MOON
Server: Apache/2.2.34 (Unix) mod_ssl/2.2.34 OpenSSL/0.9.8e-fips-rhel5 mod_bwlimited/1.4 FrontPage/5.0.2.2635
System: Linux server.asjudinet.com 2.6.32-042stab141.3 #1 SMP Fri Nov 15 22:45:34 MSK 2019 i686
User: asjudine (504)
PHP: 5.2.17
Disabled: NONE
Upload Files
File: /home/asjudine/public_html/creditos/insertsolicitudcredito_deudor.php
<?
include("head.php");
include("datacon.php"); 


$apellidosynombresField = $apellidosField . " " . $nombresField;
$tiemposervicioField = $tiemposervicioanosField . " años " . $tiemposerviciomesesField . " meses";
//$fechaField = $fechaanoField . "/" . $fechamesField . "/" . $fechadiaField;

$fechaField = date("j/n/Y");

$query="insert into solicitudcredito_deudor (ciudad,fecha,apellidosynombres,cedula,cedulade,empresa,tiemposervicio,grado,ocupacion,codigo,estadocivil,direccionresidencia,ciudadresidencia,barrio,telefono,banco,cuenta,sucursal,tipodemercancia,valorsolicitado,plazomeses,valorcuotas,devengado,descuentos,disponible,valorcredito,valorlibranza,valorcuota,refco_nombre1,refco_direccion1,refco_telefono1,refco_nombre2,refco_direccion2,refco_telefono2,refco_nombre3,refco_direccion3,refco_telefono3,refper_nombre1,refper_direccion1,refper_telefono1,refper_nombre2,refper_direccion2,refper_telefono2,refper_nombre3,refper_direccion3,refper_telefono3) VALUES ('$ciudadField','$fechaField','$apellidosynombresField','$cedulaField','$ceduladeField','$empresaField','$tiemposervicioField','$gradoField','$ocupacionField','$codigoField','$estadocivilField','$direccionresidenciaField','$ciudadresidenciaField','$barrioField','$telefonoField','$bancoField','$cuentaField','$sucursalField','$tipodemercanciaField','$valorsolicitadoField','$plazomesesField','$valorcuotasField','$devengadoField','$descuentosField','$disponibleField','$valorcreditoField','$valorlibranzaField','$valorcuotaField','$refco_nombre1Field','$refco_direccion1Field','$refco_telefono1Field','$refco_nombre2Field','$refco_direccion2Field','$refco_telefono2Field','$refco_nombre3Field','$refco_direccion3Field','$refco_telefono3Field','$refper_nombre1Field','$refper_direccion1Field','$refper_telefono1Field','$refper_nombre2Field','$refper_direccion2Field','$refper_telefono2Field','$refper_nombre3Field','$refper_direccion3Field','$refper_telefono3Field')";

$result = MYSQL_QUERY($query);

$queryseguimiento="insert into seguimiento_solicitudcredito (cedula,
															presentacionsolicitud,
															fecha_presentacionsolicitud,
															enviadoparaestudio,
															fecha_enviadoparaestudio,
															resultadoevaluacion,
															aprobado,
															aprobadofecha,
															aprobado_cuantia,
															aprobado_meses,
															aprobado_valorcuota,
															presentaciondocumentos,
															fecha_presentaciondocumentos,
															enviodocumentosestudio,
															fecha_enviodocumentosestudio,
															recepciondocumentosoficinaprincipal,
															fecha_recepciondocumentosoficinaprincipal,
															resultadoestudiocredito,
															negado,
															fecha_negado,
															modificado_cuantia,
															modificado_meses,
															modificado_valorcuota,
															devuelto,
															devueltofecha,
															devueltoobservaciones,
															desembolso_fecha,
															desembolso_banco,
															desembolso_cuenta) VALUES ('$cedulaField','SI','$fechaField','','','','','','','','','','','','','','','','','','','','','','','','','','')";

$result = MYSQL_QUERY($queryseguimiento);


?>
<style type="text/css">
<!--
.Estilo5 {font-size: 10px; font-weight: bold; font-family: Verdana, Arial, Helvetica, sans-serif; color: #000000; }
.Estilo6 {	color: #CC0000;
	font-weight: bold;
}
-->
</style>
<script Language="JavaScript"><!--
function validarcodeudor(formulario)
{

  if (formulario.cedulaField.value == "")
  {
    alert("Debe llenar el campo Cédula.");
    formulario.cedulaField.focus();
    return (false);
  }

  var checkOK = "0123456789";
  var checkStr = formulario.cedulaField.value;
  var allValid = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Escriba sólo Números en el campo Cédula. Sin espacios ni puntuación.");
    formulario.cedulaField.focus();
    return (false);
  }

  if (formulario.ciudadField.value == "")
  {
    alert("Debe llenar el campo Ciudad.");
    formulario.ciudadField.focus();
    return (false);
  }
  
   if ((formulario.fechaanoField.value == "") || (formulario.fechamesField.value == "") || (formulario.fechadiaField.value == ""))
  {
    alert("Debe llenar el campo Fecha de acuerdo al formato mostrado.");
    formulario.fechaanoField.focus();
    return (false);
  }
  
    if (formulario.apellidosField.value == "")
  {
    alert("Debe llenar el campo Apellidos.");
    formulario.apellidosField.focus();
    return (false);
  }

    if (formulario.nombresField.value == "")
  {
    alert("Debe llenar el campo Nombres.");
    formulario.nombresField.focus();
    return (false);
  }

    if (formulario.cedulaField.value == "")
  {
    alert("Debe llenar el campo Cédula.");
    formulario.cedulaField.focus();
    return (false);
  }
  
      if (formulario.ceduladeField.value == "")
  {
    alert("Debe especificar de dónde es la Cédula.");
    formulario.ceduladeField.focus();
    return (false);
  }
   if (formulario.ciudadField.value == "")
  {
    alert("No puede seleccionar un Departamento, únicamente una Ciudad");
    formulario.ciudadField.focus();
    return (false);
  }
  if (formulario.ciudadresidenciaField.value == "")
  {
    alert("No puede seleccionar un Departamento, únicamente una Ciudad");
    formulario.ciudadresidenciaField.focus();
    return (false);
  }

  return (true);
}

function validarciudad()
{
 if (document.formMaker.ciudadField.value == "")
  {
    alert("No puede seleccionar un Departamento, únicamente una Ciudad");
    document.formMaker.ciudadField.focus();
    return (false);
  }
  if (document.formMaker.ciudadresidenciaField.value == "")
  {
    alert("No puede seleccionar un Departamento, únicamente una Ciudad");
    document.formMaker.ciudadresidenciaField.focus();
    return (false);
  }
  return (true);
}
//--></script>

<h4 align="center">La Informaci&oacute;n del Solicitante 
ha sido registrada, <br>
por favor diligencie la informaci&oacute;n del Codeudor: </h4>

<form name=formMaker method=post action="insertsolicitudcredito_codeudor.php?ced=<? echo "$cedulaField"; ?>"  onSubmit="return validarcodeudor(this)">
  <table width="700" align="center" cellpadding="0" cellspacing="0" bgcolor="#EEEEEE">
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><img src="trans.gif" width="120" height="10"></td>
      <td><span class="Estilo5"><img src="trans.gif" width="140" height="10"></span></td>
      <td width="90" align=right class="Estilo5"><img src="trans.gif" width="90" height="10"></td>
      <td><span class="Estilo5"><img src="trans.gif" width="140" height="10"></span></td>
      <td width="90"><span class="Estilo5"><img src="trans.gif" width="90" height="10"></span></td>
      <td><span class="Estilo5"><img src="trans.gif" width="140" height="10"></span></td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><span class="Estilo6">C&eacute;dula Solicitante:</span></td>
      <td><? echo "$cedulaField"; ?></td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Ciudad :</b></td>
      <td><select name="ciudadField" id="ciudadField" onChange="validarciudad()">
        <option value="BOGOTA">BOGOTA</option>
        <option value="">AMAZONAS</option>
        <option value="Puerto Nari&ntilde;o">Puerto Nari&ntilde;o</option>
        <option value="Leticia">Leticia</option>
        <option value="">ANTIOQUIA</option>
        <option value="Medell&iacute;n">Medell&iacute;n</option>
        <option value="Abejorral">Abejorral</option>
        <option value="Abriaqui">Abriaqui</option>
        <option value="Alejandr&iacute;a">Alejandr&iacute;a</option>
        <option value="Amag&aacute;">Amag&aacute;</option>
        <option value="Amalfi">Amalfi</option>
        <option value="Andes">Andes</option>
        <option value="Angel&oacute;polis">Angel&oacute;polis</option>
        <option value="Angostura">Angostura</option>
        <option value="Anor&iacute;">Anor&iacute;</option>
        <option value="Antioquia">Antioquia</option>
        <option value="Anza">Anza</option>
        <option value="Apartad&oacute;">Apartad&oacute;</option>
        <option value="Arboletes">Arboletes</option>
        <option value="Argelia">Argelia</option>
        <option value="Armenia">Armenia</option>
        <option value="Barbosa">Barbosa</option>
        <option value="Belmira">Belmira</option>
        <option value="Bello">Bello</option>
        <option value="Betania">Betania</option>
        <option value="Betulia">Betulia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Brise&ntilde;o">Brise&ntilde;o</option>
        <option value="Buritica">Buritica</option>
        <option value="C&aacute;ceres">C&aacute;ceres</option>
        <option value="Caicedo">Caicedo</option>
        <option value="Caldas">Caldas</option>
        <option value="Campamento">Campamento</option>
        <option value="Ca&ntilde;asgordas">Ca&ntilde;asgordas</option>
        <option value="Caracol&iacute;">Caracol&iacute;</option>
        <option value="Caramanta">Caramanta</option>
        <option value="Carepa">Carepa</option>
        <option value="Carmen de Viboral">Carmen de Viboral</option>
        <option value="Carolina">Carolina</option>
        <option value="Caucasia">Caucasia</option>
        <option value="Chigorod&oacute;">Chigorod&oacute;</option>
        <option value="Cisneros">Cisneros</option>
        <option value="Cocorn&aacute;">Cocorn&aacute;</option>
        <option value="Concepci&oacute;n">Concepci&oacute;n</option>
        <option value="Concordia">Concordia</option>
        <option value="Copacabana">Copacabana</option>
        <option value="Dabeiba">Dabeiba</option>
        <option value="Don Mat&iacute;as">Don Mat&iacute;as</option>
        <option value="Eb&eacute;jico">Eb&eacute;jico</option>
        <option value="El Bagre">El Bagre</option>
        <option value="Entrerr&iacute;os">Entrerr&iacute;os</option>
        <option value="Envigado">Envigado</option>
        <option value="Fredonia">Fredonia</option>
        <option value="Frontino">Frontino</option>
        <option value="Giraldo">Giraldo</option>
        <option value="Girardota">Girardota</option>
        <option value="G&oacute;mez">G&oacute;mez</option>
        <option value="Granada">Granada</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Guarne">Guarne</option>
        <option value="Guatap&eacute;">Guatap&eacute;</option>
        <option value="Heliconia">Heliconia</option>
        <option value="Hispania">Hispania</option>
        <option value="Itag&uuml;&iacute;">Itag&uuml;&iacute;</option>
        <option value="Ituango">Ituango</option>
        <option value="Jard&iacute;n">Jard&iacute;n</option>
        <option value="Jeric&oacute;">Jeric&oacute;</option>
        <option value="La Ceja">La Ceja</option>
        <option value="La Estrella">La Estrella</option>
        <option value="La Pintada">La Pintada</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Liborina">Liborina</option>
        <option value="Maceo">Maceo</option>
        <option value="Marinilla">Marinilla</option>
        <option value="Montebello">Montebello</option>
        <option value="Murind&oacute;">Murind&oacute;</option>
        <option value="Mutat&aacute;">Mutat&aacute;</option>
        <option value="Nari&ntilde;o">Nari&ntilde;o</option>
        <option value="Necocl&iacute;">Necocl&iacute;</option>
        <option value="Nech&iacute;">Nech&iacute;</option>
        <option value="Olaya">Olaya</option>
        <option value="Pe&ntilde;ol">Pe&ntilde;ol</option>
        <option value="Peque">Peque</option>
        <option value="Pueblorrico">Pueblorrico</option>
        <option value="Puerto Berr&iacute;o">Puerto Berr&iacute;o</option>
        <option value="Puerto Nare">Puerto Nare</option>
        <option value="Puerto Triunfo">Puerto Triunfo</option>
        <option value="Remedios">Remedios</option>
        <option value="Retiro">Retiro</option>
        <option value="Rionegro">Rionegro</option>
        <option value="Sabanalarga">Sabanalarga</option>
        <option value="Sabaneta">Sabaneta</option>
        <option value="Salgar">Salgar</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="San Carlos">San Carlos</option>
        <option value="San francisco">San francisco</option>
        <option value="San Jer&oacute;nimo">San Jer&oacute;nimo</option>
        <option value="San Jos&eacute; de Monta&ntilde;a">San Jos&eacute; de Monta&ntilde;a</option>
        <option value="San Juan de Urab&aacute;">San Juan de Urab&aacute;</option>
        <option value="San Luis">San Luis</option>
        <option value="San Pedro">San Pedro</option>
        <option value="San Pedro de Urab&aacute;">San Pedro de Urab&aacute;</option>
        <option value="San Rafael">San Rafael</option>
        <option value="San Roque">San Roque</option>
        <option value="San Vicente">San Vicente</option>
        <option value="Santa B&aacute;rbara">Santa B&aacute;rbara</option>
        <option value="Santa Rosa de Osos">Santa Rosa de Osos</option>
        <option value="Santo Domingo">Santo Domingo</option>
        <option value="Santuario">Santuario</option>
        <option value="Segovia">Segovia</option>
        <option value="Sons&oacute;n">Sons&oacute;n</option>
        <option value="Sopetr&aacute;n">Sopetr&aacute;n</option>
        <option value="T&aacute;mesis">T&aacute;mesis</option>
        <option value="Taraza">Taraza</option>
        <option value="Tarso">Tarso</option>
        <option value="Titirib&iacute;">Titirib&iacute;</option>
        <option value="Toledo">Toledo</option>
        <option value="Turbo">Turbo</option>
        <option value="Uramita">Uramita</option>
        <option value="Urrao">Urrao</option>
        <option value="Valdivia">Valdivia</option>
        <option value="Valpara&iacute;so">Valpara&iacute;so</option>
        <option value="Vegachi">Vegachi</option>
        <option value="Venecia">Venecia</option>
        <option value="Vig&iacute;a del Fuerte">Vig&iacute;a del Fuerte</option>
        <option value="Yal&iacute;">Yal&iacute;</option>
        <option value="Yarumal">Yarumal</option>
        <option value="Yolomb&oacute;">Yolomb&oacute;</option>
        <option value="Yond&oacute; (Casabe)">Yond&oacute; (Casabe)</option>
        <option value="Zaragoza">Zaragoza</option>
        <option value="">ARAUCA</option>
        <option value="Arauca">Arauca</option>
        <option value="Arauquita">Arauquita</option>
        <option value="Cravo Norte">Cravo Norte</option>
        <option value="Fortul">Fortul</option>
        <option value="Puerto Rond&oacute;n">Puerto Rond&oacute;n</option>
        <option value="Fortul">Fortul</option>
        <option value="Puerto Rond&oacute;n">Puerto Rond&oacute;n</option>
        <option value="Saravena">Saravena</option>
        <option value="Tame">Tame</option>
        <option value="">ATLANTICO</option>
        <option value="Barranquilla">Barranquilla</option>
        <option value="Baranoa">Baranoa</option>
        <option value="Campo de la Cruz">Campo de la Cruz</option>
        <option value="Candelaria">Candelaria</option>
        <option value="Galapa">Galapa</option>
        <option value="Juan de Acosta">Juan de Acosta</option>
        <option value="Luruaco">Luruaco</option>
        <option value="Malambo">Malambo</option>
        <option value="Manat&iacute;">Manat&iacute;</option>
        <option value="Palmar de Varela">Palmar de Varela</option>
        <option value="Pioj&oacute;">Pioj&oacute;</option>
        <option value="Polonuevo">Polonuevo</option>
        <option value="Ponedera">Ponedera</option>
        <option value="Puerto Colombia">Puerto Colombia</option>
        <option value="Repel&oacute;n">Repel&oacute;n</option>
        <option value="Sabanagrande">Sabanagrande</option>
        <option value="Sabanalarga">Sabanalarga</option>
        <option value="Santa Luc&iacute;a">Santa Luc&iacute;a</option>
        <option value="Santo Tom&aacute;s">Santo Tom&aacute;s</option>
        <option value="Soledad">Soledad</option>
        <option value="Suan">Suan</option>
        <option value="Tubara">Tubara</option>
        <option value="Usiacur&iacute;">Usiacur&iacute;</option>
        <option value="">BOLIVAR</option>
        <option value="Cartagena">Cartagena</option>
        <option value="Ach&iacute;">Ach&iacute;</option>
        <option value="Altos del Rosario">Altos del Rosario</option>
        <option value="Arenal">Arenal</option>
        <option value="Arjona">Arjona</option>
        <option value="Arroyohondo">Arroyohondo</option>
        <option value="Barranco de Loba">Barranco de Loba</option>
        <option value="Calamar">Calamar</option>
        <option value="Cantagallo">Cantagallo</option>
        <option value="Cicuto">Cicuto</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Clemencia">Clemencia</option>
        <option value="El Carmen de Bol&iacute;var">El Carmen de Bol&iacute;var</option>
        <option value="El Guamo">El Guamo</option>
        <option value="El Pe&ntilde;&oacute;n">El Pe&ntilde;&oacute;n</option>
        <option value="Hatillo de Loba">Hatillo de Loba</option>
        <option value="Magangue">Magangue</option>
        <option value="Mahates">Mahates</option>
        <option value="Margarita">Margarita</option>
        <option value="Mar&iacute;a la Baja">Mar&iacute;a la Baja</option>
        <option value="Montecristo">Montecristo</option>
        <option value="Momp&oacute;s">Momp&oacute;s</option>
        <option value="Morales">Morales</option>
        <option value="Pinillos">Pinillos</option>
        <option value="Regidor">Regidor</option>
        <option value="R&iacute;o Viejo">R&iacute;o Viejo</option>
        <option value="San Cristobal">San Cristobal</option>
        <option value="San Estanislao">San Estanislao</option>
        <option value="San Fernando">San Fernando</option>
        <option value="San Jacinto">San Jacinto</option>
        <option value="San Jacinto del Cauca">San Jacinto del Cauca</option>
        <option value="San Juan Nepomuceno">San Juan Nepomuceno</option>
        <option value="San Mart&iacute;n de Loba">San Mart&iacute;n de Loba</option>
        <option value="San Pablo">San Pablo</option>
        <option value="Santa Catalina">Santa Catalina</option>
        <option value="Santa Rosa">Santa Rosa</option>
        <option value="Santa Rosa del Sur">Santa Rosa del Sur</option>
        <option value="Simit&iacute;">Simit&iacute;</option>
        <option value="Soplaviento">Soplaviento</option>
        <option value="Talaigua Nuevo">Talaigua Nuevo</option>
        <option value="Tiquisio (Puerto Rico)">Tiquisio (Puerto Rico)</option>
        <option value="Turbaco">Turbaco</option>
        <option value="Turban&aacute;">Turban&aacute;</option>
        <option value="Villanueva">Villanueva</option>
        <option value="Zambrano">Zambrano</option>
        <option value="">BOYACA</option>
        <option value="Tunja">Tunja</option>
        <option value="Almeida">Almeida</option>
        <option value="Aquitania">Aquitania</option>
        <option value="Arcabuco">Arcabuco</option>
        <option value="Bel&eacute;n">Bel&eacute;n</option>
        <option value="Berbeo">Berbeo</option>
        <option value="Beteitiva">Beteitiva</option>
        <option value="Boavita">Boavita</option>
        <option value="Boyac&aacute;">Boyac&aacute;</option>
        <option value="Brise&ntilde;o">Brise&ntilde;o</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Busbanza">Busbanza</option>
        <option value="Caldas">Caldas</option>
        <option value="Campohermoso">Campohermoso</option>
        <option value="Cerinza">Cerinza</option>
        <option value="Chinavita">Chinavita</option>
        <option value="Chiquinquir&aacute;">Chiquinquir&aacute;</option>
        <option value="Chiscas">Chiscas</option>
        <option value="Chita">Chita</option>
        <option value="Chitaranque">Chitaranque</option>
        <option value="Chivata">Chivata</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="Combita">Combita</option>
        <option value="Coper">Coper</option>
        <option value="Corrales">Corrales</option>
        <option value="Covarachia">Covarachia</option>
        <option value="Cubar">Cubar</option>
        <option value="Cucaita">Cucaita</option>
        <option value="Cuitiva">Cuitiva</option>
        <option value="Chiquiza">Chiquiza</option>
        <option value="Chivor">Chivor</option>
        <option value="Duitama">Duitama</option>
        <option value="El Cocuy">El Cocuy</option>
        <option value="El Espino">El Espino</option>
        <option value="Firavitoba">Firavitoba</option>
        <option value="Floresta">Floresta</option>
        <option value="Gachantiv&aacute;">Gachantiv&aacute;</option>
        <option value="G&aacute;meza">G&aacute;meza</option>
        <option value="Garagoa">Garagoa</option>
        <option value="Guacamayas">Guacamayas</option>
        <option value="Guateque">Guateque</option>
        <option value="Guayat&aacute;">Guayat&aacute;</option>
        <option value="Guic&aacute;n">Guic&aacute;n</option>
        <option value="Iz&aacute;">Iz&aacute;</option>
        <option value="Jenesano">Jenesano</option>
        <option value="Jeric&oacute;">Jeric&oacute;</option>
        <option value="Labranzagrande">Labranzagrande</option>
        <option value="La Capilla">La Capilla</option>
        <option value="La Victoria">La Victoria</option>
        <option value="La Ubita">La Ubita</option>
        <option value="Villa de Leyva">Villa de Leyva</option>
        <option value="Macanal">Macanal</option>
        <option value="Marip&iacute;">Marip&iacute;</option>
        <option value="Miraflores">Miraflores</option>
        <option value="Mongua">Mongua</option>
        <option value="Mongu&iacute;">Mongu&iacute;</option>
        <option value="Moniquir&aacute;">Moniquir&aacute;</option>
        <option value="Motavita">Motavita</option>
        <option value="Muzo">Muzo</option>
        <option value="Nobsa">Nobsa</option>
        <option value="Nuevo Col&oacute;n">Nuevo Col&oacute;n</option>
        <option value="Oicat&aacute;">Oicat&aacute;</option>
        <option value="Otanche">Otanche</option>
        <option value="Pachavita">Pachavita</option>
        <option value="P&aacute;ez">P&aacute;ez</option>
        <option value="Paipa">Paipa</option>
        <option value="Pajarito">Pajarito</option>
        <option value="Panqueba">Panqueba</option>
        <option value="Pauna">Pauna</option>
        <option value="Paya">Paya</option>
        <option value="Paz de R&iacute;o">Paz de R&iacute;o</option>
        <option value="Pesca">Pesca</option>
        <option value="Pisva">Pisva</option>
        <option value="Puerto Boyac&aacute;">Puerto Boyac&aacute;</option>
        <option value="Quipama">Quipama</option>
        <option value="Ramiquir&iacute;">Ramiquir&iacute;</option>
        <option value="R&aacute;quira">R&aacute;quira</option>
        <option value="Rond&oacute;n">Rond&oacute;n</option>
        <option value="Saboy&aacute;">Saboy&aacute;</option>
        <option value="S&aacute;chica">S&aacute;chica</option>
        <option value="Samac&aacute;">Samac&aacute;</option>
        <option value="San Eduardo">San Eduardo</option>
        <option value="San Jos&eacute; de Pare">San Jos&eacute; de Pare</option>
        <option value="San Luis de Gaceno">San Luis de Gaceno</option>
        <option value="San Mateo">San Mateo</option>
        <option value="San Miguel de Sema">San Miguel de Sema</option>
        <option value="San Pablo de Borbur">San Pablo de Borbur</option>
        <option value="Santana">Santana</option>
        <option value="Santa Mar&iacute;a">Santa Mar&iacute;a</option>
        <option value="Santa Rosa de Viterbo">Santa Rosa de Viterbo</option>
        <option value="Santa Sof&iacute;a">Santa Sof&iacute;a</option>
        <option value="Sativanorte">Sativanorte</option>
        <option value="Sativasur">Sativasur</option>
        <option value="Siachoque">Siachoque</option>
        <option value="Soat&aacute;">Soat&aacute;</option>
        <option value="Socot&aacute;">Socot&aacute;</option>
        <option value="Socha">Socha</option>
        <option value="Sogamoso">Sogamoso</option>
        <option value="Somondoco">Somondoco</option>
        <option value="Sora">Sora</option>
        <option value="Sotaquir&aacute;">Sotaquir&aacute;</option>
        <option value="Sorac&aacute;">Sorac&aacute;</option>
        <option value="Susac&oacute;n">Susac&oacute;n</option>
        <option value="Sutamarch&aacute;n">Sutamarch&aacute;n</option>
        <option value="Sutatenza">Sutatenza</option>
        <option value="Tasco">Tasco</option>
        <option value="Tenza">Tenza</option>
        <option value="Tiban&aacute;">Tiban&aacute;</option>
        <option value="Tibasosa">Tibasosa</option>
        <option value="Tinjac&aacute;">Tinjac&aacute;</option>
        <option value="Tipacoque">Tipacoque</option>
        <option value="Toca">Toca</option>
        <option value="Togu&iacute;">Togu&iacute;</option>
        <option value="Topag&aacute;">Topag&aacute;</option>
        <option value="Tota">Tota</option>
        <option value="Tunungua">Tunungua</option>
        <option value="Turmequ&eacute;">Turmequ&eacute;</option>
        <option value="Tuta">Tuta</option>
        <option value="Tutas&aacute;">Tutas&aacute;</option>
        <option value="Umbita">Umbita</option>
        <option value="Ventaquemada">Ventaquemada</option>
        <option value="Viracach&aacute;">Viracach&aacute;</option>
        <option value="Zetaquir&aacute;">Zetaquir&aacute;</option>
        <option value="">CALDAS</option>
        <option value="Manizales">Manizales</option>
        <option value="Aguadas">Aguadas</option>
        <option value="Anserma">Anserma</option>
        <option value="Aranzaz&uacute;">Aranzaz&uacute;</option>
        <option value="Belalc&aacute;zar">Belalc&aacute;zar</option>
        <option value="Chinchina">Chinchina</option>
        <option value="Filadelfia">Filadelfia</option>
        <option value="La Dorada">La Dorada</option>
        <option value="La Merced">La Merced</option>
        <option value="Manzanares">Manzanares</option>
        <option value="Marmato">Marmato</option>
        <option value="Marquetalia">Marquetalia</option>
        <option value="Marulanda">Marulanda</option>
        <option value="Neira">Neira</option>
        <option value="P&aacute;cora">P&aacute;cora</option>
        <option value="Palestina">Palestina</option>
        <option value="Pensilvania">Pensilvania</option>
        <option value="Riosucio">Riosucio</option>
        <option value="Risaralda">Risaralda</option>
        <option value="Salamina">Salamina</option>
        <option value="Saman&aacute;">Saman&aacute;</option>
        <option value="San Jos&eacute;">San Jos&eacute;</option>
        <option value="Sup&iacute;a">Sup&iacute;a</option>
        <option value="Victoria">Victoria</option>
        <option value="Villamar&iacute;a">Villamar&iacute;a</option>
        <option value="Viterbo">Viterbo</option>
        <option value="Caquet&aacute; 18 Florencia">Caquet&aacute; 18 Florencia</option>
        <option value="Albania">Albania</option>
        <option value="Bel&eacute;n de los Andaquies">Bel&eacute;n de los Andaquies</option>
        <option value="Cartagena del Chair&aacute;">Cartagena del Chair&aacute;</option>
        <option value="Curillo">Curillo</option>
        <option value="El Doncello">El Doncello</option>
        <option value="El Paujil">El Paujil</option>
        <option value="La Monta&ntilde;ita">La Monta&ntilde;ita</option>
        <option value="Mil&aacute;n">Mil&aacute;n</option>
        <option value="Morelia">Morelia</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="San Jos&eacute; del Fragua">San Jos&eacute; del Fragua</option>
        <option value="San Vicente del Cagu&aacute;n">San Vicente del Cagu&aacute;n</option>
        <option value="Solano">Solano</option>
        <option value="Solita">Solita</option>
        <option value="Valpara&iacute;so">Valpara&iacute;so</option>
        <option value="">CASANARE</option>
        <option value="Yopal">Yopal</option>
        <option value="Aguazul">Aguazul</option>
        <option value="Chameza">Chameza</option>
        <option value="Hato Corozal">Hato Corozal</option>
        <option value="La Salina">La Salina</option>
        <option value="Man&iacute;">Man&iacute;</option>
        <option value="Monterrey">Monterrey</option>
        <option value="Nunch&iacute;a">Nunch&iacute;a</option>
        <option value="Orocu&eacute;">Orocu&eacute;</option>
        <option value="Paz de Ariporo">Paz de Ariporo</option>
        <option value="Pore">Pore</option>
        <option value="Recetor">Recetor</option>
        <option value="Sabalarga">Sabalarga</option>
        <option value="Sacama">Sacama</option>
        <option value="San Luis de Palenque">San Luis de Palenque</option>
        <option value="T&aacute;mara">T&aacute;mara</option>
        <option value="Tauramena">Tauramena</option>
        <option value="Trinidad">Trinidad</option>
        <option value="Villanueva">Villanueva</option>
        <option value="">CAUCA</option>
        <option value="Popay&aacute;n">Popay&aacute;n</option>
        <option value="Almaguer">Almaguer</option>
        <option value="Argelia">Argelia</option>
        <option value="Balboa">Balboa</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Buenos Aires">Buenos Aires</option>
        <option value="Cajib&iacute;o">Cajib&iacute;o</option>
        <option value="Caldon&oacute;">Caldon&oacute;</option>
        <option value="Caloto">Caloto</option>
        <option value="Corinto">Corinto</option>
        <option value="El Tambo">El Tambo</option>
        <option value="Florencia">Florencia</option>
        <option value="Guap&iacute;">Guap&iacute;</option>
        <option value="Inza">Inza</option>
        <option value="Jambalo">Jambalo</option>
        <option value="La Sierra">La Sierra</option>
        <option value="La Vega">La Vega</option>
        <option value="L&oacute;pez (Micay)">L&oacute;pez (Micay)</option>
        <option value="Mercaderes">Mercaderes</option>
        <option value="Miranda">Miranda</option>
        <option value="Morales">Morales</option>
        <option value="Padilla">Padilla</option>
        <option value="P&aacute;ez (Belalcazar)">P&aacute;ez (Belalcazar)</option>
        <option value="Pat&iacute;a (El Bordo)">Pat&iacute;a (El Bordo)</option>
        <option value="Piamonte">Piamonte</option>
        <option value="Piendam&oacute;">Piendam&oacute;</option>
        <option value="Puerto Tejada">Puerto Tejada</option>
        <option value="Purac&eacute; (Coconuco)">Purac&eacute; (Coconuco)</option>
        <option value="Rosas">Rosas</option>
        <option value="San Sebasti&aacute;n">San Sebasti&aacute;n</option>
        <option value="Santander de Quilichao">Santander de Quilichao</option>
        <option value="Santa Rosa">Santa Rosa</option>
        <option value="Silvia">Silvia</option>
        <option value="Sotara (Paispamba)">Sotara (Paispamba)</option>
        <option value="Su&aacute;rez">Su&aacute;rez</option>
        <option value="Timb&iacute;o">Timb&iacute;o</option>
        <option value="Timbiqu&iacute;">Timbiqu&iacute;</option>
        <option value="Toribio">Toribio</option>
        <option value="Totoro">Totoro</option>
        <option value="">CESAR</option>
        <option value="Valledupar">Valledupar</option>
        <option value="Aguachica">Aguachica</option>
        <option value="Agust&iacute;n Codazzi">Agust&iacute;n Codazzi</option>
        <option value="Astrea">Astrea</option>
        <option value="Becerril">Becerril</option>
        <option value="Bosconia">Bosconia</option>
        <option value="Chimichagua">Chimichagua</option>
        <option value="Chiriguan&aacute;">Chiriguan&aacute;</option>
        <option value="Curuman&iacute;">Curuman&iacute;</option>
        <option value="El Copey">El Copey</option>
        <option value="El Paso">El Paso</option>
        <option value="Gamarra">Gamarra</option>
        <option value="Gonz&aacute;lez">Gonz&aacute;lez</option>
        <option value="La Gloria">La Gloria</option>
        <option value="La Jagua de Ibirico">La Jagua de Ibirico</option>
        <option value="Manaure Balc&oacute;n Cesar">Manaure Balc&oacute;n Cesar</option>
        <option value="Pailitas">Pailitas</option>
        <option value="Pelaya">Pelaya</option>
        <option value="Pueblo Bello">Pueblo Bello</option>
        <option value="R&iacute;o de Oro">R&iacute;o de Oro</option>
        <option value="La Paz (Robles)">La Paz (Robles)</option>
        <option value="San Alberto">San Alberto</option>
        <option value="San Diego">San Diego</option>
        <option value="San Mart&iacute;n">San Mart&iacute;n</option>
        <option value="Tamalameque">Tamalameque</option>
        <option value="">CORDOBA</option>
        <option value="Monter&iacute;a">Monter&iacute;a</option>
        <option value="Ayapel">Ayapel</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Canalete">Canalete</option>
        <option value="Ceret&eacute;">Ceret&eacute;</option>
        <option value="Chim&aacute;">Chim&aacute;</option>
        <option value="Chin&uacute;">Chin&uacute;</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="Cotorra">Cotorra</option>
        <option value="La Apartada (Frontera)">La Apartada (Frontera)</option>
        <option value="Lorica">Lorica</option>
        <option value="Los C&oacute;rdobas">Los C&oacute;rdobas</option>
        <option value="Momil">Momil</option>
        <option value="Montel&iacute;bano">Montel&iacute;bano</option>
        <option value="Mo&ntilde;itos">Mo&ntilde;itos</option>
        <option value="Planeta Rica">Planeta Rica</option>
        <option value="Pueblo Nuevo">Pueblo Nuevo</option>
        <option value="Puerto Escondido">Puerto Escondido</option>
        <option value="Puerto Libertador">Puerto Libertador</option>
        <option value="Pur&iacute;sima">Pur&iacute;sima</option>
        <option value="Sah&uacute;n">Sah&uacute;n</option>
        <option value="San Andr&eacute;s Sotavento">San Andr&eacute;s Sotavento</option>
        <option value="San Antero">San Antero</option>
        <option value="San Bernardo del Viento">San Bernardo del Viento</option>
        <option value="San Carlos">San Carlos</option>
        <option value="San Pelayo">San Pelayo</option>
        <option value="Tierralta">Tierralta</option>
        <option value="Valencia">Valencia</option>
        <option value="">CUNDINAMARCA</option>
        <option value="Agua de Dios">Agua de Dios</option>
        <option value="Alb&aacute;n">Alb&aacute;n</option>
        <option value="Anapoima">Anapoima</option>
        <option value="Anolaima">Anolaima</option>
        <option value="Arbel&aacute;ez">Arbel&aacute;ez</option>
        <option value="Beltr&aacute;n">Beltr&aacute;n</option>
        <option value="Bituima">Bituima</option>
        <option value="Bojac&aacute;">Bojac&aacute;</option>
        <option value="Cabrera">Cabrera</option>
        <option value="Cachipay">Cachipay</option>
        <option value="Cajic&aacute;">Cajic&aacute;</option>
        <option value="Caparrap&iacute;">Caparrap&iacute;</option>
        <option value="C&aacute;queza">C&aacute;queza</option>
        <option value="Carmen de Carupa">Carmen de Carupa</option>
        <option value="Chaguan&iacute;">Chaguan&iacute;</option>
        <option value="Ch&iacute;a">Ch&iacute;a</option>
        <option value="Chipaque">Chipaque</option>
        <option value="Choach&iacute;">Choach&iacute;</option>
        <option value="Chocont&aacute;">Chocont&aacute;</option>
        <option value="Cogua">Cogua</option>
        <option value="Cota">Cota</option>
        <option value="Cucunub&aacute;">Cucunub&aacute;</option>
        <option value="El Colegio">El Colegio</option>
        <option value="El Pe&ntilde;on">El Pe&ntilde;on</option>
        <option value="El Rosal">El Rosal</option>
        <option value="Facatativ&aacute;">Facatativ&aacute;</option>
        <option value="F&oacute;meque">F&oacute;meque</option>
        <option value="Fosca">Fosca</option>
        <option value="Funza">Funza</option>
        <option value="F&uacute;quene">F&uacute;quene</option>
        <option value="Fusagasuga">Fusagasuga</option>
        <option value="Gachal&aacute;">Gachal&aacute;</option>
        <option value="Gachancip&aacute;">Gachancip&aacute;</option>
        <option value="Gachet&aacute;">Gachet&aacute;</option>
        <option value="Gama">Gama</option>
        <option value="Girardot">Girardot</option>
        <option value="Granada">Granada</option>
        <option value="Guachet&aacute;">Guachet&aacute;</option>
        <option value="Guaduas">Guaduas</option>
        <option value="Guasca">Guasca</option>
        <option value="Guataqu&iacute;">Guataqu&iacute;</option>
        <option value="Guatavita">Guatavita</option>
        <option value="Guayabal de Siquima">Guayabal de Siquima</option>
        <option value="Guayabetal">Guayabetal</option>
        <option value="Guti&eacute;rrez">Guti&eacute;rrez</option>
        <option value="Jerusal&eacute;n">Jerusal&eacute;n</option>
        <option value="Jun&iacute;n">Jun&iacute;n</option>
        <option value="La Calera">La Calera</option>
        <option value="La Mesa">La Mesa</option>
        <option value="La Palma">La Palma</option>
        <option value="La Pe&ntilde;a">La Pe&ntilde;a</option>
        <option value="La Vega">La Vega</option>
        <option value="Lenguazaque">Lenguazaque</option>
        <option value="Machet&aacute;">Machet&aacute;</option>
        <option value="Madrid">Madrid</option>
        <option value="Manta">Manta</option>
        <option value="Medina">Medina</option>
        <option value="Mosquera">Mosquera</option>
        <option value="Nari&ntilde;o">Nari&ntilde;o</option>
        <option value="Nemoc&oacute;n">Nemoc&oacute;n</option>
        <option value="Nilo">Nilo</option>
        <option value="Nimaima">Nimaima</option>
        <option value="Nocaima">Nocaima</option>
        <option value="Venecia (Ospina P&eacute;rez)">Venecia (Ospina P&eacute;rez)</option>
        <option value="Pacho">Pacho</option>
        <option value="Paime">Paime</option>
        <option value="Pandi">Pandi</option>
        <option value="Paratebueno">Paratebueno</option>
        <option value="Pasca">Pasca</option>
        <option value="Puerto Salgar">Puerto Salgar</option>
        <option value="Pul&iacute;">Pul&iacute;</option>
        <option value="Quebradanegra">Quebradanegra</option>
        <option value="Quetame">Quetame</option>
        <option value="Quipile">Quipile</option>
        <option value="Rafael">Rafael</option>
        <option value="Ricaurte">Ricaurte</option>
        <option value="San Antonio de Tequendama">San Antonio de Tequendama</option>
        <option value="San Bernardo">San Bernardo</option>
        <option value="San Cayetano">San Cayetano</option>
        <option value="San Francisco">San Francisco</option>
        <option value="San Juan de R&iacute;o Seco">San Juan de R&iacute;o Seco</option>
        <option value="Sasaima">Sasaima</option>
        <option value="Sesquil&eacute;">Sesquil&eacute;</option>
        <option value="Sibat&eacute;">Sibat&eacute;</option>
        <option value="Silvania">Silvania</option>
        <option value="Simijaca">Simijaca</option>
        <option value="Soacha">Soacha</option>
        <option value="Sop&oacute;">Sop&oacute;</option>
        <option value="Subachoque">Subachoque</option>
        <option value="Suesca">Suesca</option>
        <option value="Supat&aacute;">Supat&aacute;</option>
        <option value="Susa">Susa</option>
        <option value="Sutatausa">Sutatausa</option>
        <option value="Tabio">Tabio</option>
        <option value="Tausa">Tausa</option>
        <option value="Tena">Tena</option>
        <option value="Tenjo">Tenjo</option>
        <option value="Tibacuy">Tibacuy</option>
        <option value="Tibirita">Tibirita</option>
        <option value="Tocaima">Tocaima</option>
        <option value="Tocancip&aacute;">Tocancip&aacute;</option>
        <option value="Topaip&iacute;">Topaip&iacute;</option>
        <option value="Ubal&aacute;">Ubal&aacute;</option>
        <option value="Ubaque">Ubaque</option>
        <option value="Ubat&eacute;">Ubat&eacute;</option>
        <option value="Une">Une</option>
        <option value="Utica">Utica</option>
        <option value="Vergara">Vergara</option>
        <option value="Viani">Viani</option>
        <option value="Villag&oacute;mez">Villag&oacute;mez</option>
        <option value="Villapinz&oacute;n">Villapinz&oacute;n</option>
        <option value="Villeta">Villeta</option>
        <option value="Viot&aacute;">Viot&aacute;</option>
        <option value="Yacop&iacute;">Yacop&iacute;</option>
        <option value="Zipac&oacute;n">Zipac&oacute;n</option>
        <option value="Zipaquir&aacute;">Zipaquir&aacute;</option>
        <option value="">CHOCO</option>
        <option value="Quibd&oacute;">Quibd&oacute;</option>
        <option value="Acand&iacute;">Acand&iacute;</option>
        <option value="Alto Baud&oacute; (Pie de Pato)">Alto Baud&oacute; (Pie de Pato)</option>
        <option value="Atrato (Yuto)">Atrato (Yuto)</option>
        <option value="Bagad&oacute;">Bagad&oacute;</option>
        <option value="Bah&iacute;a Solano (M&uacute;tis)">Bah&iacute;a Solano (M&uacute;tis)</option>
        <option value="Bajo Baud&oacute; (Pizarro)">Bajo Baud&oacute; (Pizarro)</option>
        <option value="Bojay&aacute; (Bellavista)">Bojay&aacute; (Bellavista)</option>
        <option value="Cant&oacute;n de San Pablo">Cant&oacute;n de San Pablo</option>
        <option value="Condoto">Condoto</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Litoral de San Juan">El Litoral de San Juan</option>
        <option value="Itsmina">Itsmina</option>
        <option value="Jurad&oacute;">Jurad&oacute;</option>
        <option value="Llor&oacute;">Llor&oacute;</option>
        <option value="Novita">Novita</option>
        <option value="Nuqu&iacute;">Nuqu&iacute;</option>
        <option value="Riosucio">Riosucio</option>
        <option value="San Jos&eacute; del Palmar">San Jos&eacute; del Palmar</option>
        <option value="Sip&iacute;">Sip&iacute;</option>
        <option value="Tad&oacute;">Tad&oacute;</option>
        <option value="Ungu&iacute;a">Ungu&iacute;a</option>
        <option value="">GUAINIA</option>
        <option value="Guain&iacute;a">Puerto In&iacute;rida</option>
        <option value="">GUAVIARE</option>
        <option value="San Jos&eacute; del Guaviare">San Jos&eacute; del Guaviare</option>
        <option value="Calamar">Calamar</option>
        <option value="El Retorno">El Retorno</option>
        <option value="Miraflores">Miraflores</option>
        <option value="">HUILA</option>
        <option value="Neiva">Neiva</option>
        <option value="Acevedo">Acevedo</option>
        <option value="Agrado">Agrado</option>
        <option value="Aipe">Aipe</option>
        <option value="Algeciras">Algeciras</option>
        <option value="Altamira">Altamira</option>
        <option value="Baraya">Baraya</option>
        <option value="Campoalegre">Campoalegre</option>
        <option value="Colombia">Colombia</option>
        <option value="El&iacute;as">El&iacute;as</option>
        <option value="Garz&oacute;n">Garz&oacute;n</option>
        <option value="Gigante">Gigante</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Hobo">Hobo</option>
        <option value="Iquira">Iquira</option>
        <option value="Isnos">Isnos</option>
        <option value="La Argentina">La Argentina</option>
        <option value="La Plata">La Plata</option>
        <option value="N&aacute;taga">N&aacute;taga</option>
        <option value="Oporapa">Oporapa</option>
        <option value="Paicol">Paicol</option>
        <option value="Palermo">Palermo</option>
        <option value="Palestina">Palestina</option>
        <option value="Pital">Pital</option>
        <option value="Pitalito">Pitalito</option>
        <option value="Rivera">Rivera</option>
        <option value="Saladoblanco">Saladoblanco</option>
        <option value="San Agust&iacute;n">San Agust&iacute;n</option>
        <option value="Santa Mar&iacute;a">Santa Mar&iacute;a</option>
        <option value="Suaza">Suaza</option>
        <option value="Tarqu&iacute;">Tarqu&iacute;</option>
        <option value="Tesalia">Tesalia</option>
        <option value="Tello">Tello</option>
        <option value="Teruel">Teruel</option>
        <option value="Timan&aacute;">Timan&aacute;</option>
        <option value="Villavieja">Villavieja</option>
        <option value="Yaguar&aacute;">Yaguar&aacute;</option>
        <option value="">LA GUAJIRA</option>
        <option value="Riohacha">Riohacha</option>
        <option value="Barrancas">Barrancas</option>
        <option value="Dibulla">Dibulla</option>
        <option value="Distracci&oacute;n">Distracci&oacute;n</option>
        <option value="El Molino">El Molino</option>
        <option value="Fonseca">Fonseca</option>
        <option value="Hatonuevo">Hatonuevo</option>
        <option value="Maicao">Maicao</option>
        <option value="Manaure">Manaure</option>
        <option value="San Juan del Cesar">San Juan del Cesar</option>
        <option value="Uribia">Uribia</option>
        <option value="Urumita">Urumita</option>
        <option value="Villanueva">Villanueva</option>
        <option value="">MAGDALENA</option>
        <option value="Santa Marta">Santa Marta</option>
        <option value="Aracataca">Aracataca</option>
        <option value="Ariguan&iacute; (El Dif&iacute;cil)">Ariguan&iacute; (El Dif&iacute;cil)</option>
        <option value="Cerro San Antonio">Cerro San Antonio</option>
        <option value="Chivolo">Chivolo</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="El Banco">El Banco</option>
        <option value="El Pi&ntilde;&oacute;n">El Pi&ntilde;&oacute;n</option>
        <option value="El Ret&eacute;n">El Ret&eacute;n</option>
        <option value="Fundaci&oacute;n">Fundaci&oacute;n</option>
        <option value="Guamal">Guamal</option>
        <option value="Pedraza">Pedraza</option>
        <option value="Piji&ntilde;o del Carmen">Piji&ntilde;o del Carmen</option>
        <option value="Pivijay">Pivijay</option>
        <option value="Plato">Plato</option>
        <option value="Publoviejo">Publoviejo</option>
        <option value="Remolino">Remolino</option>
        <option value="Salamina">Salamina</option>
        <option value="San Sebasti&aacute;n de Buuenavista">San Sebasti&aacute;n de Buuenavista</option>
        <option value="San Zen&oacute;n">San Zen&oacute;n</option>
        <option value="Santa Ana">Santa Ana</option>
        <option value="Sitionuevo">Sitionuevo</option>
        <option value="Tenerife">Tenerife</option>
        <option value="Meta 50 Villavicencio">Meta 50 Villavicencio</option>
        <option value="Acac&iacute;as">Acac&iacute;as</option>
        <option value="Barranca de Upia">Barranca de Upia</option>
        <option value="Cabuyano">Cabuyano</option>
        <option value="Castilla la Nueva">Castilla la Nueva</option>
        <option value="Cubarral">Cubarral</option>
        <option value="Cumaral">Cumaral</option>
        <option value="El Calvario">El Calvario</option>
        <option value="El Castillo">El Castillo</option>
        <option value="El Dorado">El Dorado</option>
        <option value="Fuente de Oro">Fuente de Oro</option>
        <option value="Granada">Granada</option>
        <option value="Guamal">Guamal</option>
        <option value="Mapirap&aacute;n">Mapirap&aacute;n</option>
        <option value="Mesetas">Mesetas</option>
        <option value="La Macarena">La Macarena</option>
        <option value="La Uribe">La Uribe</option>
        <option value="Lejan&iacute;as">Lejan&iacute;as</option>
        <option value="Puerto Concordia">Puerto Concordia</option>
        <option value="Puerto Gait&aacute;n">Puerto Gait&aacute;n</option>
        <option value="Puerto L&oacute;pez">Puerto L&oacute;pez</option>
        <option value="Puerto Lleras">Puerto Lleras</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="Restrepo">Restrepo</option>
        <option value="San Carlos de Guaroa">San Carlos de Guaroa</option>
        <option value="San Juan de Arama">San Juan de Arama</option>
        <option value="San Juanito">San Juanito</option>
        <option value="San Mart&iacute;n">San Mart&iacute;n</option>
        <option value="Vista Hermosa">Vista Hermosa</option>
        <option value="">NARI&Ntilde;O</option>
        <option value="Pasto">Pasto</option>
        <option value="Alb&aacute;n (San Jos&eacute;)">Alb&aacute;n (San Jos&eacute;)</option>
        <option value="Aldana">Aldana</option>
        <option value="Ancuya">Ancuya</option>
        <option value="Arboleda (Berruecos)">Arboleda (Berruecos)</option>
        <option value="Barbacoas">Barbacoas</option>
        <option value="Bel&eacute;n">Bel&eacute;n</option>
        <option value="Buesaco">Buesaco</option>
        <option value="Col&oacute;n (G&eacute;nova)">Col&oacute;n (G&eacute;nova)</option>
        <option value="Consaca">Consaca</option>
        <option value="Contadero">Contadero</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Cuaspud (Carlosama)">Cuaspud (Carlosama)</option>
        <option value="Cumbal">Cumbal</option>
        <option value="Cumbitara">Cumbitara</option>
        <option value="Chachagui">Chachagui</option>
        <option value="El Charco">El Charco</option>
        <option value="El Rosario">El Rosario</option>
        <option value="El Tabl&oacute;n">El Tabl&oacute;n</option>
        <option value="El Tambo">El Tambo</option>
        <option value="Funes">Funes</option>
        <option value="Guachucal">Guachucal</option>
        <option value="Guaitarilla">Guaitarilla</option>
        <option value="Gualmat&aacute;n">Gualmat&aacute;n</option>
        <option value="Iles">Iles</option>
        <option value="Im&uacute;es">Im&uacute;es</option>
        <option value="Ipiales">Ipiales</option>
        <option value="La Cruz">La Cruz</option>
        <option value="La Florida">La Florida</option>
        <option value="La Llanada">La Llanada</option>
        <option value="La Tola">La Tola</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Leiva">Leiva</option>
        <option value="Linares">Linares</option>
        <option value="Los Andes (Sotomayor)">Los Andes (Sotomayor)</option>
        <option value="Mag&uuml;&iacute; (Pay&aacute;n)">Mag&uuml;&iacute; (Pay&aacute;n)</option>
        <option value="Mallama (Piedrancha)">Mallama (Piedrancha)</option>
        <option value="Mosquera">Mosquera</option>
        <option value="Olaya">Olaya</option>
        <option value="Ospina">Ospina</option>
        <option value="Francisco Pizarro">Francisco Pizarro</option>
        <option value="Policarpa">Policarpa</option>
        <option value="Potos&iacute;">Potos&iacute;</option>
        <option value="Providencia">Providencia</option>
        <option value="Puerres">Puerres</option>
        <option value="Pupiales">Pupiales</option>
        <option value="Ricaurte">Ricaurte</option>
        <option value="Roberto Pay&aacute;n (San Jos&eacute;)">Roberto Pay&aacute;n (San Jos&eacute;)</option>
        <option value="Samaniego">Samaniego</option>
        <option value="Sandon&aacute;">Sandon&aacute;</option>
        <option value="San Bernardo">San Bernardo</option>
        <option value="San Lorenzo">San Lorenzo</option>
        <option value="San Pablo">San Pablo</option>
        <option value="San Pedro de Cartago">San Pedro de Cartago</option>
        <option value="Santa B&aacute;rbara (Iscuand&eacute;)">Santa B&aacute;rbara (Iscuand&eacute;)</option>
        <option value="Santacruz (Guach&aacute;vez)">Santacruz (Guach&aacute;vez)</option>
        <option value="Sapuyes">Sapuyes</option>
        <option value="Taminango">Taminango</option>
        <option value="Tangua">Tangua</option>
        <option value="Tumaco">Tumaco</option>
        <option value="T&uacute;querres">T&uacute;querres</option>
        <option value="Yacuanquer">Yacuanquer</option>
        <option value="">NORTE DE SANTANDER</option>
        <option value="C&uacute;cuta">C&uacute;cuta</option>
        <option value="Abrego">Abrego</option>
        <option value="Arboledas">Arboledas</option>
        <option value="Bochalema">Bochalema</option>
        <option value="Bucarasica">Bucarasica</option>
        <option value="Cacota">Cacota</option>
        <option value="Cachira">Cachira</option>
        <option value="Chin&aacute;cota">Chin&aacute;cota</option>
        <option value="Chitaga">Chitaga</option>
        <option value="Convenci&oacute;n">Convenci&oacute;n</option>
        <option value="Cucutilla">Cucutilla</option>
        <option value="Durania">Durania</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Tarra">El Tarra</option>
        <option value="El Zulia">El Zulia</option>
        <option value="Gramalote">Gramalote</option>
        <option value="Hacari">Hacari</option>
        <option value="Herr&aacute;n">Herr&aacute;n</option>
        <option value="Labateca">Labateca</option>
        <option value="La Esperanza">La Esperanza</option>
        <option value="La Playa">La Playa</option>
        <option value="Los Patios">Los Patios</option>
        <option value="Lourdes">Lourdes</option>
        <option value="Mutiscua">Mutiscua</option>
        <option value="Oca&ntilde;a">Oca&ntilde;a</option>
        <option value="Pamplona">Pamplona</option>
        <option value="Pamplonita">Pamplonita</option>
        <option value="Puerto Santander">Puerto Santander</option>
        <option value="Ragonvalia">Ragonvalia</option>
        <option value="Salazar">Salazar</option>
        <option value="San Calixto">San Calixto</option>
        <option value="San Cayetano">San Cayetano</option>
        <option value="Santiago">Santiago</option>
        <option value="Sardinata">Sardinata</option>
        <option value="Silos">Silos</option>
        <option value="Teorama">Teorama</option>
        <option value="Tib&uacute;">Tib&uacute;</option>
        <option value="Toledo">Toledo</option>
        <option value="Villa Caro">Villa Caro</option>
        <option value="Villa del Rosario">Villa del Rosario</option>
        <option value="">PUTUMAYO</option>
        <option value="Mocoa">Mocoa</option>
        <option value="Col&oacute;n">Col&oacute;n</option>
        <option value="Orito">Orito</option>
        <option value="Puerto As&iacute;s">Puerto As&iacute;s</option>
        <option value="Puerto Caicedo">Puerto Caicedo</option>
        <option value="Puerto Guzm&aacute;n">Puerto Guzm&aacute;n</option>
        <option value="Puerto Legu&iacute;zamo">Puerto Legu&iacute;zamo</option>
        <option value="Sibundoy">Sibundoy</option>
        <option value="San Francisco">San Francisco</option>
        <option value="San Miguel">San Miguel</option>
        <option value="Santiago">Santiago</option>
        <option value="Villa Gamuez (La Hormiga)">Villa Gamuez (La Hormiga)</option>
        <option value="Villa Garz&oacute;n">Villa Garz&oacute;n</option>
        <option value="Quind&iacute;o 63 Armenia">Quind&iacute;o 63 Armenia</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Calarc&aacute;">Calarc&aacute;</option>
        <option value="Circasia">Circasia</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Filandia">Filandia</option>
        <option value="G&eacute;nova">G&eacute;nova</option>
        <option value="La Tebaida">La Tebaida</option>
        <option value="Montenegro">Montenegro</option>
        <option value="Pijao">Pijao</option>
        <option value="Quimbaya">Quimbaya</option>
        <option value="Salento">Salento</option>
        <option value="">RISARALDA</option>
        <option value="Pereira">Pereira</option>
        <option value="Ap&iacute;a">Ap&iacute;a</option>
        <option value="Balboa">Balboa</option>
        <option value="Bel&eacute;n de Umbr&iacute;a">Bel&eacute;n de Umbr&iacute;a</option>
        <option value="Dos Quebradas">Dos Quebradas</option>
        <option value="Guatica">Guatica</option>
        <option value="La Celia">La Celia</option>
        <option value="La Virginia">La Virginia</option>
        <option value="Marsella">Marsella</option>
        <option value="Mistrato">Mistrato</option>
        <option value="Pueblo Rico">Pueblo Rico</option>
        <option value="Quinch&iacute;a">Quinch&iacute;a</option>
        <option value="Santa Rosa de Cabal">Santa Rosa de Cabal</option>
        <option value="Santuario">Santuario</option>
        <option value="">SAN ANDRES</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="Providencia">Providencia</option>
        <option value="">SANTANDER</option>
        <option value="Bucaramanga">Bucaramanga</option>
        <option value="Aguada">Aguada</option>
        <option value="Albania">Albania</option>
        <option value="Aratoca">Aratoca</option>
        <option value="Barbosa">Barbosa</option>
        <option value="Barichara">Barichara</option>
        <option value="Barrancabermeja">Barrancabermeja</option>
        <option value="Betulia">Betulia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Cabrera">Cabrera</option>
        <option value="California">California</option>
        <option value="Capitanejo">Capitanejo</option>
        <option value="Carcas&iacute;">Carcas&iacute;</option>
        <option value="Cepita">Cepita</option>
        <option value="Cerrito">Cerrito</option>
        <option value="Charal&aacute;">Charal&aacute;</option>
        <option value="Charta">Charta</option>
        <option value="Chima">Chima</option>
        <option value="Chipat&aacute;">Chipat&aacute;</option>
        <option value="Cimitarra">Cimitarra</option>
        <option value="Concepci&oacute;n">Concepci&oacute;n</option>
        <option value="Confines">Confines</option>
        <option value="Contrataci&oacute;n">Contrataci&oacute;n</option>
        <option value="Coromoro">Coromoro</option>
        <option value="Curit&iacute;">Curit&iacute;</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Guacamayo">El Guacamayo</option>
        <option value="El Pe&ntilde;&oacute;n">El Pe&ntilde;&oacute;n</option>
        <option value="El Play&oacute;n">El Play&oacute;n</option>
        <option value="Encino">Encino</option>
        <option value="Enciso">Enciso</option>
        <option value="Flori&aacute;n">Flori&aacute;n</option>
        <option value="Floridablanca">Floridablanca</option>
        <option value="Gal&aacute;n">Gal&aacute;n</option>
        <option value="G&aacute;mbita">G&aacute;mbita</option>
        <option value="Gir&oacute;n">Gir&oacute;n</option>
        <option value="Guaca">Guaca</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Guapota">Guapota</option>
        <option value="Guavata">Guavata</option>
        <option value="Guepsa">Guepsa</option>
        <option value="Hato">Hato</option>
        <option value="Jes&uacute;s Mar&iacute;a">Jes&uacute;s Mar&iacute;a</option>
        <option value="Jord&aacute;n">Jord&aacute;n</option>
        <option value="La Belleza">La Belleza</option>
        <option value="Land&aacute;zuri">Land&aacute;zuri</option>
        <option value="La Paz">La Paz</option>
        <option value="Lebrija">Lebrija</option>
        <option value="Los Santos">Los Santos</option>
        <option value="Macaravita">Macaravita</option>
        <option value="M&aacute;laga">M&aacute;laga</option>
        <option value="Matanza">Matanza</option>
        <option value="Mogotes">Mogotes</option>
        <option value="Molagavita">Molagavita</option>
        <option value="Ocamonte">Ocamonte</option>
        <option value="Oiba">Oiba</option>
        <option value="Onzaga">Onzaga</option>
        <option value="Palmar">Palmar</option>
        <option value="Palmas del Socorro">Palmas del Socorro</option>
        <option value="P&aacute;ramo">P&aacute;ramo</option>
        <option value="Pie de Cuesta">Pie de Cuesta</option>
        <option value="Pinchote">Pinchote</option>
        <option value="Puente Nacional">Puente Nacional</option>
        <option value="Puerto Parra">Puerto Parra</option>
        <option value="Puerto Wilches">Puerto Wilches</option>
        <option value="Rionegro">Rionegro</option>
        <option value="Sabana de Torres">Sabana de Torres</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="San Benito">San Benito</option>
        <option value="San Gil">San Gil</option>
        <option value="San Joaqu&iacute;n">San Joaqu&iacute;n</option>
        <option value="San Jos&eacute; de Miranda">San Jos&eacute; de Miranda</option>
        <option value="San Miguel">San Miguel</option>
        <option value="San Vicente de Chucur&iacute;">San Vicente de Chucur&iacute;</option>
        <option value="Santa B&aacute;rbara">Santa B&aacute;rbara</option>
        <option value="Santa Helena del Op&oacute;n">Santa Helena del Op&oacute;n</option>
        <option value="Simacota">Simacota</option>
        <option value="Socorro">Socorro</option>
        <option value="Suaita">Suaita</option>
        <option value="Sucre">Sucre</option>
        <option value="Surat&aacute;">Surat&aacute;</option>
        <option value="Tona">Tona</option>
        <option value="Valle de San Jos&eacute;">Valle de San Jos&eacute;</option>
        <option value="V&eacute;lez">V&eacute;lez</option>
        <option value="Vetas">Vetas</option>
        <option value="Villanueva">Villanueva</option>
        <option value="Zapatoca">Zapatoca</option>
        <option value="">SUCRE</option>
        <option value="Sincelejo">Sincelejo</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Caimito">Caimito</option>
        <option value="Coloso (Ricaurte)">Coloso (Ricaurte)</option>
        <option value="Corozal">Corozal</option>
        <option value="Chal&aacute;n">Chal&aacute;n</option>
        <option value="Galeras (Nueva Granada)">Galeras (Nueva Granada)</option>
        <option value="Guarand&aacute;">Guarand&aacute;</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Los Palmitos">Los Palmitos</option>
        <option value="Majagual">Majagual</option>
        <option value="Morroa">Morroa</option>
        <option value="Ovejas">Ovejas</option>
        <option value="Palmito">Palmito</option>
        <option value="Sampu&eacute;s">Sampu&eacute;s</option>
        <option value="San Benito Abad">San Benito Abad</option>
        <option value="San Juan de Betulia">San Juan de Betulia</option>
        <option value="San Marcos">San Marcos</option>
        <option value="San Onofre">San Onofre</option>
        <option value="San Pedro">San Pedro</option>
        <option value="Since">Since</option>
        <option value="Sucre">Sucre</option>
        <option value="Tol&uacute;">Tol&uacute;</option>
        <option value="Toluviejo">Toluviejo</option>
        <option value="">TOLIMA</option>
        <option value="Ibagu&eacute;">Ibagu&eacute;</option>
        <option value="Alpujarra">Alpujarra</option>
        <option value="Alvarado">Alvarado</option>
        <option value="Ambalema">Ambalema</option>
        <option value="Anzo&aacute;tegui">Anzo&aacute;tegui</option>
        <option value="Armero (Guayabal)">Armero (Guayabal)</option>
        <option value="Ataco">Ataco</option>
        <option value="Cajamarca">Cajamarca</option>
        <option value="Carmen de Apical&aacute;">Carmen de Apical&aacute;</option>
        <option value="Casabianca">Casabianca</option>
        <option value="Chaparral">Chaparral</option>
        <option value="Coello">Coello</option>
        <option value="Coyaima">Coyaima</option>
        <option value="Cunday">Cunday</option>
        <option value="Dolores">Dolores</option>
        <option value="Espinal">Espinal</option>
        <option value="Falan">Falan</option>
        <option value="Flandes">Flandes</option>
        <option value="Fresno">Fresno</option>
        <option value="Guamo">Guamo</option>
        <option value="Herveo">Herveo</option>
        <option value="Honda">Honda</option>
        <option value="Icononzo">Icononzo</option>
        <option value="L&eacute;rida">L&eacute;rida</option>
        <option value="L&iacute;bano">L&iacute;bano</option>
        <option value="Mariquita">Mariquita</option>
        <option value="Melgar">Melgar</option>
        <option value="Murillo">Murillo</option>
        <option value="Natagaima">Natagaima</option>
        <option value="Ortega">Ortega</option>
        <option value="Palocabildo">Palocabildo</option>
        <option value="Piedras">Piedras</option>
        <option value="Planadas">Planadas</option>
        <option value="Prado">Prado</option>
        <option value="Purificaci&oacute;n">Purificaci&oacute;n</option>
        <option value="Rioblanco">Rioblanco</option>
        <option value="Roncesvalles">Roncesvalles</option>
        <option value="Rovira">Rovira</option>
        <option value="Salda&ntilde;a">Salda&ntilde;a</option>
        <option value="San Antonio">San Antonio</option>
        <option value="San Luis">San Luis</option>
        <option value="Santa Isabel">Santa Isabel</option>
        <option value="Su&aacute;rez">Su&aacute;rez</option>
        <option value="Valle de San Juan">Valle de San Juan</option>
        <option value="Venadillo">Venadillo</option>
        <option value="Villahermosa">Villahermosa</option>
        <option value="Villarrica">Villarrica</option>
        <option value="">VALLE</option>
        <option value="Cali">Cali</option>
        <option value="Alcal&aacute;">Alcal&aacute;</option>
        <option value="Andaluc&iacute;a">Andaluc&iacute;a</option>
        <option value="Ansermanuevo">Ansermanuevo</option>
        <option value="Argelia">Argelia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Buenaventura">Buenaventura</option>
        <option value="Buga">Buga</option>
        <option value="Bugalagrande">Bugalagrande</option>
        <option value="Caicedonia">Caicedonia</option>
        <option value="Calima (Dari&eacute;n)">Calima (Dari&eacute;n)</option>
        <option value="Candelaria">Candelaria</option>
        <option value="Cartago">Cartago</option>
        <option value="Dagua">Dagua</option>
        <option value="El &Aacute;guila">El &Aacute;guila</option>
        <option value="El Cairo">El Cairo</option>
        <option value="El Cerrito">El Cerrito</option>
        <option value="El Dovio">El Dovio</option>
        <option value="Florida">Florida</option>
        <option value="Ginebra">Ginebra</option>
        <option value="Guacar&iacute;">Guacar&iacute;</option>
        <option value="Jamund&iacute;">Jamund&iacute;</option>
        <option value="La Cumbre">La Cumbre</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="La Victoria">La Victoria</option>
        <option value="Obando">Obando</option>
        <option value="Palmira">Palmira</option>
        <option value="Pradera">Pradera</option>
        <option value="Restrepo">Restrepo</option>
        <option value="Riofr&iacute;o">Riofr&iacute;o</option>
        <option value="Roldanillo">Roldanillo</option>
        <option value="San Pedro">San Pedro</option>
        <option value="Sevilla">Sevilla</option>
        <option value="Toro">Toro</option>
        <option value="Trujillo">Trujillo</option>
        <option value="Tul&uacute;a">Tul&uacute;a</option>
        <option value="Ulloa">Ulloa</option>
        <option value="Versalles">Versalles</option>
        <option value="Vijes">Vijes</option>
        <option value="Yotoco">Yotoco</option>
        <option value="Yumbo">Yumbo</option>
        <option value="Zarzal">Zarzal</option>
        <option value="">VAUPES</option>
        <option value="Mit&uacute;">Mit&uacute;</option>
        <option value="Carur&uacute;">Carur&uacute;</option>
        <option value="Tataira">Tataira</option>
        <option value="">VICHADA</option>
        <option value="Puerto Carre&ntilde;o">Puerto Carre&ntilde;o</option>
        <option value="La Primavera">La Primavera</option>
        <option value="Santa Rosalia">Santa Rosalia</option>
        <option value="Cumaribo">Cumaribo</option>
      </select>
      </td>
      <td align=right class="Estilo5"><b>Fecha : </b></td>
      <td colspan="2"><span class="Estilo5"><b><?php $fechaField = date("j/n/Y"); echo "$fechaField";
?></b></span></td>
      <td>&nbsp;</td>
    </tr>
    <tr valign=top height=30>
      <td align=right class="Estilo5"><b>Apellidos :</b></td>
      <td><input name="apellidosField" type="text">
          <span class="Estilo5"></span></td>
      <td align="right"><span class="Estilo5"><b>Nombres :</b></span></td>
      <td><input name="nombresField" type="text"></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>C&eacute;dula :</b></td>
      <td><input type="text" name="cedulaField">
      </td>
      <td align=right class="Estilo5"><b>de :</b></td>
      <td><input name="ceduladeField" type="text" id="ceduladeField"></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr valign=top height=30>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td colspan="2" align="left" valign="bottom"><span class="Estilo5"><b>Tiempo servicio</b></span></td>
      <td>&nbsp;</td>
    </tr>
    <tr valign=top height=30>
      <td align=right class="Estilo5"><b>Empresa :</b></td>
      <td><input type="text" name="empresaField"></td>
      <td align=right valign="bottom" class="Estilo5"><b>A&ntilde;os :</b></td>
      <td valign="bottom"><input name="tiemposervicioanosField" type="text" id="tiemposervicioanosField" size="2" maxlength="2">
          <span class="Estilo5"><b>Meses :
          <input name="tiemposerviciomesesField" type="text" id="tiemposerviciomesesField" size="2" maxlength="2">
        </b></span></td>
      <td align="right"><span class="Estilo5"></span></td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Grado :</b></td>
      <td><input type="text" name="gradoField">
      </td>
      <td align=right class="Estilo5"><b>Ocupaci&oacute;n :</b></td>
      <td><input type="text" name="ocupacionField">
      </td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>C&oacute;digo :</b></td>
      <td><input type="text" name="codigoField">
      </td>
      <td align=right class="Estilo5"><b>Estado civil :</b></td>
      <td><input type="text" name="estadocivilField">
      </td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right>&nbsp;</td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right><b class="Estilo5">Informaci&oacute;n de Residencia :</b></td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="direccionresidenciaField">
      </td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Ciudad :</b></td>
      <td><select name="ciudadresidenciaField" id="ciudadresidenciaField" onChange="validarciudad()">
        <option value="BOGOTA">BOGOTA</option>
        <option value="">AMAZONAS</option>
        <option value="Puerto Nari&ntilde;o">Puerto Nari&ntilde;o</option>
        <option value="Leticia">Leticia</option>
        <option value="">ANTIOQUIA</option>
        <option value="Medell&iacute;n">Medell&iacute;n</option>
        <option value="Abejorral">Abejorral</option>
        <option value="Abriaqui">Abriaqui</option>
        <option value="Alejandr&iacute;a">Alejandr&iacute;a</option>
        <option value="Amag&aacute;">Amag&aacute;</option>
        <option value="Amalfi">Amalfi</option>
        <option value="Andes">Andes</option>
        <option value="Angel&oacute;polis">Angel&oacute;polis</option>
        <option value="Angostura">Angostura</option>
        <option value="Anor&iacute;">Anor&iacute;</option>
        <option value="Antioquia">Antioquia</option>
        <option value="Anza">Anza</option>
        <option value="Apartad&oacute;">Apartad&oacute;</option>
        <option value="Arboletes">Arboletes</option>
        <option value="Argelia">Argelia</option>
        <option value="Armenia">Armenia</option>
        <option value="Barbosa">Barbosa</option>
        <option value="Belmira">Belmira</option>
        <option value="Bello">Bello</option>
        <option value="Betania">Betania</option>
        <option value="Betulia">Betulia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Brise&ntilde;o">Brise&ntilde;o</option>
        <option value="Buritica">Buritica</option>
        <option value="C&aacute;ceres">C&aacute;ceres</option>
        <option value="Caicedo">Caicedo</option>
        <option value="Caldas">Caldas</option>
        <option value="Campamento">Campamento</option>
        <option value="Ca&ntilde;asgordas">Ca&ntilde;asgordas</option>
        <option value="Caracol&iacute;">Caracol&iacute;</option>
        <option value="Caramanta">Caramanta</option>
        <option value="Carepa">Carepa</option>
        <option value="Carmen de Viboral">Carmen de Viboral</option>
        <option value="Carolina">Carolina</option>
        <option value="Caucasia">Caucasia</option>
        <option value="Chigorod&oacute;">Chigorod&oacute;</option>
        <option value="Cisneros">Cisneros</option>
        <option value="Cocorn&aacute;">Cocorn&aacute;</option>
        <option value="Concepci&oacute;n">Concepci&oacute;n</option>
        <option value="Concordia">Concordia</option>
        <option value="Copacabana">Copacabana</option>
        <option value="Dabeiba">Dabeiba</option>
        <option value="Don Mat&iacute;as">Don Mat&iacute;as</option>
        <option value="Eb&eacute;jico">Eb&eacute;jico</option>
        <option value="El Bagre">El Bagre</option>
        <option value="Entrerr&iacute;os">Entrerr&iacute;os</option>
        <option value="Envigado">Envigado</option>
        <option value="Fredonia">Fredonia</option>
        <option value="Frontino">Frontino</option>
        <option value="Giraldo">Giraldo</option>
        <option value="Girardota">Girardota</option>
        <option value="G&oacute;mez">G&oacute;mez</option>
        <option value="Granada">Granada</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Guarne">Guarne</option>
        <option value="Guatap&eacute;">Guatap&eacute;</option>
        <option value="Heliconia">Heliconia</option>
        <option value="Hispania">Hispania</option>
        <option value="Itag&uuml;&iacute;">Itag&uuml;&iacute;</option>
        <option value="Ituango">Ituango</option>
        <option value="Jard&iacute;n">Jard&iacute;n</option>
        <option value="Jeric&oacute;">Jeric&oacute;</option>
        <option value="La Ceja">La Ceja</option>
        <option value="La Estrella">La Estrella</option>
        <option value="La Pintada">La Pintada</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Liborina">Liborina</option>
        <option value="Maceo">Maceo</option>
        <option value="Marinilla">Marinilla</option>
        <option value="Montebello">Montebello</option>
        <option value="Murind&oacute;">Murind&oacute;</option>
        <option value="Mutat&aacute;">Mutat&aacute;</option>
        <option value="Nari&ntilde;o">Nari&ntilde;o</option>
        <option value="Necocl&iacute;">Necocl&iacute;</option>
        <option value="Nech&iacute;">Nech&iacute;</option>
        <option value="Olaya">Olaya</option>
        <option value="Pe&ntilde;ol">Pe&ntilde;ol</option>
        <option value="Peque">Peque</option>
        <option value="Pueblorrico">Pueblorrico</option>
        <option value="Puerto Berr&iacute;o">Puerto Berr&iacute;o</option>
        <option value="Puerto Nare">Puerto Nare</option>
        <option value="Puerto Triunfo">Puerto Triunfo</option>
        <option value="Remedios">Remedios</option>
        <option value="Retiro">Retiro</option>
        <option value="Rionegro">Rionegro</option>
        <option value="Sabanalarga">Sabanalarga</option>
        <option value="Sabaneta">Sabaneta</option>
        <option value="Salgar">Salgar</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="San Carlos">San Carlos</option>
        <option value="San francisco">San francisco</option>
        <option value="San Jer&oacute;nimo">San Jer&oacute;nimo</option>
        <option value="San Jos&eacute; de Monta&ntilde;a">San Jos&eacute; de Monta&ntilde;a</option>
        <option value="San Juan de Urab&aacute;">San Juan de Urab&aacute;</option>
        <option value="San Luis">San Luis</option>
        <option value="San Pedro">San Pedro</option>
        <option value="San Pedro de Urab&aacute;">San Pedro de Urab&aacute;</option>
        <option value="San Rafael">San Rafael</option>
        <option value="San Roque">San Roque</option>
        <option value="San Vicente">San Vicente</option>
        <option value="Santa B&aacute;rbara">Santa B&aacute;rbara</option>
        <option value="Santa Rosa de Osos">Santa Rosa de Osos</option>
        <option value="Santo Domingo">Santo Domingo</option>
        <option value="Santuario">Santuario</option>
        <option value="Segovia">Segovia</option>
        <option value="Sons&oacute;n">Sons&oacute;n</option>
        <option value="Sopetr&aacute;n">Sopetr&aacute;n</option>
        <option value="T&aacute;mesis">T&aacute;mesis</option>
        <option value="Taraza">Taraza</option>
        <option value="Tarso">Tarso</option>
        <option value="Titirib&iacute;">Titirib&iacute;</option>
        <option value="Toledo">Toledo</option>
        <option value="Turbo">Turbo</option>
        <option value="Uramita">Uramita</option>
        <option value="Urrao">Urrao</option>
        <option value="Valdivia">Valdivia</option>
        <option value="Valpara&iacute;so">Valpara&iacute;so</option>
        <option value="Vegachi">Vegachi</option>
        <option value="Venecia">Venecia</option>
        <option value="Vig&iacute;a del Fuerte">Vig&iacute;a del Fuerte</option>
        <option value="Yal&iacute;">Yal&iacute;</option>
        <option value="Yarumal">Yarumal</option>
        <option value="Yolomb&oacute;">Yolomb&oacute;</option>
        <option value="Yond&oacute; (Casabe)">Yond&oacute; (Casabe)</option>
        <option value="Zaragoza">Zaragoza</option>
        <option value="">ARAUCA</option>
        <option value="Arauca">Arauca</option>
        <option value="Arauquita">Arauquita</option>
        <option value="Cravo Norte">Cravo Norte</option>
        <option value="Fortul">Fortul</option>
        <option value="Puerto Rond&oacute;n">Puerto Rond&oacute;n</option>
        <option value="Fortul">Fortul</option>
        <option value="Puerto Rond&oacute;n">Puerto Rond&oacute;n</option>
        <option value="Saravena">Saravena</option>
        <option value="Tame">Tame</option>
        <option value="">ATLANTICO</option>
        <option value="Barranquilla">Barranquilla</option>
        <option value="Baranoa">Baranoa</option>
        <option value="Campo de la Cruz">Campo de la Cruz</option>
        <option value="Candelaria">Candelaria</option>
        <option value="Galapa">Galapa</option>
        <option value="Juan de Acosta">Juan de Acosta</option>
        <option value="Luruaco">Luruaco</option>
        <option value="Malambo">Malambo</option>
        <option value="Manat&iacute;">Manat&iacute;</option>
        <option value="Palmar de Varela">Palmar de Varela</option>
        <option value="Pioj&oacute;">Pioj&oacute;</option>
        <option value="Polonuevo">Polonuevo</option>
        <option value="Ponedera">Ponedera</option>
        <option value="Puerto Colombia">Puerto Colombia</option>
        <option value="Repel&oacute;n">Repel&oacute;n</option>
        <option value="Sabanagrande">Sabanagrande</option>
        <option value="Sabanalarga">Sabanalarga</option>
        <option value="Santa Luc&iacute;a">Santa Luc&iacute;a</option>
        <option value="Santo Tom&aacute;s">Santo Tom&aacute;s</option>
        <option value="Soledad">Soledad</option>
        <option value="Suan">Suan</option>
        <option value="Tubara">Tubara</option>
        <option value="Usiacur&iacute;">Usiacur&iacute;</option>
        <option value="">BOLIVAR</option>
        <option value="Cartagena">Cartagena</option>
        <option value="Ach&iacute;">Ach&iacute;</option>
        <option value="Altos del Rosario">Altos del Rosario</option>
        <option value="Arenal">Arenal</option>
        <option value="Arjona">Arjona</option>
        <option value="Arroyohondo">Arroyohondo</option>
        <option value="Barranco de Loba">Barranco de Loba</option>
        <option value="Calamar">Calamar</option>
        <option value="Cantagallo">Cantagallo</option>
        <option value="Cicuto">Cicuto</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Clemencia">Clemencia</option>
        <option value="El Carmen de Bol&iacute;var">El Carmen de Bol&iacute;var</option>
        <option value="El Guamo">El Guamo</option>
        <option value="El Pe&ntilde;&oacute;n">El Pe&ntilde;&oacute;n</option>
        <option value="Hatillo de Loba">Hatillo de Loba</option>
        <option value="Magangue">Magangue</option>
        <option value="Mahates">Mahates</option>
        <option value="Margarita">Margarita</option>
        <option value="Mar&iacute;a la Baja">Mar&iacute;a la Baja</option>
        <option value="Montecristo">Montecristo</option>
        <option value="Momp&oacute;s">Momp&oacute;s</option>
        <option value="Morales">Morales</option>
        <option value="Pinillos">Pinillos</option>
        <option value="Regidor">Regidor</option>
        <option value="R&iacute;o Viejo">R&iacute;o Viejo</option>
        <option value="San Cristobal">San Cristobal</option>
        <option value="San Estanislao">San Estanislao</option>
        <option value="San Fernando">San Fernando</option>
        <option value="San Jacinto">San Jacinto</option>
        <option value="San Jacinto del Cauca">San Jacinto del Cauca</option>
        <option value="San Juan Nepomuceno">San Juan Nepomuceno</option>
        <option value="San Mart&iacute;n de Loba">San Mart&iacute;n de Loba</option>
        <option value="San Pablo">San Pablo</option>
        <option value="Santa Catalina">Santa Catalina</option>
        <option value="Santa Rosa">Santa Rosa</option>
        <option value="Santa Rosa del Sur">Santa Rosa del Sur</option>
        <option value="Simit&iacute;">Simit&iacute;</option>
        <option value="Soplaviento">Soplaviento</option>
        <option value="Talaigua Nuevo">Talaigua Nuevo</option>
        <option value="Tiquisio (Puerto Rico)">Tiquisio (Puerto Rico)</option>
        <option value="Turbaco">Turbaco</option>
        <option value="Turban&aacute;">Turban&aacute;</option>
        <option value="Villanueva">Villanueva</option>
        <option value="Zambrano">Zambrano</option>
        <option value="">BOYACA</option>
        <option value="Tunja">Tunja</option>
        <option value="Almeida">Almeida</option>
        <option value="Aquitania">Aquitania</option>
        <option value="Arcabuco">Arcabuco</option>
        <option value="Bel&eacute;n">Bel&eacute;n</option>
        <option value="Berbeo">Berbeo</option>
        <option value="Beteitiva">Beteitiva</option>
        <option value="Boavita">Boavita</option>
        <option value="Boyac&aacute;">Boyac&aacute;</option>
        <option value="Brise&ntilde;o">Brise&ntilde;o</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Busbanza">Busbanza</option>
        <option value="Caldas">Caldas</option>
        <option value="Campohermoso">Campohermoso</option>
        <option value="Cerinza">Cerinza</option>
        <option value="Chinavita">Chinavita</option>
        <option value="Chiquinquir&aacute;">Chiquinquir&aacute;</option>
        <option value="Chiscas">Chiscas</option>
        <option value="Chita">Chita</option>
        <option value="Chitaranque">Chitaranque</option>
        <option value="Chivata">Chivata</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="Combita">Combita</option>
        <option value="Coper">Coper</option>
        <option value="Corrales">Corrales</option>
        <option value="Covarachia">Covarachia</option>
        <option value="Cubar">Cubar</option>
        <option value="Cucaita">Cucaita</option>
        <option value="Cuitiva">Cuitiva</option>
        <option value="Chiquiza">Chiquiza</option>
        <option value="Chivor">Chivor</option>
        <option value="Duitama">Duitama</option>
        <option value="El Cocuy">El Cocuy</option>
        <option value="El Espino">El Espino</option>
        <option value="Firavitoba">Firavitoba</option>
        <option value="Floresta">Floresta</option>
        <option value="Gachantiv&aacute;">Gachantiv&aacute;</option>
        <option value="G&aacute;meza">G&aacute;meza</option>
        <option value="Garagoa">Garagoa</option>
        <option value="Guacamayas">Guacamayas</option>
        <option value="Guateque">Guateque</option>
        <option value="Guayat&aacute;">Guayat&aacute;</option>
        <option value="Guic&aacute;n">Guic&aacute;n</option>
        <option value="Iz&aacute;">Iz&aacute;</option>
        <option value="Jenesano">Jenesano</option>
        <option value="Jeric&oacute;">Jeric&oacute;</option>
        <option value="Labranzagrande">Labranzagrande</option>
        <option value="La Capilla">La Capilla</option>
        <option value="La Victoria">La Victoria</option>
        <option value="La Ubita">La Ubita</option>
        <option value="Villa de Leyva">Villa de Leyva</option>
        <option value="Macanal">Macanal</option>
        <option value="Marip&iacute;">Marip&iacute;</option>
        <option value="Miraflores">Miraflores</option>
        <option value="Mongua">Mongua</option>
        <option value="Mongu&iacute;">Mongu&iacute;</option>
        <option value="Moniquir&aacute;">Moniquir&aacute;</option>
        <option value="Motavita">Motavita</option>
        <option value="Muzo">Muzo</option>
        <option value="Nobsa">Nobsa</option>
        <option value="Nuevo Col&oacute;n">Nuevo Col&oacute;n</option>
        <option value="Oicat&aacute;">Oicat&aacute;</option>
        <option value="Otanche">Otanche</option>
        <option value="Pachavita">Pachavita</option>
        <option value="P&aacute;ez">P&aacute;ez</option>
        <option value="Paipa">Paipa</option>
        <option value="Pajarito">Pajarito</option>
        <option value="Panqueba">Panqueba</option>
        <option value="Pauna">Pauna</option>
        <option value="Paya">Paya</option>
        <option value="Paz de R&iacute;o">Paz de R&iacute;o</option>
        <option value="Pesca">Pesca</option>
        <option value="Pisva">Pisva</option>
        <option value="Puerto Boyac&aacute;">Puerto Boyac&aacute;</option>
        <option value="Quipama">Quipama</option>
        <option value="Ramiquir&iacute;">Ramiquir&iacute;</option>
        <option value="R&aacute;quira">R&aacute;quira</option>
        <option value="Rond&oacute;n">Rond&oacute;n</option>
        <option value="Saboy&aacute;">Saboy&aacute;</option>
        <option value="S&aacute;chica">S&aacute;chica</option>
        <option value="Samac&aacute;">Samac&aacute;</option>
        <option value="San Eduardo">San Eduardo</option>
        <option value="San Jos&eacute; de Pare">San Jos&eacute; de Pare</option>
        <option value="San Luis de Gaceno">San Luis de Gaceno</option>
        <option value="San Mateo">San Mateo</option>
        <option value="San Miguel de Sema">San Miguel de Sema</option>
        <option value="San Pablo de Borbur">San Pablo de Borbur</option>
        <option value="Santana">Santana</option>
        <option value="Santa Mar&iacute;a">Santa Mar&iacute;a</option>
        <option value="Santa Rosa de Viterbo">Santa Rosa de Viterbo</option>
        <option value="Santa Sof&iacute;a">Santa Sof&iacute;a</option>
        <option value="Sativanorte">Sativanorte</option>
        <option value="Sativasur">Sativasur</option>
        <option value="Siachoque">Siachoque</option>
        <option value="Soat&aacute;">Soat&aacute;</option>
        <option value="Socot&aacute;">Socot&aacute;</option>
        <option value="Socha">Socha</option>
        <option value="Sogamoso">Sogamoso</option>
        <option value="Somondoco">Somondoco</option>
        <option value="Sora">Sora</option>
        <option value="Sotaquir&aacute;">Sotaquir&aacute;</option>
        <option value="Sorac&aacute;">Sorac&aacute;</option>
        <option value="Susac&oacute;n">Susac&oacute;n</option>
        <option value="Sutamarch&aacute;n">Sutamarch&aacute;n</option>
        <option value="Sutatenza">Sutatenza</option>
        <option value="Tasco">Tasco</option>
        <option value="Tenza">Tenza</option>
        <option value="Tiban&aacute;">Tiban&aacute;</option>
        <option value="Tibasosa">Tibasosa</option>
        <option value="Tinjac&aacute;">Tinjac&aacute;</option>
        <option value="Tipacoque">Tipacoque</option>
        <option value="Toca">Toca</option>
        <option value="Togu&iacute;">Togu&iacute;</option>
        <option value="Topag&aacute;">Topag&aacute;</option>
        <option value="Tota">Tota</option>
        <option value="Tunungua">Tunungua</option>
        <option value="Turmequ&eacute;">Turmequ&eacute;</option>
        <option value="Tuta">Tuta</option>
        <option value="Tutas&aacute;">Tutas&aacute;</option>
        <option value="Umbita">Umbita</option>
        <option value="Ventaquemada">Ventaquemada</option>
        <option value="Viracach&aacute;">Viracach&aacute;</option>
        <option value="Zetaquir&aacute;">Zetaquir&aacute;</option>
        <option value="">CALDAS</option>
        <option value="Manizales">Manizales</option>
        <option value="Aguadas">Aguadas</option>
        <option value="Anserma">Anserma</option>
        <option value="Aranzaz&uacute;">Aranzaz&uacute;</option>
        <option value="Belalc&aacute;zar">Belalc&aacute;zar</option>
        <option value="Chinchina">Chinchina</option>
        <option value="Filadelfia">Filadelfia</option>
        <option value="La Dorada">La Dorada</option>
        <option value="La Merced">La Merced</option>
        <option value="Manzanares">Manzanares</option>
        <option value="Marmato">Marmato</option>
        <option value="Marquetalia">Marquetalia</option>
        <option value="Marulanda">Marulanda</option>
        <option value="Neira">Neira</option>
        <option value="P&aacute;cora">P&aacute;cora</option>
        <option value="Palestina">Palestina</option>
        <option value="Pensilvania">Pensilvania</option>
        <option value="Riosucio">Riosucio</option>
        <option value="Risaralda">Risaralda</option>
        <option value="Salamina">Salamina</option>
        <option value="Saman&aacute;">Saman&aacute;</option>
        <option value="San Jos&eacute;">San Jos&eacute;</option>
        <option value="Sup&iacute;a">Sup&iacute;a</option>
        <option value="Victoria">Victoria</option>
        <option value="Villamar&iacute;a">Villamar&iacute;a</option>
        <option value="Viterbo">Viterbo</option>
        <option value="Caquet&aacute; 18 Florencia">Caquet&aacute; 18 Florencia</option>
        <option value="Albania">Albania</option>
        <option value="Bel&eacute;n de los Andaquies">Bel&eacute;n de los Andaquies</option>
        <option value="Cartagena del Chair&aacute;">Cartagena del Chair&aacute;</option>
        <option value="Curillo">Curillo</option>
        <option value="El Doncello">El Doncello</option>
        <option value="El Paujil">El Paujil</option>
        <option value="La Monta&ntilde;ita">La Monta&ntilde;ita</option>
        <option value="Mil&aacute;n">Mil&aacute;n</option>
        <option value="Morelia">Morelia</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="San Jos&eacute; del Fragua">San Jos&eacute; del Fragua</option>
        <option value="San Vicente del Cagu&aacute;n">San Vicente del Cagu&aacute;n</option>
        <option value="Solano">Solano</option>
        <option value="Solita">Solita</option>
        <option value="Valpara&iacute;so">Valpara&iacute;so</option>
        <option value="">CASANARE</option>
        <option value="Yopal">Yopal</option>
        <option value="Aguazul">Aguazul</option>
        <option value="Chameza">Chameza</option>
        <option value="Hato Corozal">Hato Corozal</option>
        <option value="La Salina">La Salina</option>
        <option value="Man&iacute;">Man&iacute;</option>
        <option value="Monterrey">Monterrey</option>
        <option value="Nunch&iacute;a">Nunch&iacute;a</option>
        <option value="Orocu&eacute;">Orocu&eacute;</option>
        <option value="Paz de Ariporo">Paz de Ariporo</option>
        <option value="Pore">Pore</option>
        <option value="Recetor">Recetor</option>
        <option value="Sabalarga">Sabalarga</option>
        <option value="Sacama">Sacama</option>
        <option value="San Luis de Palenque">San Luis de Palenque</option>
        <option value="T&aacute;mara">T&aacute;mara</option>
        <option value="Tauramena">Tauramena</option>
        <option value="Trinidad">Trinidad</option>
        <option value="Villanueva">Villanueva</option>
        <option value="">CAUCA</option>
        <option value="Popay&aacute;n">Popay&aacute;n</option>
        <option value="Almaguer">Almaguer</option>
        <option value="Argelia">Argelia</option>
        <option value="Balboa">Balboa</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Buenos Aires">Buenos Aires</option>
        <option value="Cajib&iacute;o">Cajib&iacute;o</option>
        <option value="Caldon&oacute;">Caldon&oacute;</option>
        <option value="Caloto">Caloto</option>
        <option value="Corinto">Corinto</option>
        <option value="El Tambo">El Tambo</option>
        <option value="Florencia">Florencia</option>
        <option value="Guap&iacute;">Guap&iacute;</option>
        <option value="Inza">Inza</option>
        <option value="Jambalo">Jambalo</option>
        <option value="La Sierra">La Sierra</option>
        <option value="La Vega">La Vega</option>
        <option value="L&oacute;pez (Micay)">L&oacute;pez (Micay)</option>
        <option value="Mercaderes">Mercaderes</option>
        <option value="Miranda">Miranda</option>
        <option value="Morales">Morales</option>
        <option value="Padilla">Padilla</option>
        <option value="P&aacute;ez (Belalcazar)">P&aacute;ez (Belalcazar)</option>
        <option value="Pat&iacute;a (El Bordo)">Pat&iacute;a (El Bordo)</option>
        <option value="Piamonte">Piamonte</option>
        <option value="Piendam&oacute;">Piendam&oacute;</option>
        <option value="Puerto Tejada">Puerto Tejada</option>
        <option value="Purac&eacute; (Coconuco)">Purac&eacute; (Coconuco)</option>
        <option value="Rosas">Rosas</option>
        <option value="San Sebasti&aacute;n">San Sebasti&aacute;n</option>
        <option value="Santander de Quilichao">Santander de Quilichao</option>
        <option value="Santa Rosa">Santa Rosa</option>
        <option value="Silvia">Silvia</option>
        <option value="Sotara (Paispamba)">Sotara (Paispamba)</option>
        <option value="Su&aacute;rez">Su&aacute;rez</option>
        <option value="Timb&iacute;o">Timb&iacute;o</option>
        <option value="Timbiqu&iacute;">Timbiqu&iacute;</option>
        <option value="Toribio">Toribio</option>
        <option value="Totoro">Totoro</option>
        <option value="">CESAR</option>
        <option value="Valledupar">Valledupar</option>
        <option value="Aguachica">Aguachica</option>
        <option value="Agust&iacute;n Codazzi">Agust&iacute;n Codazzi</option>
        <option value="Astrea">Astrea</option>
        <option value="Becerril">Becerril</option>
        <option value="Bosconia">Bosconia</option>
        <option value="Chimichagua">Chimichagua</option>
        <option value="Chiriguan&aacute;">Chiriguan&aacute;</option>
        <option value="Curuman&iacute;">Curuman&iacute;</option>
        <option value="El Copey">El Copey</option>
        <option value="El Paso">El Paso</option>
        <option value="Gamarra">Gamarra</option>
        <option value="Gonz&aacute;lez">Gonz&aacute;lez</option>
        <option value="La Gloria">La Gloria</option>
        <option value="La Jagua de Ibirico">La Jagua de Ibirico</option>
        <option value="Manaure Balc&oacute;n Cesar">Manaure Balc&oacute;n Cesar</option>
        <option value="Pailitas">Pailitas</option>
        <option value="Pelaya">Pelaya</option>
        <option value="Pueblo Bello">Pueblo Bello</option>
        <option value="R&iacute;o de Oro">R&iacute;o de Oro</option>
        <option value="La Paz (Robles)">La Paz (Robles)</option>
        <option value="San Alberto">San Alberto</option>
        <option value="San Diego">San Diego</option>
        <option value="San Mart&iacute;n">San Mart&iacute;n</option>
        <option value="Tamalameque">Tamalameque</option>
        <option value="">CORDOBA</option>
        <option value="Monter&iacute;a">Monter&iacute;a</option>
        <option value="Ayapel">Ayapel</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Canalete">Canalete</option>
        <option value="Ceret&eacute;">Ceret&eacute;</option>
        <option value="Chim&aacute;">Chim&aacute;</option>
        <option value="Chin&uacute;">Chin&uacute;</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="Cotorra">Cotorra</option>
        <option value="La Apartada (Frontera)">La Apartada (Frontera)</option>
        <option value="Lorica">Lorica</option>
        <option value="Los C&oacute;rdobas">Los C&oacute;rdobas</option>
        <option value="Momil">Momil</option>
        <option value="Montel&iacute;bano">Montel&iacute;bano</option>
        <option value="Mo&ntilde;itos">Mo&ntilde;itos</option>
        <option value="Planeta Rica">Planeta Rica</option>
        <option value="Pueblo Nuevo">Pueblo Nuevo</option>
        <option value="Puerto Escondido">Puerto Escondido</option>
        <option value="Puerto Libertador">Puerto Libertador</option>
        <option value="Pur&iacute;sima">Pur&iacute;sima</option>
        <option value="Sah&uacute;n">Sah&uacute;n</option>
        <option value="San Andr&eacute;s Sotavento">San Andr&eacute;s Sotavento</option>
        <option value="San Antero">San Antero</option>
        <option value="San Bernardo del Viento">San Bernardo del Viento</option>
        <option value="San Carlos">San Carlos</option>
        <option value="San Pelayo">San Pelayo</option>
        <option value="Tierralta">Tierralta</option>
        <option value="Valencia">Valencia</option>
        <option value="">CUNDINAMARCA</option>
        <option value="Agua de Dios">Agua de Dios</option>
        <option value="Alb&aacute;n">Alb&aacute;n</option>
        <option value="Anapoima">Anapoima</option>
        <option value="Anolaima">Anolaima</option>
        <option value="Arbel&aacute;ez">Arbel&aacute;ez</option>
        <option value="Beltr&aacute;n">Beltr&aacute;n</option>
        <option value="Bituima">Bituima</option>
        <option value="Bojac&aacute;">Bojac&aacute;</option>
        <option value="Cabrera">Cabrera</option>
        <option value="Cachipay">Cachipay</option>
        <option value="Cajic&aacute;">Cajic&aacute;</option>
        <option value="Caparrap&iacute;">Caparrap&iacute;</option>
        <option value="C&aacute;queza">C&aacute;queza</option>
        <option value="Carmen de Carupa">Carmen de Carupa</option>
        <option value="Chaguan&iacute;">Chaguan&iacute;</option>
        <option value="Ch&iacute;a">Ch&iacute;a</option>
        <option value="Chipaque">Chipaque</option>
        <option value="Choach&iacute;">Choach&iacute;</option>
        <option value="Chocont&aacute;">Chocont&aacute;</option>
        <option value="Cogua">Cogua</option>
        <option value="Cota">Cota</option>
        <option value="Cucunub&aacute;">Cucunub&aacute;</option>
        <option value="El Colegio">El Colegio</option>
        <option value="El Pe&ntilde;on">El Pe&ntilde;on</option>
        <option value="El Rosal">El Rosal</option>
        <option value="Facatativ&aacute;">Facatativ&aacute;</option>
        <option value="F&oacute;meque">F&oacute;meque</option>
        <option value="Fosca">Fosca</option>
        <option value="Funza">Funza</option>
        <option value="F&uacute;quene">F&uacute;quene</option>
        <option value="Fusagasuga">Fusagasuga</option>
        <option value="Gachal&aacute;">Gachal&aacute;</option>
        <option value="Gachancip&aacute;">Gachancip&aacute;</option>
        <option value="Gachet&aacute;">Gachet&aacute;</option>
        <option value="Gama">Gama</option>
        <option value="Girardot">Girardot</option>
        <option value="Granada">Granada</option>
        <option value="Guachet&aacute;">Guachet&aacute;</option>
        <option value="Guaduas">Guaduas</option>
        <option value="Guasca">Guasca</option>
        <option value="Guataqu&iacute;">Guataqu&iacute;</option>
        <option value="Guatavita">Guatavita</option>
        <option value="Guayabal de Siquima">Guayabal de Siquima</option>
        <option value="Guayabetal">Guayabetal</option>
        <option value="Guti&eacute;rrez">Guti&eacute;rrez</option>
        <option value="Jerusal&eacute;n">Jerusal&eacute;n</option>
        <option value="Jun&iacute;n">Jun&iacute;n</option>
        <option value="La Calera">La Calera</option>
        <option value="La Mesa">La Mesa</option>
        <option value="La Palma">La Palma</option>
        <option value="La Pe&ntilde;a">La Pe&ntilde;a</option>
        <option value="La Vega">La Vega</option>
        <option value="Lenguazaque">Lenguazaque</option>
        <option value="Machet&aacute;">Machet&aacute;</option>
        <option value="Madrid">Madrid</option>
        <option value="Manta">Manta</option>
        <option value="Medina">Medina</option>
        <option value="Mosquera">Mosquera</option>
        <option value="Nari&ntilde;o">Nari&ntilde;o</option>
        <option value="Nemoc&oacute;n">Nemoc&oacute;n</option>
        <option value="Nilo">Nilo</option>
        <option value="Nimaima">Nimaima</option>
        <option value="Nocaima">Nocaima</option>
        <option value="Venecia (Ospina P&eacute;rez)">Venecia (Ospina P&eacute;rez)</option>
        <option value="Pacho">Pacho</option>
        <option value="Paime">Paime</option>
        <option value="Pandi">Pandi</option>
        <option value="Paratebueno">Paratebueno</option>
        <option value="Pasca">Pasca</option>
        <option value="Puerto Salgar">Puerto Salgar</option>
        <option value="Pul&iacute;">Pul&iacute;</option>
        <option value="Quebradanegra">Quebradanegra</option>
        <option value="Quetame">Quetame</option>
        <option value="Quipile">Quipile</option>
        <option value="Rafael">Rafael</option>
        <option value="Ricaurte">Ricaurte</option>
        <option value="San Antonio de Tequendama">San Antonio de Tequendama</option>
        <option value="San Bernardo">San Bernardo</option>
        <option value="San Cayetano">San Cayetano</option>
        <option value="San Francisco">San Francisco</option>
        <option value="San Juan de R&iacute;o Seco">San Juan de R&iacute;o Seco</option>
        <option value="Sasaima">Sasaima</option>
        <option value="Sesquil&eacute;">Sesquil&eacute;</option>
        <option value="Sibat&eacute;">Sibat&eacute;</option>
        <option value="Silvania">Silvania</option>
        <option value="Simijaca">Simijaca</option>
        <option value="Soacha">Soacha</option>
        <option value="Sop&oacute;">Sop&oacute;</option>
        <option value="Subachoque">Subachoque</option>
        <option value="Suesca">Suesca</option>
        <option value="Supat&aacute;">Supat&aacute;</option>
        <option value="Susa">Susa</option>
        <option value="Sutatausa">Sutatausa</option>
        <option value="Tabio">Tabio</option>
        <option value="Tausa">Tausa</option>
        <option value="Tena">Tena</option>
        <option value="Tenjo">Tenjo</option>
        <option value="Tibacuy">Tibacuy</option>
        <option value="Tibirita">Tibirita</option>
        <option value="Tocaima">Tocaima</option>
        <option value="Tocancip&aacute;">Tocancip&aacute;</option>
        <option value="Topaip&iacute;">Topaip&iacute;</option>
        <option value="Ubal&aacute;">Ubal&aacute;</option>
        <option value="Ubaque">Ubaque</option>
        <option value="Ubat&eacute;">Ubat&eacute;</option>
        <option value="Une">Une</option>
        <option value="Utica">Utica</option>
        <option value="Vergara">Vergara</option>
        <option value="Viani">Viani</option>
        <option value="Villag&oacute;mez">Villag&oacute;mez</option>
        <option value="Villapinz&oacute;n">Villapinz&oacute;n</option>
        <option value="Villeta">Villeta</option>
        <option value="Viot&aacute;">Viot&aacute;</option>
        <option value="Yacop&iacute;">Yacop&iacute;</option>
        <option value="Zipac&oacute;n">Zipac&oacute;n</option>
        <option value="Zipaquir&aacute;">Zipaquir&aacute;</option>
        <option value="">CHOCO</option>
        <option value="Quibd&oacute;">Quibd&oacute;</option>
        <option value="Acand&iacute;">Acand&iacute;</option>
        <option value="Alto Baud&oacute; (Pie de Pato)">Alto Baud&oacute; (Pie de Pato)</option>
        <option value="Atrato (Yuto)">Atrato (Yuto)</option>
        <option value="Bagad&oacute;">Bagad&oacute;</option>
        <option value="Bah&iacute;a Solano (M&uacute;tis)">Bah&iacute;a Solano (M&uacute;tis)</option>
        <option value="Bajo Baud&oacute; (Pizarro)">Bajo Baud&oacute; (Pizarro)</option>
        <option value="Bojay&aacute; (Bellavista)">Bojay&aacute; (Bellavista)</option>
        <option value="Cant&oacute;n de San Pablo">Cant&oacute;n de San Pablo</option>
        <option value="Condoto">Condoto</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Litoral de San Juan">El Litoral de San Juan</option>
        <option value="Itsmina">Itsmina</option>
        <option value="Jurad&oacute;">Jurad&oacute;</option>
        <option value="Llor&oacute;">Llor&oacute;</option>
        <option value="Novita">Novita</option>
        <option value="Nuqu&iacute;">Nuqu&iacute;</option>
        <option value="Riosucio">Riosucio</option>
        <option value="San Jos&eacute; del Palmar">San Jos&eacute; del Palmar</option>
        <option value="Sip&iacute;">Sip&iacute;</option>
        <option value="Tad&oacute;">Tad&oacute;</option>
        <option value="Ungu&iacute;a">Ungu&iacute;a</option>
        <option value="">GUAINIA</option>
        <option value="Guain&iacute;a">Puerto In&iacute;rida</option>
        <option value="">GUAVIARE</option>
        <option value="San Jos&eacute; del Guaviare">San Jos&eacute; del Guaviare</option>
        <option value="Calamar">Calamar</option>
        <option value="El Retorno">El Retorno</option>
        <option value="Miraflores">Miraflores</option>
        <option value="">HUILA</option>
        <option value="Neiva">Neiva</option>
        <option value="Acevedo">Acevedo</option>
        <option value="Agrado">Agrado</option>
        <option value="Aipe">Aipe</option>
        <option value="Algeciras">Algeciras</option>
        <option value="Altamira">Altamira</option>
        <option value="Baraya">Baraya</option>
        <option value="Campoalegre">Campoalegre</option>
        <option value="Colombia">Colombia</option>
        <option value="El&iacute;as">El&iacute;as</option>
        <option value="Garz&oacute;n">Garz&oacute;n</option>
        <option value="Gigante">Gigante</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Hobo">Hobo</option>
        <option value="Iquira">Iquira</option>
        <option value="Isnos">Isnos</option>
        <option value="La Argentina">La Argentina</option>
        <option value="La Plata">La Plata</option>
        <option value="N&aacute;taga">N&aacute;taga</option>
        <option value="Oporapa">Oporapa</option>
        <option value="Paicol">Paicol</option>
        <option value="Palermo">Palermo</option>
        <option value="Palestina">Palestina</option>
        <option value="Pital">Pital</option>
        <option value="Pitalito">Pitalito</option>
        <option value="Rivera">Rivera</option>
        <option value="Saladoblanco">Saladoblanco</option>
        <option value="San Agust&iacute;n">San Agust&iacute;n</option>
        <option value="Santa Mar&iacute;a">Santa Mar&iacute;a</option>
        <option value="Suaza">Suaza</option>
        <option value="Tarqu&iacute;">Tarqu&iacute;</option>
        <option value="Tesalia">Tesalia</option>
        <option value="Tello">Tello</option>
        <option value="Teruel">Teruel</option>
        <option value="Timan&aacute;">Timan&aacute;</option>
        <option value="Villavieja">Villavieja</option>
        <option value="Yaguar&aacute;">Yaguar&aacute;</option>
        <option value="">LA GUAJIRA</option>
        <option value="Riohacha">Riohacha</option>
        <option value="Barrancas">Barrancas</option>
        <option value="Dibulla">Dibulla</option>
        <option value="Distracci&oacute;n">Distracci&oacute;n</option>
        <option value="El Molino">El Molino</option>
        <option value="Fonseca">Fonseca</option>
        <option value="Hatonuevo">Hatonuevo</option>
        <option value="Maicao">Maicao</option>
        <option value="Manaure">Manaure</option>
        <option value="San Juan del Cesar">San Juan del Cesar</option>
        <option value="Uribia">Uribia</option>
        <option value="Urumita">Urumita</option>
        <option value="Villanueva">Villanueva</option>
        <option value="">MAGDALENA</option>
        <option value="Santa Marta">Santa Marta</option>
        <option value="Aracataca">Aracataca</option>
        <option value="Ariguan&iacute; (El Dif&iacute;cil)">Ariguan&iacute; (El Dif&iacute;cil)</option>
        <option value="Cerro San Antonio">Cerro San Antonio</option>
        <option value="Chivolo">Chivolo</option>
        <option value="Ci&eacute;naga">Ci&eacute;naga</option>
        <option value="El Banco">El Banco</option>
        <option value="El Pi&ntilde;&oacute;n">El Pi&ntilde;&oacute;n</option>
        <option value="El Ret&eacute;n">El Ret&eacute;n</option>
        <option value="Fundaci&oacute;n">Fundaci&oacute;n</option>
        <option value="Guamal">Guamal</option>
        <option value="Pedraza">Pedraza</option>
        <option value="Piji&ntilde;o del Carmen">Piji&ntilde;o del Carmen</option>
        <option value="Pivijay">Pivijay</option>
        <option value="Plato">Plato</option>
        <option value="Publoviejo">Publoviejo</option>
        <option value="Remolino">Remolino</option>
        <option value="Salamina">Salamina</option>
        <option value="San Sebasti&aacute;n de Buuenavista">San Sebasti&aacute;n de Buuenavista</option>
        <option value="San Zen&oacute;n">San Zen&oacute;n</option>
        <option value="Santa Ana">Santa Ana</option>
        <option value="Sitionuevo">Sitionuevo</option>
        <option value="Tenerife">Tenerife</option>
        <option value="Meta 50 Villavicencio">Meta 50 Villavicencio</option>
        <option value="Acac&iacute;as">Acac&iacute;as</option>
        <option value="Barranca de Upia">Barranca de Upia</option>
        <option value="Cabuyano">Cabuyano</option>
        <option value="Castilla la Nueva">Castilla la Nueva</option>
        <option value="Cubarral">Cubarral</option>
        <option value="Cumaral">Cumaral</option>
        <option value="El Calvario">El Calvario</option>
        <option value="El Castillo">El Castillo</option>
        <option value="El Dorado">El Dorado</option>
        <option value="Fuente de Oro">Fuente de Oro</option>
        <option value="Granada">Granada</option>
        <option value="Guamal">Guamal</option>
        <option value="Mapirap&aacute;n">Mapirap&aacute;n</option>
        <option value="Mesetas">Mesetas</option>
        <option value="La Macarena">La Macarena</option>
        <option value="La Uribe">La Uribe</option>
        <option value="Lejan&iacute;as">Lejan&iacute;as</option>
        <option value="Puerto Concordia">Puerto Concordia</option>
        <option value="Puerto Gait&aacute;n">Puerto Gait&aacute;n</option>
        <option value="Puerto L&oacute;pez">Puerto L&oacute;pez</option>
        <option value="Puerto Lleras">Puerto Lleras</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="Restrepo">Restrepo</option>
        <option value="San Carlos de Guaroa">San Carlos de Guaroa</option>
        <option value="San Juan de Arama">San Juan de Arama</option>
        <option value="San Juanito">San Juanito</option>
        <option value="San Mart&iacute;n">San Mart&iacute;n</option>
        <option value="Vista Hermosa">Vista Hermosa</option>
        <option value="">NARI&Ntilde;O</option>
        <option value="Pasto">Pasto</option>
        <option value="Alb&aacute;n (San Jos&eacute;)">Alb&aacute;n (San Jos&eacute;)</option>
        <option value="Aldana">Aldana</option>
        <option value="Ancuya">Ancuya</option>
        <option value="Arboleda (Berruecos)">Arboleda (Berruecos)</option>
        <option value="Barbacoas">Barbacoas</option>
        <option value="Bel&eacute;n">Bel&eacute;n</option>
        <option value="Buesaco">Buesaco</option>
        <option value="Col&oacute;n (G&eacute;nova)">Col&oacute;n (G&eacute;nova)</option>
        <option value="Consaca">Consaca</option>
        <option value="Contadero">Contadero</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Cuaspud (Carlosama)">Cuaspud (Carlosama)</option>
        <option value="Cumbal">Cumbal</option>
        <option value="Cumbitara">Cumbitara</option>
        <option value="Chachagui">Chachagui</option>
        <option value="El Charco">El Charco</option>
        <option value="El Rosario">El Rosario</option>
        <option value="El Tabl&oacute;n">El Tabl&oacute;n</option>
        <option value="El Tambo">El Tambo</option>
        <option value="Funes">Funes</option>
        <option value="Guachucal">Guachucal</option>
        <option value="Guaitarilla">Guaitarilla</option>
        <option value="Gualmat&aacute;n">Gualmat&aacute;n</option>
        <option value="Iles">Iles</option>
        <option value="Im&uacute;es">Im&uacute;es</option>
        <option value="Ipiales">Ipiales</option>
        <option value="La Cruz">La Cruz</option>
        <option value="La Florida">La Florida</option>
        <option value="La Llanada">La Llanada</option>
        <option value="La Tola">La Tola</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Leiva">Leiva</option>
        <option value="Linares">Linares</option>
        <option value="Los Andes (Sotomayor)">Los Andes (Sotomayor)</option>
        <option value="Mag&uuml;&iacute; (Pay&aacute;n)">Mag&uuml;&iacute; (Pay&aacute;n)</option>
        <option value="Mallama (Piedrancha)">Mallama (Piedrancha)</option>
        <option value="Mosquera">Mosquera</option>
        <option value="Olaya">Olaya</option>
        <option value="Ospina">Ospina</option>
        <option value="Francisco Pizarro">Francisco Pizarro</option>
        <option value="Policarpa">Policarpa</option>
        <option value="Potos&iacute;">Potos&iacute;</option>
        <option value="Providencia">Providencia</option>
        <option value="Puerres">Puerres</option>
        <option value="Pupiales">Pupiales</option>
        <option value="Ricaurte">Ricaurte</option>
        <option value="Roberto Pay&aacute;n (San Jos&eacute;)">Roberto Pay&aacute;n (San Jos&eacute;)</option>
        <option value="Samaniego">Samaniego</option>
        <option value="Sandon&aacute;">Sandon&aacute;</option>
        <option value="San Bernardo">San Bernardo</option>
        <option value="San Lorenzo">San Lorenzo</option>
        <option value="San Pablo">San Pablo</option>
        <option value="San Pedro de Cartago">San Pedro de Cartago</option>
        <option value="Santa B&aacute;rbara (Iscuand&eacute;)">Santa B&aacute;rbara (Iscuand&eacute;)</option>
        <option value="Santacruz (Guach&aacute;vez)">Santacruz (Guach&aacute;vez)</option>
        <option value="Sapuyes">Sapuyes</option>
        <option value="Taminango">Taminango</option>
        <option value="Tangua">Tangua</option>
        <option value="Tumaco">Tumaco</option>
        <option value="T&uacute;querres">T&uacute;querres</option>
        <option value="Yacuanquer">Yacuanquer</option>
        <option value="">NORTE DE SANTANDER</option>
        <option value="C&uacute;cuta">C&uacute;cuta</option>
        <option value="Abrego">Abrego</option>
        <option value="Arboledas">Arboledas</option>
        <option value="Bochalema">Bochalema</option>
        <option value="Bucarasica">Bucarasica</option>
        <option value="Cacota">Cacota</option>
        <option value="Cachira">Cachira</option>
        <option value="Chin&aacute;cota">Chin&aacute;cota</option>
        <option value="Chitaga">Chitaga</option>
        <option value="Convenci&oacute;n">Convenci&oacute;n</option>
        <option value="Cucutilla">Cucutilla</option>
        <option value="Durania">Durania</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Tarra">El Tarra</option>
        <option value="El Zulia">El Zulia</option>
        <option value="Gramalote">Gramalote</option>
        <option value="Hacari">Hacari</option>
        <option value="Herr&aacute;n">Herr&aacute;n</option>
        <option value="Labateca">Labateca</option>
        <option value="La Esperanza">La Esperanza</option>
        <option value="La Playa">La Playa</option>
        <option value="Los Patios">Los Patios</option>
        <option value="Lourdes">Lourdes</option>
        <option value="Mutiscua">Mutiscua</option>
        <option value="Oca&ntilde;a">Oca&ntilde;a</option>
        <option value="Pamplona">Pamplona</option>
        <option value="Pamplonita">Pamplonita</option>
        <option value="Puerto Santander">Puerto Santander</option>
        <option value="Ragonvalia">Ragonvalia</option>
        <option value="Salazar">Salazar</option>
        <option value="San Calixto">San Calixto</option>
        <option value="San Cayetano">San Cayetano</option>
        <option value="Santiago">Santiago</option>
        <option value="Sardinata">Sardinata</option>
        <option value="Silos">Silos</option>
        <option value="Teorama">Teorama</option>
        <option value="Tib&uacute;">Tib&uacute;</option>
        <option value="Toledo">Toledo</option>
        <option value="Villa Caro">Villa Caro</option>
        <option value="Villa del Rosario">Villa del Rosario</option>
        <option value="">PUTUMAYO</option>
        <option value="Mocoa">Mocoa</option>
        <option value="Col&oacute;n">Col&oacute;n</option>
        <option value="Orito">Orito</option>
        <option value="Puerto As&iacute;s">Puerto As&iacute;s</option>
        <option value="Puerto Caicedo">Puerto Caicedo</option>
        <option value="Puerto Guzm&aacute;n">Puerto Guzm&aacute;n</option>
        <option value="Puerto Legu&iacute;zamo">Puerto Legu&iacute;zamo</option>
        <option value="Sibundoy">Sibundoy</option>
        <option value="San Francisco">San Francisco</option>
        <option value="San Miguel">San Miguel</option>
        <option value="Santiago">Santiago</option>
        <option value="Villa Gamuez (La Hormiga)">Villa Gamuez (La Hormiga)</option>
        <option value="Villa Garz&oacute;n">Villa Garz&oacute;n</option>
        <option value="Quind&iacute;o 63 Armenia">Quind&iacute;o 63 Armenia</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Calarc&aacute;">Calarc&aacute;</option>
        <option value="Circasia">Circasia</option>
        <option value="C&oacute;rdoba">C&oacute;rdoba</option>
        <option value="Filandia">Filandia</option>
        <option value="G&eacute;nova">G&eacute;nova</option>
        <option value="La Tebaida">La Tebaida</option>
        <option value="Montenegro">Montenegro</option>
        <option value="Pijao">Pijao</option>
        <option value="Quimbaya">Quimbaya</option>
        <option value="Salento">Salento</option>
        <option value="">RISARALDA</option>
        <option value="Pereira">Pereira</option>
        <option value="Ap&iacute;a">Ap&iacute;a</option>
        <option value="Balboa">Balboa</option>
        <option value="Bel&eacute;n de Umbr&iacute;a">Bel&eacute;n de Umbr&iacute;a</option>
        <option value="Dos Quebradas">Dos Quebradas</option>
        <option value="Guatica">Guatica</option>
        <option value="La Celia">La Celia</option>
        <option value="La Virginia">La Virginia</option>
        <option value="Marsella">Marsella</option>
        <option value="Mistrato">Mistrato</option>
        <option value="Pueblo Rico">Pueblo Rico</option>
        <option value="Quinch&iacute;a">Quinch&iacute;a</option>
        <option value="Santa Rosa de Cabal">Santa Rosa de Cabal</option>
        <option value="Santuario">Santuario</option>
        <option value="">SAN ANDRES</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="Providencia">Providencia</option>
        <option value="">SANTANDER</option>
        <option value="Bucaramanga">Bucaramanga</option>
        <option value="Aguada">Aguada</option>
        <option value="Albania">Albania</option>
        <option value="Aratoca">Aratoca</option>
        <option value="Barbosa">Barbosa</option>
        <option value="Barichara">Barichara</option>
        <option value="Barrancabermeja">Barrancabermeja</option>
        <option value="Betulia">Betulia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Cabrera">Cabrera</option>
        <option value="California">California</option>
        <option value="Capitanejo">Capitanejo</option>
        <option value="Carcas&iacute;">Carcas&iacute;</option>
        <option value="Cepita">Cepita</option>
        <option value="Cerrito">Cerrito</option>
        <option value="Charal&aacute;">Charal&aacute;</option>
        <option value="Charta">Charta</option>
        <option value="Chima">Chima</option>
        <option value="Chipat&aacute;">Chipat&aacute;</option>
        <option value="Cimitarra">Cimitarra</option>
        <option value="Concepci&oacute;n">Concepci&oacute;n</option>
        <option value="Confines">Confines</option>
        <option value="Contrataci&oacute;n">Contrataci&oacute;n</option>
        <option value="Coromoro">Coromoro</option>
        <option value="Curit&iacute;">Curit&iacute;</option>
        <option value="El Carmen">El Carmen</option>
        <option value="El Guacamayo">El Guacamayo</option>
        <option value="El Pe&ntilde;&oacute;n">El Pe&ntilde;&oacute;n</option>
        <option value="El Play&oacute;n">El Play&oacute;n</option>
        <option value="Encino">Encino</option>
        <option value="Enciso">Enciso</option>
        <option value="Flori&aacute;n">Flori&aacute;n</option>
        <option value="Floridablanca">Floridablanca</option>
        <option value="Gal&aacute;n">Gal&aacute;n</option>
        <option value="G&aacute;mbita">G&aacute;mbita</option>
        <option value="Gir&oacute;n">Gir&oacute;n</option>
        <option value="Guaca">Guaca</option>
        <option value="Guadalupe">Guadalupe</option>
        <option value="Guapota">Guapota</option>
        <option value="Guavata">Guavata</option>
        <option value="Guepsa">Guepsa</option>
        <option value="Hato">Hato</option>
        <option value="Jes&uacute;s Mar&iacute;a">Jes&uacute;s Mar&iacute;a</option>
        <option value="Jord&aacute;n">Jord&aacute;n</option>
        <option value="La Belleza">La Belleza</option>
        <option value="Land&aacute;zuri">Land&aacute;zuri</option>
        <option value="La Paz">La Paz</option>
        <option value="Lebrija">Lebrija</option>
        <option value="Los Santos">Los Santos</option>
        <option value="Macaravita">Macaravita</option>
        <option value="M&aacute;laga">M&aacute;laga</option>
        <option value="Matanza">Matanza</option>
        <option value="Mogotes">Mogotes</option>
        <option value="Molagavita">Molagavita</option>
        <option value="Ocamonte">Ocamonte</option>
        <option value="Oiba">Oiba</option>
        <option value="Onzaga">Onzaga</option>
        <option value="Palmar">Palmar</option>
        <option value="Palmas del Socorro">Palmas del Socorro</option>
        <option value="P&aacute;ramo">P&aacute;ramo</option>
        <option value="Pie de Cuesta">Pie de Cuesta</option>
        <option value="Pinchote">Pinchote</option>
        <option value="Puente Nacional">Puente Nacional</option>
        <option value="Puerto Parra">Puerto Parra</option>
        <option value="Puerto Wilches">Puerto Wilches</option>
        <option value="Rionegro">Rionegro</option>
        <option value="Sabana de Torres">Sabana de Torres</option>
        <option value="San Andr&eacute;s">San Andr&eacute;s</option>
        <option value="San Benito">San Benito</option>
        <option value="San Gil">San Gil</option>
        <option value="San Joaqu&iacute;n">San Joaqu&iacute;n</option>
        <option value="San Jos&eacute; de Miranda">San Jos&eacute; de Miranda</option>
        <option value="San Miguel">San Miguel</option>
        <option value="San Vicente de Chucur&iacute;">San Vicente de Chucur&iacute;</option>
        <option value="Santa B&aacute;rbara">Santa B&aacute;rbara</option>
        <option value="Santa Helena del Op&oacute;n">Santa Helena del Op&oacute;n</option>
        <option value="Simacota">Simacota</option>
        <option value="Socorro">Socorro</option>
        <option value="Suaita">Suaita</option>
        <option value="Sucre">Sucre</option>
        <option value="Surat&aacute;">Surat&aacute;</option>
        <option value="Tona">Tona</option>
        <option value="Valle de San Jos&eacute;">Valle de San Jos&eacute;</option>
        <option value="V&eacute;lez">V&eacute;lez</option>
        <option value="Vetas">Vetas</option>
        <option value="Villanueva">Villanueva</option>
        <option value="Zapatoca">Zapatoca</option>
        <option value="">SUCRE</option>
        <option value="Sincelejo">Sincelejo</option>
        <option value="Buenavista">Buenavista</option>
        <option value="Caimito">Caimito</option>
        <option value="Coloso (Ricaurte)">Coloso (Ricaurte)</option>
        <option value="Corozal">Corozal</option>
        <option value="Chal&aacute;n">Chal&aacute;n</option>
        <option value="Galeras (Nueva Granada)">Galeras (Nueva Granada)</option>
        <option value="Guarand&aacute;">Guarand&aacute;</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="Los Palmitos">Los Palmitos</option>
        <option value="Majagual">Majagual</option>
        <option value="Morroa">Morroa</option>
        <option value="Ovejas">Ovejas</option>
        <option value="Palmito">Palmito</option>
        <option value="Sampu&eacute;s">Sampu&eacute;s</option>
        <option value="San Benito Abad">San Benito Abad</option>
        <option value="San Juan de Betulia">San Juan de Betulia</option>
        <option value="San Marcos">San Marcos</option>
        <option value="San Onofre">San Onofre</option>
        <option value="San Pedro">San Pedro</option>
        <option value="Since">Since</option>
        <option value="Sucre">Sucre</option>
        <option value="Tol&uacute;">Tol&uacute;</option>
        <option value="Toluviejo">Toluviejo</option>
        <option value="">TOLIMA</option>
        <option value="Ibagu&eacute;">Ibagu&eacute;</option>
        <option value="Alpujarra">Alpujarra</option>
        <option value="Alvarado">Alvarado</option>
        <option value="Ambalema">Ambalema</option>
        <option value="Anzo&aacute;tegui">Anzo&aacute;tegui</option>
        <option value="Armero (Guayabal)">Armero (Guayabal)</option>
        <option value="Ataco">Ataco</option>
        <option value="Cajamarca">Cajamarca</option>
        <option value="Carmen de Apical&aacute;">Carmen de Apical&aacute;</option>
        <option value="Casabianca">Casabianca</option>
        <option value="Chaparral">Chaparral</option>
        <option value="Coello">Coello</option>
        <option value="Coyaima">Coyaima</option>
        <option value="Cunday">Cunday</option>
        <option value="Dolores">Dolores</option>
        <option value="Espinal">Espinal</option>
        <option value="Falan">Falan</option>
        <option value="Flandes">Flandes</option>
        <option value="Fresno">Fresno</option>
        <option value="Guamo">Guamo</option>
        <option value="Herveo">Herveo</option>
        <option value="Honda">Honda</option>
        <option value="Icononzo">Icononzo</option>
        <option value="L&eacute;rida">L&eacute;rida</option>
        <option value="L&iacute;bano">L&iacute;bano</option>
        <option value="Mariquita">Mariquita</option>
        <option value="Melgar">Melgar</option>
        <option value="Murillo">Murillo</option>
        <option value="Natagaima">Natagaima</option>
        <option value="Ortega">Ortega</option>
        <option value="Palocabildo">Palocabildo</option>
        <option value="Piedras">Piedras</option>
        <option value="Planadas">Planadas</option>
        <option value="Prado">Prado</option>
        <option value="Purificaci&oacute;n">Purificaci&oacute;n</option>
        <option value="Rioblanco">Rioblanco</option>
        <option value="Roncesvalles">Roncesvalles</option>
        <option value="Rovira">Rovira</option>
        <option value="Salda&ntilde;a">Salda&ntilde;a</option>
        <option value="San Antonio">San Antonio</option>
        <option value="San Luis">San Luis</option>
        <option value="Santa Isabel">Santa Isabel</option>
        <option value="Su&aacute;rez">Su&aacute;rez</option>
        <option value="Valle de San Juan">Valle de San Juan</option>
        <option value="Venadillo">Venadillo</option>
        <option value="Villahermosa">Villahermosa</option>
        <option value="Villarrica">Villarrica</option>
        <option value="">VALLE</option>
        <option value="Cali">Cali</option>
        <option value="Alcal&aacute;">Alcal&aacute;</option>
        <option value="Andaluc&iacute;a">Andaluc&iacute;a</option>
        <option value="Ansermanuevo">Ansermanuevo</option>
        <option value="Argelia">Argelia</option>
        <option value="Bol&iacute;var">Bol&iacute;var</option>
        <option value="Buenaventura">Buenaventura</option>
        <option value="Buga">Buga</option>
        <option value="Bugalagrande">Bugalagrande</option>
        <option value="Caicedonia">Caicedonia</option>
        <option value="Calima (Dari&eacute;n)">Calima (Dari&eacute;n)</option>
        <option value="Candelaria">Candelaria</option>
        <option value="Cartago">Cartago</option>
        <option value="Dagua">Dagua</option>
        <option value="El &Aacute;guila">El &Aacute;guila</option>
        <option value="El Cairo">El Cairo</option>
        <option value="El Cerrito">El Cerrito</option>
        <option value="El Dovio">El Dovio</option>
        <option value="Florida">Florida</option>
        <option value="Ginebra">Ginebra</option>
        <option value="Guacar&iacute;">Guacar&iacute;</option>
        <option value="Jamund&iacute;">Jamund&iacute;</option>
        <option value="La Cumbre">La Cumbre</option>
        <option value="La Uni&oacute;n">La Uni&oacute;n</option>
        <option value="La Victoria">La Victoria</option>
        <option value="Obando">Obando</option>
        <option value="Palmira">Palmira</option>
        <option value="Pradera">Pradera</option>
        <option value="Restrepo">Restrepo</option>
        <option value="Riofr&iacute;o">Riofr&iacute;o</option>
        <option value="Roldanillo">Roldanillo</option>
        <option value="San Pedro">San Pedro</option>
        <option value="Sevilla">Sevilla</option>
        <option value="Toro">Toro</option>
        <option value="Trujillo">Trujillo</option>
        <option value="Tul&uacute;a">Tul&uacute;a</option>
        <option value="Ulloa">Ulloa</option>
        <option value="Versalles">Versalles</option>
        <option value="Vijes">Vijes</option>
        <option value="Yotoco">Yotoco</option>
        <option value="Yumbo">Yumbo</option>
        <option value="Zarzal">Zarzal</option>
        <option value="">VAUPES</option>
        <option value="Mit&uacute;">Mit&uacute;</option>
        <option value="Carur&uacute;">Carur&uacute;</option>
        <option value="Tataira">Tataira</option>
        <option value="">VICHADA</option>
        <option value="Puerto Carre&ntilde;o">Puerto Carre&ntilde;o</option>
        <option value="La Primavera">La Primavera</option>
        <option value="Santa Rosalia">Santa Rosalia</option>
        <option value="Cumaribo">Cumaribo</option>
      </select></td>
      <td align=right class="Estilo5"><b>Barrio :</b></td>
      <td><input type="text" name="barrioField">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="telefonoField">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td align=right class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Devengado :</b></td>
      <td><input type="text" name="devengadoField">
      </td>
      <td align=right class="Estilo5"><b>Descuentos :</b></td>
      <td><input type="text" name="descuentosField">
      </td>
      <td align=right class="Estilo5"><b>Disponible :</b></td>
      <td><input type="text" name="disponibleField">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Valor cr&eacute;dito :</b></td>
      <td><input type="text" name="valorcreditoField">
      </td>
      <td align=right class="Estilo5"><b>Valor libranza :</b></td>
      <td><input type="text" name="valorlibranzaField">
      </td>
      <td align=right class="Estilo5"><b>Valor cuota :</b></td>
      <td><input type="text" name="valorcuotaField">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right><b class="Estilo5">Referencias Personales/Comerciales :</b></td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Nombre :</b></td>
      <td><input type="text" name="refco_nombre1Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refco_direccion1Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refco_telefono1Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Nombre :</b></td>
      <td><input type="text" name="refco_nombre2Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refco_direccion2Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refco_telefono2Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right class="Estilo5"><b>Nombre :</b></td>
      <td><input type="text" name="refco_nombre3Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refco_direccion3Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refco_telefono3Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td colspan="2" align=right><b class="Estilo5">Referencias Familiares :</b></td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
      <td class="Estilo5">&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr height=30 valign=top>
      <td align=right><span class="Estilo5">Nombre :</span></td>
      <td><input type="text" name="refper_nombre1Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refper_direccion1Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refper_telefono1Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right><span class="Estilo5">Nombre :</span></td>
      <td><input type="text" name="refper_nombre2Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refper_direccion2Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refper_telefono2Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right><span class="Estilo5">Nombre :</span></td>
      <td><input type="text" name="refper_nombre3Field">
      </td>
      <td align=right class="Estilo5"><b>Direcci&oacute;n :</b></td>
      <td><input type="text" name="refper_direccion3Field">
      </td>
      <td align=right class="Estilo5"><b>Tel&eacute;fono :</b></td>
      <td><input type="text" name="refper_telefono3Field">
      </td>
    </tr>
    <tr height=30 valign=top>
      <td align=right><input type="hidden" name="ceduladeudor" value="<? echo "$cedulaField"; ?>"></td>
      <td>&nbsp;</td>
      <td colspan="2" align=right><input type=submit name=Submit value="Registrar Informaci&oacute;n del Codeudor"></td>
      <td align=right><input type=reset name=Submit2 value="Limpiar Campos"></td>
      <td>&nbsp;</td>
    </tr>
  </table>
</form>
<?
include("foot.php");
?>