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Continuaci n se consignan, D./D a. en su calidad de 1. CERTIFICA, a efectos de la solicitud de la prestaci n por IT / Riesgo que son ciertos todos los datos que a continuaci n se consignan, Datos empresa CCC Nombre o raz n social 1. Datos empresa Nombre o raz n social Domicilio (calle/plaza/...) Localidad C digo Postal Domicilio (calle/plaza/...) CCC Provincia Localidad C digo Postal Provincia 2. Datos trabajador/a Segundo apellido Primer apellido 2. Datos trabajador/a Segun.

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