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[TABLE="class: grid, width: 800, align: center"]
[TR]
[TD="bgcolor: #002235, colspan: 2"][CENTER][IMG]https://image.ibb.co/g7fXme/Solvencia.png[/IMG]
[COLOR=#ffffff][FONT=century gothic][B][SIZE=3]Trámite personal Solvencia de Antecedentes Penales[/SIZE][/B][/FONT][/COLOR][/CENTER]
[/TD]
[/TR]
[TR]
[TD="bgcolor: #002235, colspan: 2"][CENTER][FONT=century gothic][COLOR=#ffffff][B]Datos del Solicitante[/B][/COLOR][/FONT][/CENTER]
[/TD]
[/TR]
[TR]
[TD="bgcolor: #efefef"]Fotografía:[/TD]
[TD][IMG]https://static.up-cdn.com/roleplay/mapa/images/skins/186.jpg[/IMG][/TD]
[/TR]
[TR]
[TD="bgcolor: #efefef"]Copia del Pasaporte:[/TD]
[TD][IMG]https://i.gyazo.com/c9a118056ef586c34c0fc0be9ca6ebb6.png[/IMG][/TD]
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[TR]
[TD="bgcolor: #efefef"]Número telefónico:[/TD]
[TD]972885[/TD]
[/TR]
[TR]
[TD="bgcolor: #efefef"]Residencia:[/TD]
[TD]Los Santos - PC-41[/TD]
[/TR]
[TR]
[TD="bgcolor: #efefef"]Comprobante de Pago:[/TD]
[TD][IMG]https://i.gyazo.com/a3033513d00112bc73c9216f4cd69a38.png[/IMG][/TD]
[/TR]
[TR]
[TD="bgcolor: #002235, colspan: 2"][CENTER][FONT=century gothic][COLOR=#ffffff][B]Datos del Aboga[/B][B]do[/B][/COLOR][/FONT][/CENTER]
[/TD]
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[TR]
[TD="bgcolor: #efefef"]Nombre Completo y Copia del Pasaporte:[/TD]
[TD]RESPONDER AQUÍ[/TD]
[/TR]
[TR]
[TD="bgcolor: #efefef"]Número telefónico:[/TD]
[TD]RESPONDER AQUÍ[/TD]
[/TR]
[/TABLE]