Código: R-SEG-054

Fecha: Diciembre de 2018

FILIAL de Aplicación:
SOLICIT
Corporativo
“Manifiesto que la información y documentación suministrada para las finalidades señaladas en este formulario, puede contener datos personales de empleados, socios, miembros de Junta Directiva, proveedores o clientes de la c
Acepto que FRONTERA ENERGY, no asume responsabilidad alguna por consecuencias derivadas de información inexacta o errónea, que haya sido manifestada en el presente

TIPO DE NUMERO CONTACTO TELEFONO DE

NOMBRES APELLIDOS EXPEDIDA EN: LUGAR DE NACIMIENTO FECHA NACIMIENTO TIPO DE SANGRE DIRECCION DE RESIDENCIA TELEFONO VEREDA CIUDAD
IDENTIFICACION IDENTIFICACION EMERGENCIA FAMILIAR EMERGENCIA

FERNANDO SOTOMAYOR GONZALEZ C.C 9,655,023 YOPAL BOGOTA 9/1/1983 O+ PUERTO GAITAN 3182041938 N/A PUERTO GAITÁN CARLOS GOZALEZ 3188282554
 SOLICITUD DE INGRESO Y SALIDA

para las finalidades señaladas en este formulario, puede contener datos personales de empleados, socios, miembros de Junta Directiva, proveedores o clientes de la compañía que represento, por lo cual certifico que la misma ha sido obtenida de acuerdo a lo dispuesto en la legislación aplicable, y que la compañía cuenta con las autorizaciones necesarias para el tratamiento, circulación y/o transferencia de estos datos a FRONTERA ENERGY.
RONTERA ENERGY, no asume responsabilidad alguna por consecuencias derivadas de información inexacta o errónea, que haya sido manifestada en el presente formulario y los documentos anexos. Será nuestra responsabilidad mantener a FRONTERA ENERGY informada por escrito, de cualquier cambio que se presente en la información aquí suministrada y la documentación adjunta.”

FECHA VENCIMIENTO
NUMERO DEL CONTRATO U ORDEN DE NOMBRE EMPRESA CAMPAMENTO DE CATEGORIA DEL
CARGO EPS ARL NOMBRE EMPRESA CONTRATISTA NIT CONTRATISTA CONTRATO U ORDEN DE NIT SUBCONTRATISTA FECHA DE INGRESO FECHA DE SALIDA CAMPO O BLOQUE GRUPO MANO DE OBRA
SERVICIO SUBCONTRATISTA ALOJAMIENTO EMPLEADO
SERVICIO

TECNICO MECANICO 3-P NUEVA EPS SURA PETROWORKS 8301161349 SGLT SAS 900787648 10/23/2021 10/27/2021 QUIFA PERFORACION NA NO CALIFICADA VISITANTE
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to en la legislación aplicable, y que la compañía cuenta con las autorizaciones necesarias para el tratamiento, circulación y/o transferencia de estos datos a FRONTERA ENERGY.
Y informada por escrito, de cualquier cambio que se presente en la información aquí suministrada y la documentación adjunta.”

VÍA DE INGRESO

TERRESTRE
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