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Submission: On March 19 via manual from CO — Scanned from DE
Submission: On March 19 via manual from CO — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div style="" class="field-container">
<div style="">
<div class="row">
<div class="col-12 label" style="color: #000000;font-family: 'Montserrat', sans-serif;">Nombre completo</div>
<div class="col-12">
<div class="input-group"><input class="form-control has-right-icon" style="font-family: 'Montserrat', sans-serif;" type="text" placeholder=""> <span class="input-group-text required-asterisk"><svg xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 384 512">
<path
d="M192 32c17.7 0 32 14.3 32 32V199.5l111.5-66.9c15.2-9.1 34.8-4.2 43.9 11s4.2 34.8-11 43.9L254.2 256l114.3 68.6c15.2 9.1 20.1 28.7 11 43.9s-28.7 20.1-43.9 11L224 312.5V448c0 17.7-14.3 32-32 32s-32-14.3-32-32V312.5L48.5 379.4c-15.2 9.1-34.8 4.2-43.9-11s-4.2-34.8 11-43.9L129.8 256 15.5 187.4c-15.2-9.1-20.1-28.7-11-43.9s28.7-20.1 43.9-11L160 199.5V64c0-17.7 14.3-32 32-32z">
</path>
</svg></span></div>
</div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style="">
<div class="row">
<div class="col-12 label" style="color: #000000;font-family: 'Montserrat', sans-serif;">Cédula</div>
<div class="col-12">
<div class="input-group"><input class="form-control has-right-icon" style="font-family: 'Montserrat', sans-serif;" type="text" placeholder=""> <span class="input-group-text required-asterisk"><svg xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 384 512">
<path
d="M192 32c17.7 0 32 14.3 32 32V199.5l111.5-66.9c15.2-9.1 34.8-4.2 43.9 11s4.2 34.8-11 43.9L254.2 256l114.3 68.6c15.2 9.1 20.1 28.7 11 43.9s-28.7 20.1-43.9 11L224 312.5V448c0 17.7-14.3 32-32 32s-32-14.3-32-32V312.5L48.5 379.4c-15.2 9.1-34.8 4.2-43.9-11s-4.2-34.8 11-43.9L129.8 256 15.5 187.4c-15.2-9.1-20.1-28.7-11-43.9s28.7-20.1 43.9-11L160 199.5V64c0-17.7 14.3-32 32-32z">
</path>
</svg></span></div>
</div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style=" icon:true; icon-position:left; fields-font-family:arial; fields-font-color:#000000;">
<div class="row">
<div class="col-12 label" style="color: #000000;font-family: 'Montserrat', sans-serif;">Email</div>
<div class="col-12">
<div class="input-group"><span class="input-group-text">@</span> <input class="form-control has-left-icon" type="email" style="font-family: 'Montserrat', sans-serif;" placeholder=""> <span class="input-group-text required-asterisk"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 384 512">
<path
d="M192 32c17.7 0 32 14.3 32 32V199.5l111.5-66.9c15.2-9.1 34.8-4.2 43.9 11s4.2 34.8-11 43.9L254.2 256l114.3 68.6c15.2 9.1 20.1 28.7 11 43.9s-28.7 20.1-43.9 11L224 312.5V448c0 17.7-14.3 32-32 32s-32-14.3-32-32V312.5L48.5 379.4c-15.2 9.1-34.8 4.2-43.9-11s-4.2-34.8 11-43.9L129.8 256 15.5 187.4c-15.2-9.1-20.1-28.7-11-43.9s28.7-20.1 43.9-11L160 199.5V64c0-17.7 14.3-32 32-32z">
</path>
</svg></span> </div>
</div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style=" icon:true; icon-position:left; fields-font-family:arial; fields-font-color:#000000;">
<div class="row">
<div class="col-12 label svelte-1i0wzix" style="color: #000000;font-family: 'Montserrat', sans-serif;">Celular</div>
<div class="col-12 svelte-1i0wzix">
<div class="phone-wrapper svelte-1i0wzix">
<div class="prefixes svelte-1i0wzix"><select class="form-select" style="font-family: 'Montserrat', sans-serif;">
<option value="[object Object]">Afganistán (+93)</option>
<option value="[object Object]">Albania (+355)</option>
<option value="[object Object]">Algeria (+213)</option>
<option value="[object Object]">Andorra (+376)</option>
<option value="[object Object]">Angola (+244)</option>
<option value="[object Object]">Antigua y Barbuda (+1268)</option>
<option value="[object Object]">Argentina (+54)</option>
<option value="[object Object]">Armenia (+374)</option>
<option value="[object Object]">Australia (+61)</option>
<option value="[object Object]">Austria (+43)</option>
<option value="[object Object]">Azerbaiyán (+994)</option>
<option value="[object Object]">Bahamas (+1242)</option>
<option value="[object Object]">Baréin (+973)</option>
<option value="[object Object]">Bangladés (+880)</option>
<option value="[object Object]">Barbados (+1246)</option>
<option value="[object Object]">Bielorrusia (+375)</option>
<option value="[object Object]">Bélgica (+32)</option>
<option value="[object Object]">Belice (+501)</option>
<option value="[object Object]">Benín (+229)</option>
<option value="[object Object]">Bután (+975)</option>
<option value="[object Object]">Bolivia (+591)</option>
<option value="[object Object]">Bosnia y Herzegovina (+387)</option>
<option value="[object Object]">Botsuana (+267)</option>
<option value="[object Object]">Brasil (+55)</option>
<option value="[object Object]">Brunéi (+673)</option>
<option value="[object Object]">Bulgaria (+359)</option>
<option value="[object Object]">Burkina Faso (+226)</option>
<option value="[object Object]">Burundi (+257)</option>
<option value="[object Object]">Camboya (+855)</option>
<option value="[object Object]">Camerún (+237)</option>
<option value="[object Object]">Canadá (+1)</option>
<option value="[object Object]">Cabo Verde (+238)</option>
<option value="[object Object]">República Centroafricana (+236)</option>
<option value="[object Object]">Chad (+235)</option>
<option value="[object Object]">Chile (+56)</option>
<option value="[object Object]">China (+86)</option>
<option value="[object Object]">Colombia (+57)</option>
<option value="[object Object]">Comoras (+269)</option>
<option value="[object Object]">República Democrática del Congo (+242)</option>
<option value="[object Object]">República del Congo (+243)</option>
<option value="[object Object]">Costa Rica (+506)</option>
<option value="[object Object]">Costa de Marfil (+225)</option>
<option value="[object Object]">Croacia (+385)</option>
<option value="[object Object]">Cuba (+53)</option>
<option value="[object Object]">Chipre (+357)</option>
<option value="[object Object]">República Checa (+420)</option>
<option value="[object Object]">Dinamarca (+45)</option>
<option value="[object Object]">Djibouti (+253)</option>
<option value="[object Object]">Dominica (+1767)</option>
<option value="[object Object]">República Dominicana (+1)</option>
<option value="[object Object]">Timor Oriental (+670)</option>
<option value="[object Object]">Ecuador (+593)</option>
<option value="[object Object]">Egipto (+20)</option>
<option value="[object Object]">El Salvador (+503)</option>
<option value="[object Object]">Guinea Ecuatorial (+240)</option>
<option value="[object Object]">Eritrea (+291)</option>
<option value="[object Object]">Estonia (+372)</option>
<option value="[object Object]">Etiopía (+251)</option>
<option value="[object Object]">Fiyi (+679)</option>
<option value="[object Object]">Finlandia (+358)</option>
<option value="[object Object]">Francia (+33)</option>
<option value="[object Object]">Gabón (+241)</option>
<option value="[object Object]">Gambia (+220)</option>
<option value="[object Object]">Georgia (+995)</option>
<option value="[object Object]">Alemania (+49)</option>
<option value="[object Object]">Ghana (+233)</option>
<option value="[object Object]">Grecia (+30)</option>
<option value="[object Object]">Granada (+1473)</option>
<option value="[object Object]">Guatemala (+502)</option>
<option value="[object Object]">Guinea (+224)</option>
<option value="[object Object]">Guinea-Bisáu (+245)</option>
<option value="[object Object]">Guyana (+592)</option>
<option value="[object Object]">Haití (+509)</option>
<option value="[object Object]">Honduras (+504)</option>
<option value="[object Object]">Hungría (+36)</option>
<option value="[object Object]">Islandia (+354)</option>
<option value="[object Object]">India (+91)</option>
<option value="[object Object]">Indonesia (+62)</option>
<option value="[object Object]">Irán (+98)</option>
<option value="[object Object]">Irak (+964)</option>
<option value="[object Object]">Irlanda (+353)</option>
<option value="[object Object]">Israel (+972)</option>
<option value="[object Object]">Italia (+39)</option>
<option value="[object Object]">Jamaica (+1876)</option>
<option value="[object Object]">Japón (+81)</option>
<option value="[object Object]">Jordania (+962)</option>
<option value="[object Object]">Kazajistán (+7)</option>
<option value="[object Object]">Kenia (+254)</option>
<option value="[object Object]">Kiribati (+686)</option>
<option value="[object Object]">Corea del Norte (+850)</option>
<option value="[object Object]">Corea del Sur (+82)</option>
<option value="[object Object]">Kuwait (+965)</option>
<option value="[object Object]">Kirguistán (+7)</option>
<option value="[object Object]">Laos (+856)</option>
<option value="[object Object]">Letonia (+371)</option>
<option value="[object Object]">Líbano (+961)</option>
<option value="[object Object]">Lesoto (+266)</option>
<option value="[object Object]">Liberia (+231)</option>
<option value="[object Object]">Libia (+218)</option>
<option value="[object Object]">Liechtenstein (+423)</option>
<option value="[object Object]">Lituania (+370)</option>
<option value="[object Object]">Luxemburgo (+352)</option>
<option value="[object Object]">Macedonia (+389)</option>
<option value="[object Object]">Madagascar (+261)</option>
<option value="[object Object]">Malaui (+265)</option>
<option value="[object Object]">Malasia (+60)</option>
<option value="[object Object]">Maldivas (+960)</option>
<option value="[object Object]">Malí (+223)</option>
<option value="[object Object]">Malta (+356)</option>
<option value="[object Object]">Islas Marshall (+692)</option>
<option value="[object Object]">Mauritania (+222)</option>
<option value="[object Object]">Mauricio (+230)</option>
<option value="[object Object]">Mexico (+52)</option>
<option value="[object Object]">Micronesia (+691)</option>
<option value="[object Object]">Moldavia (+373)</option>
<option value="[object Object]">Mónaco (+377)</option>
<option value="[object Object]">Mongolia (+976)</option>
<option value="[object Object]">Montenegro (+382)</option>
<option value="[object Object]">Marruecos (+212)</option>
<option value="[object Object]">Mozambique (+258)</option>
<option value="[object Object]">Myanmar Burma (+95)</option>
<option value="[object Object]">Namibia (+264)</option>
<option value="[object Object]">Nauru (+674)</option>
<option value="[object Object]">Nepal (+977)</option>
<option value="[object Object]">Países Bajos (+31)</option>
<option value="[object Object]">Nueva Zelanda (+64)</option>
<option value="[object Object]">Nicaragua (+505)</option>
<option value="[object Object]">Níger (+227)</option>
<option value="[object Object]">Nigeria (+234)</option>
<option value="[object Object]">Noruega (+47)</option>
<option value="[object Object]">Omán (+968)</option>
<option value="[object Object]">Pakistán (+92)</option>
<option value="[object Object]">Palaos (+680)</option>
<option value="[object Object]">Panamá (+507)</option>
<option value="[object Object]">Papúa Nueva Guinea (+675)</option>
<option value="[object Object]">Paraguay (+595)</option>
<option value="[object Object]">Perú (+51)</option>
<option value="[object Object]">Filipinas (+63)</option>
<option value="[object Object]">Polonia (+48)</option>
<option value="[object Object]">Portugal (+351)</option>
<option value="[object Object]">Catar (+974)</option>
<option value="[object Object]">Rumania (+40)</option>
<option value="[object Object]">Rusia (+7)</option>
<option value="[object Object]">Ruanda (+250)</option>
<option value="[object Object]">San Cristóbal y Nieves (+1869)</option>
<option value="[object Object]">Santa Lucía (+1758)</option>
<option value="[object Object]">San Vicente y las Granadinas (+1784)</option>
<option value="[object Object]">Samoa (+685)</option>
<option value="[object Object]">San Marino (+378)</option>
<option value="[object Object]">Santo Tomé y Príncipe (+239)</option>
<option value="[object Object]">Arabia Saudita (+966)</option>
<option value="[object Object]">Senegal (+221)</option>
<option value="[object Object]">Serbia (+381)</option>
<option value="[object Object]">Seychelles (+248)</option>
<option value="[object Object]">Sierra Leona (+232)</option>
<option value="[object Object]">Singapur (+65)</option>
<option value="[object Object]">Eslovaquia (+421)</option>
<option value="[object Object]">Eslovenia (+386)</option>
<option value="[object Object]">Islas Salomón (+677)</option>
<option value="[object Object]">Somalia (+252)</option>
<option value="[object Object]">Sudáfrica (+27)</option>
<option value="[object Object]">España (+34)</option>
<option value="[object Object]">Sri Lanka (+94)</option>
<option value="[object Object]">Sudán (+249)</option>
<option value="[object Object]">Surinam (+597)</option>
<option value="[object Object]">Suazilandia (+268)</option>
<option value="[object Object]">Suecia (+46)</option>
<option value="[object Object]">Suiza (+41)</option>
<option value="[object Object]">Siria (+963)</option>
<option value="[object Object]">Tayikistán (+992)</option>
<option value="[object Object]">Tanzania (+255)</option>
<option value="[object Object]">Tailandia (+66)</option>
<option value="[object Object]">Togo (+228)</option>
<option value="[object Object]">Tonga (+676)</option>
<option value="[object Object]">Trinidad y Tobago (+1868)</option>
<option value="[object Object]">Túnez (+216)</option>
<option value="[object Object]">Turquía (+90)</option>
<option value="[object Object]">Turkmenistán (+993)</option>
<option value="[object Object]">Tuvalu (+688)</option>
<option value="[object Object]">Uganda (+256)</option>
<option value="[object Object]">Ucrania (+380)</option>
<option value="[object Object]">Emiratos Árabes Unidos (+971)</option>
<option value="[object Object]">Reino Unido (+44)</option>
<option value="[object Object]">Estados Unidos (+1)</option>
<option value="[object Object]">Uruguay (+598)</option>
<option value="[object Object]">Uzbekistán (+998)</option>
<option value="[object Object]">Vanuatu (+678)</option>
<option value="[object Object]">Vaticano (+379)</option>
<option value="[object Object]">Venezuela (+58)</option>
<option value="[object Object]">Vietnam (+84)</option>
<option value="[object Object]">Yemen (+967)</option>
<option value="[object Object]">Zambia (+260)</option>
<option value="[object Object]">Zimbabue (+263)</option>
<option value="[object Object]">Taiwán (+886)</option>
<option value="[object Object]">Islas Vírgenes Británicas (+1284)</option>
<option value="[object Object]">Islas Caimán (+1345)</option>
<option value="[object Object]">Islas Cook (+682)</option>
<option value="[object Object]">Curazao (+599)</option>
<option value="[object Object]">San Martín (Países Bajos) (+599)</option>
<option value="[object Object]">Bonaire, San Eustaquio y Saba (+599)</option>
<option value="[object Object]">Diego Garcia (+246)</option>
<option value="[object Object]">Islas Falkland (+500)</option>
<option value="[object Object]">Islas Feroe (+298)</option>
<option value="[object Object]">Guayana Francesa (+594)</option>
<option value="[object Object]">Polinesia Francesa (+689)</option>
<option value="[object Object]">Gibraltar (+350)</option>
<option value="[object Object]">Groenlandia (+299)</option>
<option value="[object Object]">Guadalupe (+590)</option>
<option value="[object Object]">Guam (+1671)</option>
<option value="[object Object]">Hong Kong (+852)</option>
<option value="[object Object]">Macao (+853)</option>
<option value="[object Object]">Mayotte (+262)</option>
<option value="[object Object]">Montserrat (+1664)</option>
<option value="[object Object]">Nueva Caledonia (+687)</option>
<option value="[object Object]">Niue (+683)</option>
<option value="[object Object]">Islas Marianas del Norte (+1670)</option>
<option value="[object Object]">Palestina (+970)</option>
<option value="[object Object]">Puerto Rico (+1)</option>
<option value="[object Object]">Reunión (+262)</option>
<option value="[object Object]">Santa Elena, Ascensión y Tristán de Acuña (+290)</option>
<option value="[object Object]">San Pedro y Miquelón (+508)</option>
<option value="[object Object]">Islas Turcas y Caicos (+1649)</option>
<option value="[object Object]">Islas Vírgenes de los Estados Unidos (+1340)</option>
<option value="[object Object]">Wallis y Futuna (+681)</option>
<option value="[object Object]">Samoa Americana (+1684)</option>
<option value="[object Object]">Anguila (+1264)</option>
<option value="[object Object]">Aruba (+297)</option>
<option value="[object Object]">Ascension (+247)</option>
<option value="[object Object]">Bermudas (+1441)</option>
<option value="[object Object]">Martinica (+596)</option>
<option value="[object Object]">Isla de Man (+44)</option>
</select></div>
<div class="input svelte-1i0wzix">
<div class="input-group"><span class="input-group-text svelte-1i0wzix"><svg class="icon svelte-1i0wzix" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512">
<path
d="M164.9 24.6c-7.7-18.6-28-28.5-47.4-23.2l-88 24C12.1 30.2 0 46 0 64C0 311.4 200.6 512 448 512c18 0 33.8-12.1 38.6-29.5l24-88c5.3-19.4-4.6-39.7-23.2-47.4l-96-40c-16.3-6.8-35.2-2.1-46.3 11.6L304.7 368C234.3 334.7 177.3 277.7 144 207.3L193.3 167c13.7-11.2 18.4-30 11.6-46.3l-40-96z">
</path>
</svg></span> <input class="form-control has-left-icon svelte-1i0wzix" style="font-family: 'Montserrat', sans-serif;" type="number" placeholder=""> <span class="input-group-text required-asterisk"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 384 512">
<path
d="M192 32c17.7 0 32 14.3 32 32V199.5l111.5-66.9c15.2-9.1 34.8-4.2 43.9 11s4.2 34.8-11 43.9L254.2 256l114.3 68.6c15.2 9.1 20.1 28.7 11 43.9s-28.7 20.1-43.9 11L224 312.5V448c0 17.7-14.3 32-32 32s-32-14.3-32-32V312.5L48.5 379.4c-15.2 9.1-34.8 4.2-43.9-11s-4.2-34.8 11-43.9L129.8 256 15.5 187.4c-15.2-9.1-20.1-28.7-11-43.9s28.7-20.1 43.9-11L160 199.5V64c0-17.7 14.3-32 32-32z">
</path>
</svg></span> </div>
</div>
</div>
</div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style=" fields-font-family:arial; fields-font-color:#000000; display:vertical;">
<div class="row">
<div class="label col-12 svelte-1tszlmp" style="color: #000000;font-family: 'Montserrat', sans-serif;"><span>¿Eres referido?</span> <span class="required svelte-1tszlmp">*</span></div>
<div class="col-12 svelte-1tszlmp"><select class="form-select svelte-1tszlmp" name="campoe_327" style="font-family: 'Montserrat', sans-serif;">
<option value="[object Object]">Si</option>
<option value="[object Object]">No</option>
</select> </div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style=" fields-font-family:arial; fields-font-color:#000000;">
<div class="row">
<div class="col-12 label" style="color: #000000;font-family: 'Montserrat', sans-serif;">Indícanos el número de cédula del asesor comercial</div>
<div class="col-12">
<div class="input-group"><input class="form-control svelte-1vvypfm" style="font-family: 'Montserrat', sans-serif;" type="number" placeholder=""> </div>
</div>
</div>
</div>
</div>
<div style="" class="field-container">
<div style=" fields-font-family:montserrat; fields-font-color:#000000; display:vertical; link-color:#04732F; font-size:15px;">
<div class="row">
<div class="col-12 label svelte-hgd3ce" style="color: #000000;font-family: 'Montserrat', sans-serif;"></div>
<div class="col-12 svelte-hgd3ce">
<div style="display: flex;">
<div class="form-check"><input class="form-check-input" name="consent" type="checkbox" style="width: 20px !important;height: 20px !important;" value="any"> <label for="consent" class="form-check-label"
style="color: #000000;font-family: 'Montserrat', sans-serif;">Autorizo tratamiento y protección de mis datos personales conforme a la
<a target="_blank" class="link svelte-hgd3ce" rel="noreferrer" href="https://www.gana.com.co/tratamiento-datos/" style="font-family: 'Montserrat', sans-serif;color: #04732F;">política de tratamiento de datos</a> <span
class="required svelte-hgd3ce">*</span></label></div>
</div>
</div>
</div>
</div>
</div>
<div class="field-container" style="display: flex;justify-content: center;"><small class="help error" style="font-family: 'Montserrat', sans-serif;color: #000000;"></small></div>
<div style="display: flex;justify-content: center;"><button type="button"
style="line-height: 1.5;padding: 9px 18px 9px 18px; font-size: 15px;background: linear-gradient(#04732F, #0F2B07);color: #FFFFFF;font-family: 'Montserrat', sans-serif;background-color: #0A9740;border-radius: 5px;border-width:0px;border-color:#00AEDA;border-style:solid;width: fit-content;cursor:pointer;">Enviar</button>
</div>
</form>Text Content
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