verificador)

Primer Apellido / Awant Apillitu

AbCDeFGHi

Segundo Apellido / Paj Apillitu

NIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENI
CRENIEC RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECREN
RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRE

PADRE / TATA

Prenombres / Shutxi

Primer Apellido / Awant Apillitu

Segundo Apellido / Paj Apillitu

DOCUMENTO DE IDENTIDAD: 1: DNI, 2: LM/ Bol, 3: CE, 4: Otros NACIONALIDAD 1. PERUANA / PIRUWAT”A
ILLT'IYSHINUSHPTAK TUKUMINTU: 1: DNI, 2: LM/Bol, 3: May Payisit" Karniti, 4: Yaqp"a N° QAWIT" JAQISA
RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC
2. EXTRANJERA / JAYMARKAT"A
MADRE / MAMA

Prenombres / Shutxi

Primer Apellido / Awant Apillitu

Segundo Apellido / Paj Apillitu

DOCUMENTO DE IDENTIDAD: 1: DNI, 2: LM/ Bol, 3: CE, 4: Otros NACIONALIDAD 1. PERUANA / PIRUWAT”A
ILLT'IYSHINUSHPTAK TUKUMINTU: 1: DNI, 2: LM/Bol, 3: May Payisit" Karniti, 4: Yaqp"a N° QAWIT" JAQISA 2. EXTRANJERA / JAYMARKAT"A
DIRECCION / QAWIS UTP"A
Versión Bilingüe Castellano - Jaqaru

UBG. DEPARTAMENTO / TIPARTAMINTU UBG. PROVINCIA / PRUWINHSYA

Kastillanu - Jaqaru Paj Arunkasa

UBG. DISTRITO / TISTRITU UBG. CENT. POBLADO / COM. NATIVA O CAMPESINA

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRE
UJTXITX MARKA / INTIJIN KUMUNIRARI - KAMPISIN KUMUNIRARI

FECHA DE REGISTRO / AYKAP"AS QILLQT'KI

OFICINA REGISTRAL / RIJISTRU SIWIL UTA DIA / URU MES / PAJSHI AÑO / WATA

UBG. DEPARTAMENTO / TIPARTAMINTU UBG. PROVINCIA / PRUWINHSYA

UBG. DISTRITO / TISTRITU UBG. CENT. POBLADO / COM. NATIVA O CAMPESINA

UJTXITX MARKA / INTIJIN KUMUNIRARI - KAMPISIN KUMUNIRARI
DECLARANTE: VINCULO DOCUMENTO DE IDENTIDAD: 1: DNI, 2: LM/ Bol, 3: CE, 4: Otros
QILLQT'IYKIRI: QUSP"ASA ILLT'IYSHINUSHPTAK TUKUMINTU: 1: DNI, 2: LM/Bol, 3: May Payisit" Karniti, 4: Yaqp"a N°

Prenombres / Shutxi

Primer Apellido / Awant Apillitu

Segundo Apellido / Paj Apillitu

DECLARANTE: VINCULO DOCUMENTO DE IDENTIDAD: 1: DNI, 2: LM/ Bol, 3: CE, 4: Otros
QILLQT'IYKIRI: QUSP"ASA ILLT'IYSHINUSHPTAK TUKUMINTU: 1: DNI, 2: LM/Bol, 3: May Payisit" Karniti, 4: Yaqp"a N°

Prenombres / Shutxi

Primer Apellido / Awant Apillitu

Segundo Apellido / Paj Apillitu

REGISTRADOR CIVIL
RIJISTRUT" QILLQT'IRI
Primer Apellido / Awant Apillitu Segundo Apellido / Paj Apillitu Prenombres / Shutxi
DNI N°
OBSERVACIONES: / ILLISN JAQT”APNUSHTAKI: RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

Firma del Declarante Firma del Declarante Sello y Firma del Registrador
Qillqt'iykirn Shutxayt"app"a Qillqt'iykirn Shutxayt"app"a Rijistrut" Qillqt'iykirn sillp"a Shutxayt"app"a

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC
RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC

RENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIECRENIEC
Impresión dactilar

Impresión dactilar

Impresión dactilar
Kup Ampar Intisi

Kup Ampar Intisi

Kup Ampar Intisi

Indice derecho

Indice derecho

Indice derecho
Waylla

Waylla

Waylla

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