{"id":33,"date":"2024-06-19T16:10:23","date_gmt":"2024-06-19T16:10:23","guid":{"rendered":"https:\/\/reclamacionesmarsala.eurekapark.pe\/?page_id=33"},"modified":"2024-06-28T17:19:23","modified_gmt":"2024-06-28T17:19:23","slug":"inicio","status":"publish","type":"page","link":"https:\/\/reclamacionescambridge.farenet.com.pe\/","title":{"rendered":"Inicio"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"33\" class=\"elementor elementor-33\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5049535 e-flex e-con-boxed e-con e-parent\" data-id=\"5049535\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9aab61c elementor-widget elementor-widget-shortcode\" data-id=\"9aab61c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-71 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-71\" data-uid=\"69db919b372a3\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-71\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-71 forminator-design--material  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"71\"\r\n\t\t\t\t data-color-option=\"default\" data-design=\"material\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"69db919b372a3\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69db919b372a3\" id=\"forminator-field-first-name-1_69db919b372a3-label\" class=\"forminator-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Nombre\" id=\"forminator-field-first-name-1_69db919b372a3\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_69db919b372a3\" id=\"forminator-field-last-name-1_69db919b372a3-label\" class=\"forminator-label\">Apellido <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Apellido\" id=\"forminator-field-last-name-1_69db919b372a3\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-1_69db919b372a3\" id=\"forminator-form-71__field--select-1_69db919b372a3-label\" class=\"forminator-label\">Tipo de documento <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-1_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona tu tipo de documento\" data-search=\"false\" data-search-placeholder=\"Selecciona tu tipo de documento\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-1_69db919b372a3-label\"><option value=\"\"  >Selecciona tu tipo de documento<\/option><option value=\"one\"  data-calculation=\"0\">DNI<\/option><option value=\"two\"  data-calculation=\"0\">RUC<\/option><option value=\"Pasaporte\"  data-calculation=\"0\">Pasaporte<\/option><option value=\"Carnet-de-Extranjeria\"  data-calculation=\"0\">Carnet de Extranjer\u00eda<\/option><\/select><\/div><\/div><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69db919b372a3\" id=\"forminator-field-number-2_69db919b372a3-label\" class=\"forminator-label\">N\u00famero de Documento <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"70000000\" id=\"forminator-field-number-2_69db919b372a3\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"00000001\" max=\"9999999999999999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-2_69db919b372a3\" id=\"forminator-form-71__field--select-2_69db919b372a3-label\" class=\"forminator-label\">Tipo de contacto <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-2_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Tipo de contacto\" data-search=\"false\" data-search-placeholder=\"Tipo de contacto\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-2_69db919b372a3-label\"><option value=\"\"  >Tipo de contacto<\/option><option value=\"fisicaemail\"  data-calculation=\"0\">Direcci\u00f3n f\u00edsica y correo electr\u00f3nico<\/option><option value=\"two\"  data-calculation=\"0\">Solo direcci\u00f3n f\u00edsica<\/option><\/select><\/div><\/div><div id=\"email-3\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_69db919b372a3\" id=\"forminator-field-email-3_69db919b372a3-label\" class=\"forminator-label\">Correo Electr\u00f3nico <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"Correo Eletr\u00f3nico\" id=\"forminator-field-email-3_69db919b372a3\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69db919b372a3\" id=\"forminator-field-address-1-street_address_69db919b372a3-label\" class=\"forminator-label\">Direcci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Direcci\u00f3n\" id=\"forminator-field-address-1-street_address_69db919b372a3\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-6_69db919b372a3\" id=\"forminator-form-71__field--select-6_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Departamento <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-6_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Departamento\" data-search=\"false\" data-search-placeholder=\"Seleccionar Departamento\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-6_69db919b372a3-label\"><option value=\"\"  >Seleccionar Departamento<\/option><option value=\"one\"  data-calculation=\"0\">Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">\u00c1ncash<\/option><option value=\"Apur\u00edmac\"  data-calculation=\"0\">Apur\u00edmac<\/option><option value=\"Arequipa\"  data-calculation=\"0\">Arequipa<\/option><option value=\"Ayacucho\"  data-calculation=\"0\">Ayacucho<\/option><option value=\"Cajamarca\"  data-calculation=\"0\">Cajamarca<\/option><option value=\"Cusco\"  data-calculation=\"0\">Cusco<\/option><option value=\"Huancavelica\"  data-calculation=\"0\">Huancavelica<\/option><option value=\"Hu\u00e1nuco\"  data-calculation=\"0\">Hu\u00e1nuco<\/option><option value=\"Ica\"  data-calculation=\"0\">Ica<\/option><option value=\"Jun\u00edn\"  data-calculation=\"0\">Jun\u00edn<\/option><option value=\"La-Libertad\"  data-calculation=\"0\">La Libertad<\/option><option value=\"Lambayeque\"  data-calculation=\"0\">Lambayeque<\/option><option value=\"Lima\"  data-calculation=\"0\">Lima<\/option><option value=\"Loreto\"  data-calculation=\"0\">Loreto<\/option><option value=\"Madre-de-Dios\"  data-calculation=\"0\">Madre de Dios<\/option><option value=\"Moquegua\"  data-calculation=\"0\">Moquegua<\/option><option value=\"Pasco\"  data-calculation=\"0\">Pasco<\/option><option value=\"Piura\"  data-calculation=\"0\">Piura<\/option><option value=\"Puno\"  data-calculation=\"0\">Puno<\/option><option value=\"San-Mart\u00edn\"  data-calculation=\"0\">San Mart\u00edn<\/option><option value=\"Tacna\"  data-calculation=\"0\">Tacna<\/option><option value=\"Tumbes\"  data-calculation=\"0\">Tumbes<\/option><option value=\"Ucayali\"  data-calculation=\"0\">Ucayali<\/option><option value=\"Provincia-Constitucional-del-Callao\"  data-calculation=\"0\">Provincia Constitucional del Callao<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Amazonas<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-7_69db919b372a3\" id=\"forminator-form-71__field--select-7_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Amazonas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-7_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-7\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Amazonas\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Amazonas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-7_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Amazonas<\/option><option value=\"one\"  data-calculation=\"0\">Bagua<\/option><option value=\"two\"  data-calculation=\"0\">Bongar\u00e1<\/option><option value=\"Apur\u00edmac\"  data-calculation=\"0\">Chachapoyas<\/option><option value=\"Arequipa\"  data-calculation=\"0\">Condorcanqui<\/option><option value=\"Ayacucho\"  data-calculation=\"0\">Luya<\/option><option value=\"Cajamarca\"  data-calculation=\"0\">Rodr\u00edguez de Mendoza<\/option><option value=\"Cusco\"  data-calculation=\"0\">Utcubamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-8_69db919b372a3\" id=\"forminator-form-71__field--select-8_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Distrito - Bagua <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-8_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Distrito - Bagua\" data-search=\"false\" data-search-placeholder=\"Seleccionar Distrito - Bagua\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-8_69db919b372a3-label\"><option value=\"\"  >Seleccionar Distrito - Bagua<\/option><option value=\"one\"  data-calculation=\"0\">Aramango<\/option><option value=\"two\"  data-calculation=\"0\">Bagua<\/option><option value=\"Copall\u00edn\"  data-calculation=\"0\">Copall\u00edn<\/option><option value=\"El-Parco\"  data-calculation=\"0\">El Parco<\/option><option value=\"Imaza\"  data-calculation=\"0\">Imaza<\/option><option value=\"La-Peca\"  data-calculation=\"0\">La Peca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-9_69db919b372a3\" id=\"forminator-form-71__field--select-9_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Bongar\u00e1 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-9_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Bongar\u00e1\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Bongar\u00e1\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-9_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Bongar\u00e1<\/option><option value=\"one\"  data-calculation=\"0\">Chisquilla<\/option><option value=\"two\"  data-calculation=\"0\">Churuja<\/option><option value=\"Corosha\"  data-calculation=\"0\">Corosha<\/option><option value=\"Cuispes\"  data-calculation=\"0\">Cuispes<\/option><option value=\"Florida\"  data-calculation=\"0\">Florida<\/option><option value=\"Jumbilla\"  data-calculation=\"0\">Jumbilla<\/option><option value=\"Recta\"  data-calculation=\"0\">Recta<\/option><option value=\"San-Carlos\"  data-calculation=\"0\">San Carlos<\/option><option value=\"Shipasbamba\"  data-calculation=\"0\">Shipasbamba<\/option><option value=\"Valera\"  data-calculation=\"0\">Valera<\/option><option value=\"Yambrasbamba\"  data-calculation=\"0\">Yambrasbamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-10_69db919b372a3\" id=\"forminator-form-71__field--select-10_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chachapoyas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-10_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-10\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chachapoyas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chachapoyas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-10_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chachapoyas<\/option><option value=\"one\"  data-calculation=\"0\">Asunci\u00f3n<\/option><option value=\"two\"  data-calculation=\"0\">Balsas<\/option><option value=\"Chachapoyas\"  data-calculation=\"0\">Chachapoyas<\/option><option value=\"Cheto\"  data-calculation=\"0\">Cheto<\/option><option value=\"Chiliqu\u00edn\"  data-calculation=\"0\">Chiliqu\u00edn<\/option><option value=\"Chuquibamba\"  data-calculation=\"0\">Chuquibamba<\/option><option value=\"Granada\"  data-calculation=\"0\">Granada<\/option><option value=\"Huancas\"  data-calculation=\"0\">Huancas<\/option><option value=\"La-Jalca\"  data-calculation=\"0\">La Jalca<\/option><option value=\"Leimebamba\"  data-calculation=\"0\">Leimebamba<\/option><option value=\"Levanto\"  data-calculation=\"0\">Levanto<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Mariscal-Castilla\"  data-calculation=\"0\">Mariscal Castilla<\/option><option value=\"Molinopampa\"  data-calculation=\"0\">Molinopampa<\/option><option value=\"Montevideo\"  data-calculation=\"0\">Montevideo<\/option><option value=\"Olleros\"  data-calculation=\"0\">Olleros<\/option><option value=\"Quinjalca\"  data-calculation=\"0\">Quinjalca<\/option><option value=\"San-Francisco-de-Daguas\"  data-calculation=\"0\">San Francisco de Daguas<\/option><option value=\"San-Isidro-de-Maino\"  data-calculation=\"0\">San Isidro de Maino<\/option><option value=\"Soloco\"  data-calculation=\"0\">Soloco<\/option><option value=\"Sonche\"  data-calculation=\"0\">Sonche<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-11_69db919b372a3\" id=\"forminator-form-71__field--select-11_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Condorcanqui <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-11_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-11\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Condorcanqui\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Condorcanqui\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-11_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Condorcanqui<\/option><option value=\"one\"  data-calculation=\"0\">El Cenepa<\/option><option value=\"two\"  data-calculation=\"0\">Nieva<\/option><option value=\"R\u00edo-Santiago\"  data-calculation=\"0\">R\u00edo Santiago<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-12_69db919b372a3\" id=\"forminator-form-71__field--select-12_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Luya <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-12_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-12\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Luya\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Luya\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-12_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Luya<\/option><option value=\"one\"  data-calculation=\"0\">Camporredondo<\/option><option value=\"two\"  data-calculation=\"0\">Cocabamba<\/option><option value=\"Colcamar\"  data-calculation=\"0\">Colcamar<\/option><option value=\"Conila\"  data-calculation=\"0\">Conila<\/option><option value=\"Inguilpata\"  data-calculation=\"0\">Inguilpata<\/option><option value=\"Lamud\"  data-calculation=\"0\">Lamud<\/option><option value=\"Longuita\"  data-calculation=\"0\">Longuita<\/option><option value=\"Lonya-Chico\"  data-calculation=\"0\">Lonya Chico<\/option><option value=\"Luya\"  data-calculation=\"0\">Luya<\/option><option value=\"Luya-Viejo\"  data-calculation=\"0\">Luya Viejo<\/option><option value=\"Mar\u00eda\"  data-calculation=\"0\">Mar\u00eda<\/option><option value=\"Ocalli\"  data-calculation=\"0\">Ocalli<\/option><option value=\"Ocumal\"  data-calculation=\"0\">Ocumal<\/option><option value=\"Pisuqu\u00eda\"  data-calculation=\"0\">Pisuqu\u00eda<\/option><option value=\"Providencia\"  data-calculation=\"0\">Providencia<\/option><option value=\"San-Crist\u00f3bal\"  data-calculation=\"0\">San Crist\u00f3bal<\/option><option value=\"San-Francisco-del-Yeso\"  data-calculation=\"0\">San Francisco del Yeso<\/option><option value=\"San-Jer\u00f3nimo\"  data-calculation=\"0\">San Jer\u00f3nimo<\/option><option value=\"San-Juan-de-Lopecancha\"  data-calculation=\"0\">San Juan de Lopecancha<\/option><option value=\"Santa-Catalina\"  data-calculation=\"0\">Santa Catalina<\/option><option value=\"Santo-Tom\u00e1s\"  data-calculation=\"0\">Santo Tom\u00e1s<\/option><option value=\"Tingo\"  data-calculation=\"0\">Tingo<\/option><option value=\"Trita\"  data-calculation=\"0\">Trita<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-13_69db919b372a3\" id=\"forminator-form-71__field--select-13_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Rodriguez de Mendoza <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-13_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-13\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Rodriguez de Mendoza\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Rodriguez de Mendoza\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-13_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Rodriguez de Mendoza<\/option><option value=\"one\"  data-calculation=\"0\">Chirimoto<\/option><option value=\"two\"  data-calculation=\"0\">Cochamal<\/option><option value=\"Huambo\"  data-calculation=\"0\">Huambo<\/option><option value=\"Limabamba\"  data-calculation=\"0\">Limabamba<\/option><option value=\"Longar\"  data-calculation=\"0\">Longar<\/option><option value=\"Mariscal-Benavides\"  data-calculation=\"0\">Mariscal Benavides<\/option><option value=\"Milpuc\"  data-calculation=\"0\">Milpuc<\/option><option value=\"Omia\"  data-calculation=\"0\">Omia<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Totora\"  data-calculation=\"0\">Totora<\/option><option value=\"Vista-Alegre\"  data-calculation=\"0\">Vista Alegre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-14\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-14_69db919b372a3\" id=\"forminator-form-71__field--select-14_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Utcubamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-14_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-14\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Utcubamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Utcubamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-14_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Utcubamba<\/option><option value=\"one\"  data-calculation=\"0\">Bagua Grande<\/option><option value=\"two\"  data-calculation=\"0\">Cajaruro<\/option><option value=\"Cumba\"  data-calculation=\"0\">Cumba<\/option><option value=\"El-Milagro\"  data-calculation=\"0\">El Milagro<\/option><option value=\"Jamalca\"  data-calculation=\"0\">Jamalca<\/option><option value=\"Lonya-Grande\"  data-calculation=\"0\">Lonya Grande<\/option><option value=\"Yam\u00f3n\"  data-calculation=\"0\">Yam\u00f3n<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Ancash<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-15\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-15_69db919b372a3\" id=\"forminator-form-71__field--select-15_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Ancash <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-15_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-15\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Ancash\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Ancash\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-15_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Ancash<\/option><option value=\"one\"  data-calculation=\"0\">Aija<\/option><option value=\"two\"  data-calculation=\"0\">Antonio Raymondi<\/option><option value=\"Asunci\u00f3n\"  data-calculation=\"0\">Asunci\u00f3n<\/option><option value=\"Bolognesi\"  data-calculation=\"0\">Bolognesi<\/option><option value=\"Carhuaz\"  data-calculation=\"0\">Carhuaz<\/option><option value=\"Carlos-Ferm\u00edn-Fitzcarrald\"  data-calculation=\"0\">Carlos Ferm\u00edn Fitzcarrald<\/option><option value=\"Casma\"  data-calculation=\"0\">Casma<\/option><option value=\"Corongo\"  data-calculation=\"0\">Corongo<\/option><option value=\"Huaraz\"  data-calculation=\"0\">Huaraz<\/option><option value=\"Huari\"  data-calculation=\"0\">Huari<\/option><option value=\"Huarmey\"  data-calculation=\"0\">Huarmey<\/option><option value=\"Huaylas\"  data-calculation=\"0\">Huaylas<\/option><option value=\"Mariscal-Luzuriaga\"  data-calculation=\"0\">Mariscal Luzuriaga<\/option><option value=\"Ocros\"  data-calculation=\"0\">Ocros<\/option><option value=\"Pallasca\"  data-calculation=\"0\">Pallasca<\/option><option value=\"Pomabamba\"  data-calculation=\"0\">Pomabamba<\/option><option value=\"Recuay\"  data-calculation=\"0\">Recuay<\/option><option value=\"Santa\"  data-calculation=\"0\">Santa<\/option><option value=\"Sihuas\"  data-calculation=\"0\">Sihuas<\/option><option value=\"Yungay\"  data-calculation=\"0\">Yungay<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-42\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-42_69db919b372a3\" id=\"forminator-form-71__field--select-42_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Aija <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-42_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-42\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Aija\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Aija\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-42_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Aija<\/option><option value=\"one\"  data-calculation=\"0\">Aija<\/option><option value=\"two\"  data-calculation=\"0\">Coris<\/option><option value=\"Huacll\u00e1n\"  data-calculation=\"0\">Huacll\u00e1n<\/option><option value=\"La-Merced\"  data-calculation=\"0\">La Merced<\/option><option value=\"Succha\"  data-calculation=\"0\">Succha<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-43\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-43_69db919b372a3\" id=\"forminator-form-71__field--select-43_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Antonio Raymondi <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-43_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-43\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Antonio Raymondi\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Antonio Raymondi\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-43_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Antonio Raymondi<\/option><option value=\"one\"  data-calculation=\"0\">Aczo<\/option><option value=\"two\"  data-calculation=\"0\">Chaccho<\/option><option value=\"Chingas\"  data-calculation=\"0\">Chingas<\/option><option value=\"Llamell\u00edn\"  data-calculation=\"0\">Llamell\u00edn<\/option><option value=\"Mirgas\"  data-calculation=\"0\">Mirgas<\/option><option value=\"San-Juan-de-Rontoy\"  data-calculation=\"0\">San Juan de Rontoy<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-48\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-48_69db919b372a3\" id=\"forminator-form-71__field--select-48_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Asunci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-48_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-48\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - de Asunci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - de Asunci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-48_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - de Asunci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Chacas<\/option><option value=\"two\"  data-calculation=\"0\">Acochaca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-47\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-47_69db919b372a3\" id=\"forminator-form-71__field--select-47_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Bolognesi <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-47_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-47\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Bolognesi\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Bolognesi\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-47_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Bolognesi<\/option><option value=\"one\"  data-calculation=\"0\">Abelardo Pardo Lezameta<\/option><option value=\"two\"  data-calculation=\"0\">Antonio Raymondi<\/option><option value=\"Aquia\"  data-calculation=\"0\">Aquia<\/option><option value=\"Chiqui\u00e1n\"  data-calculation=\"0\">Chiqui\u00e1n<\/option><option value=\"Huallanca\"  data-calculation=\"0\">Huallanca<\/option><option value=\"Huasta\"  data-calculation=\"0\">Huasta<\/option><option value=\"Huayllacay\u00e1n\"  data-calculation=\"0\">Huayllacay\u00e1n<\/option><option value=\"La-Primavera\"  data-calculation=\"0\">La Primavera<\/option><option value=\"Mangas\"  data-calculation=\"0\">Mangas<\/option><option value=\"Pacll\u00f3n\"  data-calculation=\"0\">Pacll\u00f3n<\/option><option value=\"San-Miguel-de-Corpanqui\"  data-calculation=\"0\">San Miguel de Corpanqui<\/option><option value=\"Ticllos\"  data-calculation=\"0\">Ticllos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-46\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-46_69db919b372a3\" id=\"forminator-form-71__field--select-46_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Carhuaz <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-46_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-46\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Carhuaz\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Carhuaz\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-46_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Carhuaz<\/option><option value=\"one\"  data-calculation=\"0\">Carhuaz<\/option><option value=\"two\"  data-calculation=\"0\">Acopampa<\/option><option value=\"Amashca\"  data-calculation=\"0\">Amashca<\/option><option value=\"Anta\"  data-calculation=\"0\">Anta<\/option><option value=\"Ataquero\"  data-calculation=\"0\">Ataquero<\/option><option value=\"Marcar\u00e1\"  data-calculation=\"0\">Marcar\u00e1<\/option><option value=\"Pariacoto\"  data-calculation=\"0\">Pariacoto<\/option><option value=\"San-Miguel-de-Aco\"  data-calculation=\"0\">San Miguel de Aco<\/option><option value=\"Shilla\"  data-calculation=\"0\">Shilla<\/option><option value=\"Tinco\"  data-calculation=\"0\">Tinco<\/option><option value=\"Yungar\"  data-calculation=\"0\">Yungar<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-45\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-45_69db919b372a3\" id=\"forminator-form-71__field--select-45_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Carlos Ferm\u00edn Fitzcarrald <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-45_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-45\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Carlos Ferm\u00edn Fitzcarrald\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Carlos Ferm\u00edn Fitzcarrald\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-45_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Carlos Ferm\u00edn Fitzcarrald<\/option><option value=\"one\"  data-calculation=\"0\">San Luis<\/option><option value=\"two\"  data-calculation=\"0\">San Nicol\u00e1s<\/option><option value=\"Yauya\"  data-calculation=\"0\">Yauya<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-44\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-44_69db919b372a3\" id=\"forminator-form-71__field--select-44_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Casma <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-44_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-44\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Casma\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Casma\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-44_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Casma<\/option><option value=\"one\"  data-calculation=\"0\">Casma<\/option><option value=\"two\"  data-calculation=\"0\">Buena Vista Alta<\/option><option value=\"Comandante-Noel\"  data-calculation=\"0\">Comandante Noel<\/option><option value=\"Yaut\u00e1n\"  data-calculation=\"0\">Yaut\u00e1n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-49\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-49_69db919b372a3\" id=\"forminator-form-71__field--select-49_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Corongo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-49_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-49\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Corongo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Corongo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-49_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Corongo<\/option><option value=\"one\"  data-calculation=\"0\">Corongo<\/option><option value=\"two\"  data-calculation=\"0\">Aco<\/option><option value=\"Bambas\"  data-calculation=\"0\">Bambas<\/option><option value=\"Cusca\"  data-calculation=\"0\">Cusca<\/option><option value=\"La-Pampa\"  data-calculation=\"0\">La Pampa<\/option><option value=\"Yanac\"  data-calculation=\"0\">Yanac<\/option><option value=\"Yupan\"  data-calculation=\"0\">Yupan<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-52\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-52_69db919b372a3\" id=\"forminator-form-71__field--select-52_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huaraz <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-52_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-52\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huaraz\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huaraz\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-52_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huaraz<\/option><option value=\"one\"  data-calculation=\"0\">Huaraz<\/option><option value=\"two\"  data-calculation=\"0\">Cochabamba<\/option><option value=\"Colcabamba\"  data-calculation=\"0\">Colcabamba<\/option><option value=\"Huanchay\"  data-calculation=\"0\">Huanchay<\/option><option value=\"Independencia\"  data-calculation=\"0\">Independencia<\/option><option value=\"Jangas\"  data-calculation=\"0\">Jangas<\/option><option value=\"La-Libertad\"  data-calculation=\"0\">La Libertad<\/option><option value=\"Olleros\"  data-calculation=\"0\">Olleros<\/option><option value=\"Pira\"  data-calculation=\"0\">Pira<\/option><option value=\"Tarica\"  data-calculation=\"0\">Tarica<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-51\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-51_69db919b372a3\" id=\"forminator-form-71__field--select-51_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huari <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-51_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-51\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huari\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huari\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-51_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huari<\/option><option value=\"one\"  data-calculation=\"0\">Huari<\/option><option value=\"two\"  data-calculation=\"0\">Anra<\/option><option value=\"Cajay\"  data-calculation=\"0\">Cajay<\/option><option value=\"Chav\u00edn-de-Huantar\"  data-calculation=\"0\">Chav\u00edn de Huantar<\/option><option value=\"Huacachi\"  data-calculation=\"0\">Huacachi<\/option><option value=\"Huacchis\"  data-calculation=\"0\">Huacchis<\/option><option value=\"Huachis\"  data-calculation=\"0\">Huachis<\/option><option value=\"Hu\u00e1ntar\"  data-calculation=\"0\">Hu\u00e1ntar<\/option><option value=\"Masin\"  data-calculation=\"0\">Masin<\/option><option value=\"Paucas\"  data-calculation=\"0\">Paucas<\/option><option value=\"Pont\u00f3\"  data-calculation=\"0\">Pont\u00f3<\/option><option value=\"Rahuapampa\"  data-calculation=\"0\">Rahuapampa<\/option><option value=\"Rapay\u00e1n\"  data-calculation=\"0\">Rapay\u00e1n<\/option><option value=\"San-Marcos\"  data-calculation=\"0\">San Marcos<\/option><option value=\"San-Pedro-de-Chan\u00e1\"  data-calculation=\"0\">San Pedro de Chan\u00e1<\/option><option value=\"Uco\"  data-calculation=\"0\">Uco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-50\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-50_69db919b372a3\" id=\"forminator-form-71__field--select-50_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huarmey <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-50_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-50\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huarmey\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huarmey\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-50_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huarmey<\/option><option value=\"one\"  data-calculation=\"0\">Huarmey<\/option><option value=\"two\"  data-calculation=\"0\">Culebras<\/option><option value=\"Huayan\"  data-calculation=\"0\">Huayan<\/option><option value=\"Malvas\"  data-calculation=\"0\">Malvas<\/option><option value=\"Cochapeti\"  data-calculation=\"0\">Cochapeti<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-55\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-55_69db919b372a3\" id=\"forminator-form-71__field--select-55_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huaylas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-55_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-55\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huaylas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huaylas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-55_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huaylas<\/option><option value=\"one\"  data-calculation=\"0\">Caraz<\/option><option value=\"two\"  data-calculation=\"0\">Huallanca<\/option><option value=\"Huata\"  data-calculation=\"0\">Huata<\/option><option value=\"Huaylas\"  data-calculation=\"0\">Huaylas<\/option><option value=\"Mato\"  data-calculation=\"0\">Mato<\/option><option value=\"Pampacocha\"  data-calculation=\"0\">Pampacocha<\/option><option value=\"Pueblo-Libre\"  data-calculation=\"0\">Pueblo Libre<\/option><option value=\"Santa-Cruz\"  data-calculation=\"0\">Santa Cruz<\/option><option value=\"Santo-Toribio\"  data-calculation=\"0\">Santo Toribio<\/option><option value=\"Yuracmarca\"  data-calculation=\"0\">Yuracmarca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-54\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-54_69db919b372a3\" id=\"forminator-form-71__field--select-54_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Mariscal Luzuriaga <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-54_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-54\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Mariscal Luzuriaga\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Mariscal Luzuriaga\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-54_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Mariscal Luzuriaga<\/option><option value=\"one\"  data-calculation=\"0\">Piscobamba<\/option><option value=\"two\"  data-calculation=\"0\">Casca<\/option><option value=\"Eleazar-Guzm\u00e1n-Barr\u00f3n\"  data-calculation=\"0\">Eleazar Guzm\u00e1n Barr\u00f3n<\/option><option value=\"Fidel-Olivas-Escudero\"  data-calculation=\"0\">Fidel Olivas Escudero<\/option><option value=\"Llama\"  data-calculation=\"0\">Llama<\/option><option value=\"Llumpa\"  data-calculation=\"0\">Llumpa<\/option><option value=\"Musga\"  data-calculation=\"0\">Musga<\/option><option value=\"Lucma\"  data-calculation=\"0\">Lucma<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-53\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-53_69db919b372a3\" id=\"forminator-form-71__field--select-53_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ocros <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-53_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-53\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ocros\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ocros\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-53_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ocros<\/option><option value=\"one\"  data-calculation=\"0\">Ocros<\/option><option value=\"two\"  data-calculation=\"0\">Acas<\/option><option value=\"Cajamarquilla\"  data-calculation=\"0\">Cajamarquilla<\/option><option value=\"Carhuapampa\"  data-calculation=\"0\">Carhuapampa<\/option><option value=\"Cochas\"  data-calculation=\"0\">Cochas<\/option><option value=\"Congas\"  data-calculation=\"0\">Congas<\/option><option value=\"Llipa\"  data-calculation=\"0\">Llipa<\/option><option value=\"San-Crist\u00f3bal-de-Raj\u00e1n\"  data-calculation=\"0\">San Crist\u00f3bal de Raj\u00e1n<\/option><option value=\"San-Pedro\"  data-calculation=\"0\">San Pedro<\/option><option value=\"Santiago-de-Chilcas\"  data-calculation=\"0\">Santiago de Chilcas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-58\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-58_69db919b372a3\" id=\"forminator-form-71__field--select-58_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pallasca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-58_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-58\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pallasca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pallasca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-58_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pallasca<\/option><option value=\"one\"  data-calculation=\"0\">Cabana<\/option><option value=\"two\"  data-calculation=\"0\">Bolognesi<\/option><option value=\"Conchucos\"  data-calculation=\"0\">Conchucos<\/option><option value=\"Huacaschuque\"  data-calculation=\"0\">Huacaschuque<\/option><option value=\"Huandoval\"  data-calculation=\"0\">Huandoval<\/option><option value=\"Lacabamba\"  data-calculation=\"0\">Lacabamba<\/option><option value=\"Llapo\"  data-calculation=\"0\">Llapo<\/option><option value=\"Pallasca\"  data-calculation=\"0\">Pallasca<\/option><option value=\"Pampas\"  data-calculation=\"0\">Pampas<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Tauca\"  data-calculation=\"0\">Tauca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-57\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-57_69db919b372a3\" id=\"forminator-form-71__field--select-57_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pomabamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-57_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-57\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pomabamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pomabamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-57_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pomabamba<\/option><option value=\"one\"  data-calculation=\"0\">Pomabamba<\/option><option value=\"two\"  data-calculation=\"0\">Huayll\u00e1n<\/option><option value=\"Parobamba\"  data-calculation=\"0\">Parobamba<\/option><option value=\"Quinuabamba\"  data-calculation=\"0\">Quinuabamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-56\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-56_69db919b372a3\" id=\"forminator-form-71__field--select-56_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Recuay <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-56_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-56\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Recuay\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Recuay\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-56_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Recuay<\/option><option value=\"one\"  data-calculation=\"0\">Recuay<\/option><option value=\"two\"  data-calculation=\"0\">Catac<\/option><option value=\"Cotaparaco\"  data-calculation=\"0\">Cotaparaco<\/option><option value=\"Huayllapampa\"  data-calculation=\"0\">Huayllapampa<\/option><option value=\"Llacll\u00edn\"  data-calculation=\"0\">Llacll\u00edn<\/option><option value=\"Marca\"  data-calculation=\"0\">Marca<\/option><option value=\"Pampas-Chico\"  data-calculation=\"0\">Pampas Chico<\/option><option value=\"Parar\u00edn\"  data-calculation=\"0\">Parar\u00edn<\/option><option value=\"Tapacocha\"  data-calculation=\"0\">Tapacocha<\/option><option value=\"Ticapampa\"  data-calculation=\"0\">Ticapampa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-60\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-60_69db919b372a3\" id=\"forminator-form-71__field--select-60_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Santa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-60_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-60\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Santa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Santa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-60_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Santa<\/option><option value=\"one\"  data-calculation=\"0\">Chimbote<\/option><option value=\"two\"  data-calculation=\"0\">C\u00e1ceres del Per\u00fa<\/option><option value=\"Coishco\"  data-calculation=\"0\">Coishco<\/option><option value=\"Macate\"  data-calculation=\"0\">Macate<\/option><option value=\"Moro\"  data-calculation=\"0\">Moro<\/option><option value=\"Nepe\u00f1a\"  data-calculation=\"0\">Nepe\u00f1a<\/option><option value=\"Nuevo-Chimbote\"  data-calculation=\"0\">Nuevo Chimbote<\/option><option value=\"Samanco\"  data-calculation=\"0\">Samanco<\/option><option value=\"Santa\"  data-calculation=\"0\">Santa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-61\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-61_69db919b372a3\" id=\"forminator-form-71__field--select-61_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sihuas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-61_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-61\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sihuas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sihuas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-61_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sihuas<\/option><option value=\"one\"  data-calculation=\"0\">Sihuas<\/option><option value=\"two\"  data-calculation=\"0\">Acobamba<\/option><option value=\"Alfonso-Ugarte\"  data-calculation=\"0\">Alfonso Ugarte<\/option><option value=\"Cashapampa\"  data-calculation=\"0\">Cashapampa<\/option><option value=\"Chingalpo\"  data-calculation=\"0\">Chingalpo<\/option><option value=\"Huayllabamba\"  data-calculation=\"0\">Huayllabamba<\/option><option value=\"Quiches\"  data-calculation=\"0\">Quiches<\/option><option value=\"Ragash\"  data-calculation=\"0\">Ragash<\/option><option value=\"San-Juan\"  data-calculation=\"0\">San Juan<\/option><option value=\"Santiago-de-Chilcas\"  data-calculation=\"0\">Santiago de Chilcas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-62\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-62_69db919b372a3\" id=\"forminator-form-71__field--select-62_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Yungay <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-62_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-62\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Yungay\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Yungay\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-62_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Yungay<\/option><option value=\"one\"  data-calculation=\"0\">Yungay<\/option><option value=\"two\"  data-calculation=\"0\">Cascapara<\/option><option value=\"Mancos\"  data-calculation=\"0\">Mancos<\/option><option value=\"Matacoto\"  data-calculation=\"0\">Matacoto<\/option><option value=\"Quillo\"  data-calculation=\"0\">Quillo<\/option><option value=\"Ranrahirca\"  data-calculation=\"0\">Ranrahirca<\/option><option value=\"Shupluy\"  data-calculation=\"0\">Shupluy<\/option><option value=\"Yanama\"  data-calculation=\"0\">Yanama<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Apurimac<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-16\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-16_69db919b372a3\" id=\"forminator-form-71__field--select-16_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Apurimac <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-16_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-16\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Apurimac\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Apurimac\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-16_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Apurimac<\/option><option value=\"one\"  data-calculation=\"0\">Abancay<\/option><option value=\"two\"  data-calculation=\"0\">Andahuaylas<\/option><option value=\"Antabamba\"  data-calculation=\"0\">Antabamba<\/option><option value=\"Aymaraes\"  data-calculation=\"0\">Aymaraes<\/option><option value=\"Chincheros\"  data-calculation=\"0\">Chincheros<\/option><option value=\"Cotabambas\"  data-calculation=\"0\">Cotabambas<\/option><option value=\"Grau\"  data-calculation=\"0\">Grau<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-59\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-59_69db919b372a3\" id=\"forminator-form-71__field--select-59_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Abancay <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-59_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-59\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Abancay\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Abancay\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-59_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Abancay<\/option><option value=\"one\"  data-calculation=\"0\">Abancay<\/option><option value=\"two\"  data-calculation=\"0\">Chacoche<\/option><option value=\"Circa\"  data-calculation=\"0\">Circa<\/option><option value=\"Curahuasi\"  data-calculation=\"0\">Curahuasi<\/option><option value=\"Huanipaca\"  data-calculation=\"0\">Huanipaca<\/option><option value=\"Lambrama\"  data-calculation=\"0\">Lambrama<\/option><option value=\"Pichirhua\"  data-calculation=\"0\">Pichirhua<\/option><option value=\"San-Pedro-de-Cachora\"  data-calculation=\"0\">San Pedro de Cachora<\/option><option value=\"Tamburco\"  data-calculation=\"0\">Tamburco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-69\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-69_69db919b372a3\" id=\"forminator-form-71__field--select-69_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Andahuaylas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-69_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-69\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Andahuaylas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Andahuaylas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-69_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Andahuaylas<\/option><option value=\"one\"  data-calculation=\"0\">Andahuaylas<\/option><option value=\"two\"  data-calculation=\"0\">Andarapa<\/option><option value=\"Chiara\"  data-calculation=\"0\">Chiara<\/option><option value=\"Huancarama\"  data-calculation=\"0\">Huancarama<\/option><option value=\"Huancaray\"  data-calculation=\"0\">Huancaray<\/option><option value=\"Huayana\"  data-calculation=\"0\">Huayana<\/option><option value=\"Kaquiabamba\"  data-calculation=\"0\">Kaquiabamba<\/option><option value=\"Kishuara\"  data-calculation=\"0\">Kishuara<\/option><option value=\"Pacobamba\"  data-calculation=\"0\">Pacobamba<\/option><option value=\"Pacucha\"  data-calculation=\"0\">Pacucha<\/option><option value=\"Pomacocha\"  data-calculation=\"0\">Pomacocha<\/option><option value=\"San-Antonio-de-Cachi\"  data-calculation=\"0\">San Antonio de Cachi<\/option><option value=\"San-Jer\u00f3nimo\"  data-calculation=\"0\">San Jer\u00f3nimo<\/option><option value=\"San-Miguel-de-Chaccrampa\"  data-calculation=\"0\">San Miguel de Chaccrampa<\/option><option value=\"Santa-Mar\u00eda-de-Chicmo\"  data-calculation=\"0\">Santa Mar\u00eda de Chicmo<\/option><option value=\"Talavera\"  data-calculation=\"0\">Talavera<\/option><option value=\"Tumay-Huaraca\"  data-calculation=\"0\">Tumay Huaraca<\/option><option value=\"Turpo\"  data-calculation=\"0\">Turpo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-68\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-68_69db919b372a3\" id=\"forminator-form-71__field--select-68_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Antabamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-68_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-68\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Antabamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Antabamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-68_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Antabamba<\/option><option value=\"one\"  data-calculation=\"0\">Antabamba<\/option><option value=\"two\"  data-calculation=\"0\">El Oro<\/option><option value=\"Huaquirca\"  data-calculation=\"0\">Huaquirca<\/option><option value=\"Juan-Espinoza-Medrano\"  data-calculation=\"0\">Juan Espinoza Medrano<\/option><option value=\"Oropesa\"  data-calculation=\"0\">Oropesa<\/option><option value=\"Pachaconas\"  data-calculation=\"0\">Pachaconas<\/option><option value=\"Sabaino\"  data-calculation=\"0\">Sabaino<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-67\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-67_69db919b372a3\" id=\"forminator-form-71__field--select-67_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Aymaraes <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-67_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-67\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Aymaraes\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Aymaraes\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-67_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Aymaraes<\/option><option value=\"one\"  data-calculation=\"0\">Chalhuanca<\/option><option value=\"two\"  data-calculation=\"0\">Capaya<\/option><option value=\"Caraybamba\"  data-calculation=\"0\">Caraybamba<\/option><option value=\"Chapimarca\"  data-calculation=\"0\">Chapimarca<\/option><option value=\"Colcabamba\"  data-calculation=\"0\">Colcabamba<\/option><option value=\"Cotaruse\"  data-calculation=\"0\">Cotaruse<\/option><option value=\"Huayllo\"  data-calculation=\"0\">Huayllo<\/option><option value=\"Justo-Apu-Sahuaraura\"  data-calculation=\"0\">Justo Apu Sahuaraura<\/option><option value=\"Lucre\"  data-calculation=\"0\">Lucre<\/option><option value=\"Pocohuanca\"  data-calculation=\"0\">Pocohuanca<\/option><option value=\"San-Juan-de-Chac\u00f1a\"  data-calculation=\"0\">San Juan de Chac\u00f1a<\/option><option value=\"Sa\u00f1ayca\"  data-calculation=\"0\">Sa\u00f1ayca<\/option><option value=\"Soraya\"  data-calculation=\"0\">Soraya<\/option><option value=\"Tapairihua\"  data-calculation=\"0\">Tapairihua<\/option><option value=\"Tintay\"  data-calculation=\"0\">Tintay<\/option><option value=\"Toraya\"  data-calculation=\"0\">Toraya<\/option><option value=\"Yanaca\"  data-calculation=\"0\">Yanaca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-66\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-66_69db919b372a3\" id=\"forminator-form-71__field--select-66_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chincheros <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-66_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-66\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chincheros\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chincheros\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-66_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chincheros<\/option><option value=\"one\"  data-calculation=\"0\">Chincheros<\/option><option value=\"two\"  data-calculation=\"0\">Anco-Huallo<\/option><option value=\"Cocharcas\"  data-calculation=\"0\">Cocharcas<\/option><option value=\"Huaccana\"  data-calculation=\"0\">Huaccana<\/option><option value=\"Ocobamba\"  data-calculation=\"0\">Ocobamba<\/option><option value=\"Ongoy\"  data-calculation=\"0\">Ongoy<\/option><option value=\"Ranracancha\"  data-calculation=\"0\">Ranracancha<\/option><option value=\"Uranmarca\"  data-calculation=\"0\">Uranmarca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-65\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-65_69db919b372a3\" id=\"forminator-form-71__field--select-65_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cotabambas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-65_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-65\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cotabambas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cotabambas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-65_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cotabambas<\/option><option value=\"one\"  data-calculation=\"0\">Tambobamba<\/option><option value=\"two\"  data-calculation=\"0\">Coyllurqui<\/option><option value=\"Cotabambas\"  data-calculation=\"0\">Cotabambas<\/option><option value=\"Haquira\"  data-calculation=\"0\">Haquira<\/option><option value=\"Mara\"  data-calculation=\"0\">Mara<\/option><option value=\"Challhuahuacho\"  data-calculation=\"0\">Challhuahuacho<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-64\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-64_69db919b372a3\" id=\"forminator-form-71__field--select-64_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Grau <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-64_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-64\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Grau\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Grau\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-64_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Grau<\/option><option value=\"one\"  data-calculation=\"0\">Chuquibambilla<\/option><option value=\"two\"  data-calculation=\"0\">Curpahuasi<\/option><option value=\"Gamarra\"  data-calculation=\"0\">Gamarra<\/option><option value=\"Huayllati\"  data-calculation=\"0\">Huayllati<\/option><option value=\"Mamara\"  data-calculation=\"0\">Mamara<\/option><option value=\"Mara\"  data-calculation=\"0\">Mara<\/option><option value=\"Pataypampa\"  data-calculation=\"0\">Pataypampa<\/option><option value=\"Progreso\"  data-calculation=\"0\">Progreso<\/option><option value=\"San-Antonio\"  data-calculation=\"0\">San Antonio<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Turpay\"  data-calculation=\"0\">Turpay<\/option><option value=\"Vilcabamba\"  data-calculation=\"0\">Vilcabamba<\/option><option value=\"Virundo\"  data-calculation=\"0\">Virundo<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Arequipa<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-17\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-17_69db919b372a3\" id=\"forminator-form-71__field--select-17_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia - Arequipa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-17_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-17\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia - Arequipa\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia - Arequipa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-17_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia - Arequipa<\/option><option value=\"one\"  data-calculation=\"0\">Arequipa<\/option><option value=\"two\"  data-calculation=\"0\">Caman\u00e1<\/option><option value=\"Caravel\u00ed\"  data-calculation=\"0\">Caravel\u00ed<\/option><option value=\"Castilla\"  data-calculation=\"0\">Castilla<\/option><option value=\"Caylloma\"  data-calculation=\"0\">Caylloma<\/option><option value=\"Condesuyos\"  data-calculation=\"0\">Condesuyos<\/option><option value=\"Islay\"  data-calculation=\"0\">Islay<\/option><option value=\"La-Uni\u00f3n\"  data-calculation=\"0\">La Uni\u00f3n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-63\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-63_69db919b372a3\" id=\"forminator-form-71__field--select-63_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Arequipa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-63_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-63\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Arequipa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Arequipa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-63_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Arequipa<\/option><option value=\"one\"  data-calculation=\"0\">Arequipa<\/option><option value=\"two\"  data-calculation=\"0\">Alto Selva Alegre<\/option><option value=\"Cayma\"  data-calculation=\"0\">Cayma<\/option><option value=\"Cerro-Colorado\"  data-calculation=\"0\">Cerro Colorado<\/option><option value=\"Characato\"  data-calculation=\"0\">Characato<\/option><option value=\"Chiguata\"  data-calculation=\"0\">Chiguata<\/option><option value=\"Jacobo-Hunter\"  data-calculation=\"0\">Jacobo Hunter<\/option><option value=\"La-Joya\"  data-calculation=\"0\">La Joya<\/option><option value=\"Mariano-Melgar\"  data-calculation=\"0\">Mariano Melgar<\/option><option value=\"Miraflores\"  data-calculation=\"0\">Miraflores<\/option><option value=\"Mollebaya\"  data-calculation=\"0\">Mollebaya<\/option><option value=\"Paucarpata\"  data-calculation=\"0\">Paucarpata<\/option><option value=\"Pocsi\"  data-calculation=\"0\">Pocsi<\/option><option value=\"Polobaya\"  data-calculation=\"0\">Polobaya<\/option><option value=\"Queque\u00f1a\"  data-calculation=\"0\">Queque\u00f1a<\/option><option value=\"Saband\u00eda\"  data-calculation=\"0\">Saband\u00eda<\/option><option value=\"Sachaca\"  data-calculation=\"0\">Sachaca<\/option><option value=\"San-Juan-de-Siguas\"  data-calculation=\"0\">San Juan de Siguas<\/option><option value=\"San-Juan-de-Tarucani\"  data-calculation=\"0\">San Juan de Tarucani<\/option><option value=\"Santa-Isabel-de-Siguas\"  data-calculation=\"0\">Santa Isabel de Siguas<\/option><option value=\"Santa-Rita-de-Siguas\"  data-calculation=\"0\">Santa Rita de Siguas<\/option><option value=\"Socabaya\"  data-calculation=\"0\">Socabaya<\/option><option value=\"Tiabaya\"  data-calculation=\"0\">Tiabaya<\/option><option value=\"Uchumayo\"  data-calculation=\"0\">Uchumayo<\/option><option value=\"V\u00edtor\"  data-calculation=\"0\">V\u00edtor<\/option><option value=\"Yanahuara\"  data-calculation=\"0\">Yanahuara<\/option><option value=\"Yarabamba\"  data-calculation=\"0\">Yarabamba<\/option><option value=\"Yura\"  data-calculation=\"0\">Yura<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-70\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-70_69db919b372a3\" id=\"forminator-form-71__field--select-70_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Caman\u00e1 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-70_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-70\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Caman\u00e1\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Caman\u00e1\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-70_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Caman\u00e1<\/option><option value=\"one\"  data-calculation=\"0\">Caman\u00e1<\/option><option value=\"two\"  data-calculation=\"0\">Jos\u00e9 Mar\u00eda Quimper<\/option><option value=\"Mariscal-C\u00e1ceres\"  data-calculation=\"0\">Mariscal C\u00e1ceres<\/option><option value=\"Nicol\u00e1s-de-Pi\u00e9rola\"  data-calculation=\"0\">Nicol\u00e1s de Pi\u00e9rola<\/option><option value=\"Oco\u00f1a\"  data-calculation=\"0\">Oco\u00f1a<\/option><option value=\"Quilca\"  data-calculation=\"0\">Quilca<\/option><option value=\"Samuel-Pastor\"  data-calculation=\"0\">Samuel Pastor<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-74\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-74_69db919b372a3\" id=\"forminator-form-71__field--select-74_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Caravel\u00ed <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-74_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-74\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Caravel\u00ed\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Caravel\u00ed\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-74_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Caravel\u00ed<\/option><option value=\"one\"  data-calculation=\"0\">Caravel\u00ed<\/option><option value=\"two\"  data-calculation=\"0\">Acar\u00ed<\/option><option value=\"Atico\"  data-calculation=\"0\">Atico<\/option><option value=\"Atiquipa\"  data-calculation=\"0\">Atiquipa<\/option><option value=\"Bella-Uni\u00f3n\"  data-calculation=\"0\">Bella Uni\u00f3n<\/option><option value=\"Cahuacho\"  data-calculation=\"0\">Cahuacho<\/option><option value=\"Chala\"  data-calculation=\"0\">Chala<\/option><option value=\"Chaparra\"  data-calculation=\"0\">Chaparra<\/option><option value=\"Huanuhuanu\"  data-calculation=\"0\">Huanuhuanu<\/option><option value=\"Jaqui\"  data-calculation=\"0\">Jaqui<\/option><option value=\"Lomas\"  data-calculation=\"0\">Lomas<\/option><option value=\"Quicacha\"  data-calculation=\"0\">Quicacha<\/option><option value=\"Yauca\"  data-calculation=\"0\">Yauca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-75\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-75_69db919b372a3\" id=\"forminator-form-71__field--select-75_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Castilla <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-75_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-75\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Castilla\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Castilla\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-75_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Castilla<\/option><option value=\"one\"  data-calculation=\"0\">Aplao<\/option><option value=\"two\"  data-calculation=\"0\">Andagua<\/option><option value=\"Ayo\"  data-calculation=\"0\">Ayo<\/option><option value=\"Chachas\"  data-calculation=\"0\">Chachas<\/option><option value=\"Chilcaymarca\"  data-calculation=\"0\">Chilcaymarca<\/option><option value=\"Choco\"  data-calculation=\"0\">Choco<\/option><option value=\"Huancarqui\"  data-calculation=\"0\">Huancarqui<\/option><option value=\"Machaguay\"  data-calculation=\"0\">Machaguay<\/option><option value=\"Orcopampa\"  data-calculation=\"0\">Orcopampa<\/option><option value=\"Pampacolca\"  data-calculation=\"0\">Pampacolca<\/option><option value=\"Tip\u00e1n\"  data-calculation=\"0\">Tip\u00e1n<\/option><option value=\"U\u00f1\u00f3n\"  data-calculation=\"0\">U\u00f1\u00f3n<\/option><option value=\"Uraca\"  data-calculation=\"0\">Uraca<\/option><option value=\"Viraco\"  data-calculation=\"0\">Viraco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-73\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-73_69db919b372a3\" id=\"forminator-form-71__field--select-73_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Caylloma <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-73_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-73\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Caylloma\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Caylloma\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-73_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Caylloma<\/option><option value=\"one\"  data-calculation=\"0\">Chivay<\/option><option value=\"two\"  data-calculation=\"0\">Achoma<\/option><option value=\"Cabanaconde\"  data-calculation=\"0\">Cabanaconde<\/option><option value=\"Callalli\"  data-calculation=\"0\">Callalli<\/option><option value=\"Caylloma\"  data-calculation=\"0\">Caylloma<\/option><option value=\"Coporaque\"  data-calculation=\"0\">Coporaque<\/option><option value=\"Huambo\"  data-calculation=\"0\">Huambo<\/option><option value=\"Huanca\"  data-calculation=\"0\">Huanca<\/option><option value=\"Ichupampa\"  data-calculation=\"0\">Ichupampa<\/option><option value=\"Lari\"  data-calculation=\"0\">Lari<\/option><option value=\"Lluta\"  data-calculation=\"0\">Lluta<\/option><option value=\"Maca\"  data-calculation=\"0\">Maca<\/option><option value=\"Madrigal\"  data-calculation=\"0\">Madrigal<\/option><option value=\"San-Antonio-de-Chuca\"  data-calculation=\"0\">San Antonio de Chuca<\/option><option value=\"Sibayo\"  data-calculation=\"0\">Sibayo<\/option><option value=\"Tapay\"  data-calculation=\"0\">Tapay<\/option><option value=\"Tisco\"  data-calculation=\"0\">Tisco<\/option><option value=\"Tuti\"  data-calculation=\"0\">Tuti<\/option><option value=\"Yanque\"  data-calculation=\"0\">Yanque<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-72\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-72_69db919b372a3\" id=\"forminator-form-71__field--select-72_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Condesuyos <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-72_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-72\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Condesuyos\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Condesuyos\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-72_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Condesuyos<\/option><option value=\"one\"  data-calculation=\"0\">Chuquibamba<\/option><option value=\"two\"  data-calculation=\"0\">Andaray<\/option><option value=\"Cayarani\"  data-calculation=\"0\">Cayarani<\/option><option value=\"Chichas\"  data-calculation=\"0\">Chichas<\/option><option value=\"Iray\"  data-calculation=\"0\">Iray<\/option><option value=\"R\u00edo-Grande\"  data-calculation=\"0\">R\u00edo Grande<\/option><option value=\"Salamanca\"  data-calculation=\"0\">Salamanca<\/option><option value=\"Yanaquihua\"  data-calculation=\"0\">Yanaquihua<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-71\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-71_69db919b372a3\" id=\"forminator-form-71__field--select-71_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Islay <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-71_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-71\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Islay\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Islay\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-71_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Islay<\/option><option value=\"one\"  data-calculation=\"0\">Mollendo<\/option><option value=\"two\"  data-calculation=\"0\">Cocachacra<\/option><option value=\"Dean-Valdivia\"  data-calculation=\"0\">Dean Valdivia<\/option><option value=\"Islay\"  data-calculation=\"0\">Islay<\/option><option value=\"Mej\u00eda\"  data-calculation=\"0\">Mej\u00eda<\/option><option value=\"Punta-de-Bomb\u00f3n\"  data-calculation=\"0\">Punta de Bomb\u00f3n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-76\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-76_69db919b372a3\" id=\"forminator-form-71__field--select-76_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - La Uni\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-76_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-76\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - La Uni\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - La Uni\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-76_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - La Uni\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Cotahuasi<\/option><option value=\"two\"  data-calculation=\"0\">Alca<\/option><option value=\"Charcana\"  data-calculation=\"0\">Charcana<\/option><option value=\"Huaynacotas\"  data-calculation=\"0\">Huaynacotas<\/option><option value=\"Pampamarca\"  data-calculation=\"0\">Pampamarca<\/option><option value=\"Puyca\"  data-calculation=\"0\">Puyca<\/option><option value=\"Quechualla\"  data-calculation=\"0\">Quechualla<\/option><option value=\"Sayla\"  data-calculation=\"0\">Sayla<\/option><option value=\"Taur\u00eda\"  data-calculation=\"0\">Taur\u00eda<\/option><option value=\"Tomepampa\"  data-calculation=\"0\">Tomepampa<\/option><option value=\"Toro\"  data-calculation=\"0\">Toro<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-6\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Ayacucho<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-18\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-18_69db919b372a3\" id=\"forminator-form-71__field--select-18_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia - Ayacucho <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-18_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-18\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia - Ayacucho\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia - Ayacucho\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-18_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia - Ayacucho<\/option><option value=\"one\"  data-calculation=\"0\">Cangallo<\/option><option value=\"two\"  data-calculation=\"0\">Huamanga<\/option><option value=\"Huanca-Sancos\"  data-calculation=\"0\">Huanca Sancos<\/option><option value=\"Huanta\"  data-calculation=\"0\">Huanta<\/option><option value=\"La-Mar\"  data-calculation=\"0\">La Mar<\/option><option value=\"Lucanas\"  data-calculation=\"0\">Lucanas<\/option><option value=\"Parinacochas\"  data-calculation=\"0\">Parinacochas<\/option><option value=\"Paucar-del-Sara-Sara\"  data-calculation=\"0\">Paucar del Sara Sara<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"V\u00edctor-Fajardo\"  data-calculation=\"0\">V\u00edctor Fajardo<\/option><option value=\"Vilcas-Huam\u00e1n\"  data-calculation=\"0\">Vilcas Huam\u00e1n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-77\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-77_69db919b372a3\" id=\"forminator-form-71__field--select-77_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cangallo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-77_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-77\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cangallo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cangallo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-77_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cangallo<\/option><option value=\"one\"  data-calculation=\"0\">Cangallo<\/option><option value=\"two\"  data-calculation=\"0\">Chuschi<\/option><option value=\"Los-Morochucos\"  data-calculation=\"0\">Los Morochucos<\/option><option value=\"Mar\u00eda-Parado-de-Bellido\"  data-calculation=\"0\">Mar\u00eda Parado de Bellido<\/option><option value=\"Paras\"  data-calculation=\"0\">Paras<\/option><option value=\"Totos\"  data-calculation=\"0\">Totos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-78\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-78_69db919b372a3\" id=\"forminator-form-71__field--select-78_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huamanga <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-78_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-78\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huamanga\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huamanga\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-78_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huamanga<\/option><option value=\"one\"  data-calculation=\"0\">Ayacucho<\/option><option value=\"two\"  data-calculation=\"0\">Acocro<\/option><option value=\"Acos-Vinchos\"  data-calculation=\"0\">Acos Vinchos<\/option><option value=\"Cayara\"  data-calculation=\"0\">Cayara<\/option><option value=\"Chiara\"  data-calculation=\"0\">Chiara<\/option><option value=\"Jes\u00fas-Nazareno\"  data-calculation=\"0\">Jes\u00fas Nazareno<\/option><option value=\"Ocros\"  data-calculation=\"0\">Ocros<\/option><option value=\"Pacaycasa\"  data-calculation=\"0\">Pacaycasa<\/option><option value=\"Quinua\"  data-calculation=\"0\">Quinua<\/option><option value=\"San-Jos\u00e9-de-Ticllas\"  data-calculation=\"0\">San Jos\u00e9 de Ticllas<\/option><option value=\"San-Juan-Bautista\"  data-calculation=\"0\">San Juan Bautista<\/option><option value=\"Santiago-de-Pischa\"  data-calculation=\"0\">Santiago de Pischa<\/option><option value=\"Socos\"  data-calculation=\"0\">Socos<\/option><option value=\"Tambillo\"  data-calculation=\"0\">Tambillo<\/option><option value=\"Vinchos\"  data-calculation=\"0\">Vinchos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-86\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-86_69db919b372a3\" id=\"forminator-form-71__field--select-86_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huanca Sancos <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-86_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-86\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huanca Sancos\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huanca Sancos\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-86_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huanca Sancos<\/option><option value=\"one\"  data-calculation=\"0\">Huanca Sancos<\/option><option value=\"two\"  data-calculation=\"0\">Carapo<\/option><option value=\"Sacsamarca\"  data-calculation=\"0\">Sacsamarca<\/option><option value=\"Santiago-de-Lucanamarca\"  data-calculation=\"0\">Santiago de Lucanamarca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-85\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-85_69db919b372a3\" id=\"forminator-form-71__field--select-85_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huanta <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-85_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-85\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huanta\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huanta\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-85_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huanta<\/option><option value=\"one\"  data-calculation=\"0\">Huanta<\/option><option value=\"two\"  data-calculation=\"0\">Ayahuanco<\/option><option value=\"Huamanguilla\"  data-calculation=\"0\">Huamanguilla<\/option><option value=\"Iguain\"  data-calculation=\"0\">Iguain<\/option><option value=\"Luricocha\"  data-calculation=\"0\">Luricocha<\/option><option value=\"Santillana\"  data-calculation=\"0\">Santillana<\/option><option value=\"Sivia\"  data-calculation=\"0\">Sivia<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-84\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-84_69db919b372a3\" id=\"forminator-form-71__field--select-84_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - La Mar <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-84_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-84\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - La Mar\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - La Mar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-84_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - La Mar<\/option><option value=\"one\"  data-calculation=\"0\">San Miguel<\/option><option value=\"two\"  data-calculation=\"0\">Anco<\/option><option value=\"Ayna\"  data-calculation=\"0\">Ayna<\/option><option value=\"Chilcas\"  data-calculation=\"0\">Chilcas<\/option><option value=\"Chungui\"  data-calculation=\"0\">Chungui<\/option><option value=\"Luis-Carranza\"  data-calculation=\"0\">Luis Carranza<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Tambo\"  data-calculation=\"0\">Tambo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-83\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-83_69db919b372a3\" id=\"forminator-form-71__field--select-83_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lucanas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-83_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-83\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lucanas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lucanas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-83_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lucanas<\/option><option value=\"one\"  data-calculation=\"0\">Puquio<\/option><option value=\"two\"  data-calculation=\"0\">Aucara<\/option><option value=\"Cabana\"  data-calculation=\"0\">Cabana<\/option><option value=\"Carmen-Salcedo\"  data-calculation=\"0\">Carmen Salcedo<\/option><option value=\"Chavi\u00f1a\"  data-calculation=\"0\">Chavi\u00f1a<\/option><option value=\"Chipao\"  data-calculation=\"0\">Chipao<\/option><option value=\"Huac-Huas\"  data-calculation=\"0\">Huac-Huas<\/option><option value=\"Laramate\"  data-calculation=\"0\">Laramate<\/option><option value=\"Leoncio-Prado\"  data-calculation=\"0\">Leoncio Prado<\/option><option value=\"Llauta\"  data-calculation=\"0\">Llauta<\/option><option value=\"Lucanas\"  data-calculation=\"0\">Lucanas<\/option><option value=\"Oca\u00f1a\"  data-calculation=\"0\">Oca\u00f1a<\/option><option value=\"Otoca\"  data-calculation=\"0\">Otoca<\/option><option value=\"Saisa\"  data-calculation=\"0\">Saisa<\/option><option value=\"San-Crist\u00f3bal\"  data-calculation=\"0\">San Crist\u00f3bal<\/option><option value=\"San-Juan\"  data-calculation=\"0\">San Juan<\/option><option value=\"San-Pedro\"  data-calculation=\"0\">San Pedro<\/option><option value=\"San-Pedro-de-Palco\"  data-calculation=\"0\">San Pedro de Palco<\/option><option value=\"Sancos\"  data-calculation=\"0\">Sancos<\/option><option value=\"Santa-Ana-de-Huaycahuacho\"  data-calculation=\"0\">Santa Ana de Huaycahuacho<\/option><option value=\"Santa-Luc\u00eda\"  data-calculation=\"0\">Santa Luc\u00eda<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-82\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-82_69db919b372a3\" id=\"forminator-form-71__field--select-82_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Parinacochas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-82_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-82\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Parinacochas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Parinacochas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-82_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Parinacochas<\/option><option value=\"one\"  data-calculation=\"0\">Coracora<\/option><option value=\"two\"  data-calculation=\"0\">Chumpi<\/option><option value=\"Coronel-Casta\u00f1eda\"  data-calculation=\"0\">Coronel Casta\u00f1eda<\/option><option value=\"Pacapausa\"  data-calculation=\"0\">Pacapausa<\/option><option value=\"Pullo\"  data-calculation=\"0\">Pullo<\/option><option value=\"Puyusca\"  data-calculation=\"0\">Puyusca<\/option><option value=\"San-Francisco-de-Ravacayco\"  data-calculation=\"0\">San Francisco de Ravacayco<\/option><option value=\"Upahuacho\"  data-calculation=\"0\">Upahuacho<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-80\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-80_69db919b372a3\" id=\"forminator-form-71__field--select-80_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Paucar del Sara Sara <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-80_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-80\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Paucar del Sara Sara\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Paucar del Sara Sara\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-80_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Paucar del Sara Sara<\/option><option value=\"one\"  data-calculation=\"0\">Pausa<\/option><option value=\"two\"  data-calculation=\"0\">Colta<\/option><option value=\"Corculla\"  data-calculation=\"0\">Corculla<\/option><option value=\"Lampa\"  data-calculation=\"0\">Lampa<\/option><option value=\"Marcabamba\"  data-calculation=\"0\">Marcabamba<\/option><option value=\"Oyolo\"  data-calculation=\"0\">Oyolo<\/option><option value=\"Pararca\"  data-calculation=\"0\">Pararca<\/option><option value=\"San-Javier-de-Alpabamba\"  data-calculation=\"0\">San Javier de Alpabamba<\/option><option value=\"San-Jos\u00e9-de-Ushua\"  data-calculation=\"0\">San Jos\u00e9 de Ushua<\/option><option value=\"Sara-Sara\"  data-calculation=\"0\">Sara Sara<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-79\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-79_69db919b372a3\" id=\"forminator-form-71__field--select-79_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sucre <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-79_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-79\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sucre\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sucre\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-79_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sucre<\/option><option value=\"one\"  data-calculation=\"0\">Querobamba<\/option><option value=\"two\"  data-calculation=\"0\">Bel\u00e9n<\/option><option value=\"Chalcos\"  data-calculation=\"0\">Chalcos<\/option><option value=\"Chilcayoc\"  data-calculation=\"0\">Chilcayoc<\/option><option value=\"Huaca\u00f1a\"  data-calculation=\"0\">Huaca\u00f1a<\/option><option value=\"Morcolla\"  data-calculation=\"0\">Morcolla<\/option><option value=\"Paico\"  data-calculation=\"0\">Paico<\/option><option value=\"San-Pedro-de-Larcay\"  data-calculation=\"0\">San Pedro de Larcay<\/option><option value=\"San-Salvador-de-Quije\"  data-calculation=\"0\">San Salvador de Quije<\/option><option value=\"Santiago-de-Paucaray\"  data-calculation=\"0\">Santiago de Paucaray<\/option><option value=\"Soraya\"  data-calculation=\"0\">Soraya<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-88\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-88_69db919b372a3\" id=\"forminator-form-71__field--select-88_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - V\u00edctor Fajardo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-88_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-88\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - V\u00edctor Fajardo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - V\u00edctor Fajardo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-88_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - V\u00edctor Fajardo<\/option><option value=\"one\"  data-calculation=\"0\">Huancapi<\/option><option value=\"two\"  data-calculation=\"0\">Alcamenca<\/option><option value=\"Apongo\"  data-calculation=\"0\">Apongo<\/option><option value=\"Asquipata\"  data-calculation=\"0\">Asquipata<\/option><option value=\"Canaria\"  data-calculation=\"0\">Canaria<\/option><option value=\"Cayara\"  data-calculation=\"0\">Cayara<\/option><option value=\"Colca\"  data-calculation=\"0\">Colca<\/option><option value=\"Huamanquiquia\"  data-calculation=\"0\">Huamanquiquia<\/option><option value=\"Huancaraylla\"  data-calculation=\"0\">Huancaraylla<\/option><option value=\"Huaya\"  data-calculation=\"0\">Huaya<\/option><option value=\"Sarhua\"  data-calculation=\"0\">Sarhua<\/option><option value=\"Vilcanchos\"  data-calculation=\"0\">Vilcanchos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-87\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-87_69db919b372a3\" id=\"forminator-form-71__field--select-87_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Vilcas Huam\u00e1n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-87_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-87\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Vilcas Huam\u00e1n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Vilcas Huam\u00e1n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-87_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Vilcas Huam\u00e1n<\/option><option value=\"one\"  data-calculation=\"0\">Vilcas Huam\u00e1n<\/option><option value=\"two\"  data-calculation=\"0\">Accomarca<\/option><option value=\"Carhuanca\"  data-calculation=\"0\">Carhuanca<\/option><option value=\"Concepci\u00f3n\"  data-calculation=\"0\">Concepci\u00f3n<\/option><option value=\"Huambalpa\"  data-calculation=\"0\">Huambalpa<\/option><option value=\"Independencia\"  data-calculation=\"0\">Independencia<\/option><option value=\"Saurama\"  data-calculation=\"0\">Saurama<\/option><option value=\"Vischongo\"  data-calculation=\"0\">Vischongo<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-7\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Cajamarca<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-19\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-19_69db919b372a3\" id=\"forminator-form-71__field--select-19_69db919b372a3-label\" class=\"forminator-label\">Seleccionar provincia - Cajamarca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-19_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-19\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar provincia - Cajamarca\" data-search=\"false\" data-search-placeholder=\"Seleccionar provincia - Cajamarca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-19_69db919b372a3-label\"><option value=\"\"  >Seleccionar provincia - Cajamarca<\/option><option value=\"one\"  data-calculation=\"0\">Cajabamba<\/option><option value=\"two\"  data-calculation=\"0\">Cajamarca<\/option><option value=\"Celend\u00edn\"  data-calculation=\"0\">Celend\u00edn<\/option><option value=\"Chota\"  data-calculation=\"0\">Chota<\/option><option value=\"Contumaz\u00e1\"  data-calculation=\"0\">Contumaz\u00e1<\/option><option value=\"Cutervo\"  data-calculation=\"0\">Cutervo<\/option><option value=\"Hualgayoc\"  data-calculation=\"0\">Hualgayoc<\/option><option value=\"Ja\u00e9n\"  data-calculation=\"0\">Ja\u00e9n<\/option><option value=\"San-Ignacio\"  data-calculation=\"0\">San Ignacio<\/option><option value=\"San-Marcos\"  data-calculation=\"0\">San Marcos<\/option><option value=\"San-Miguel\"  data-calculation=\"0\">San Miguel<\/option><option value=\"San-Pablo\"  data-calculation=\"0\">San Pablo<\/option><option value=\"Santa-Cruz\"  data-calculation=\"0\">Santa Cruz<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-81\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-81_69db919b372a3\" id=\"forminator-form-71__field--select-81_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cajabamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-81_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-81\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cajabamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cajabamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-81_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cajabamba<\/option><option value=\"one\"  data-calculation=\"0\">Cajabamba<\/option><option value=\"two\"  data-calculation=\"0\">Cachachi<\/option><option value=\"Condebamba\"  data-calculation=\"0\">Condebamba<\/option><option value=\"Condebamba\"  data-calculation=\"0\">Condebamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-89\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-89_69db919b372a3\" id=\"forminator-form-71__field--select-89_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cajamarca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-89_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-89\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cajamarca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cajamarca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-89_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cajamarca<\/option><option value=\"one\"  data-calculation=\"0\">Cajamarca<\/option><option value=\"two\"  data-calculation=\"0\">Asunci\u00f3n<\/option><option value=\"Chetilla\"  data-calculation=\"0\">Chetilla<\/option><option value=\"Cosp\u00e1n\"  data-calculation=\"0\">Cosp\u00e1n<\/option><option value=\"Enca\u00f1ada\"  data-calculation=\"0\">Enca\u00f1ada<\/option><option value=\"Jes\u00fas\"  data-calculation=\"0\">Jes\u00fas<\/option><option value=\"Llacanora\"  data-calculation=\"0\">Llacanora<\/option><option value=\"Los-Ba\u00f1os-del-Inca\"  data-calculation=\"0\">Los Ba\u00f1os del Inca<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Matara\"  data-calculation=\"0\">Matara<\/option><option value=\"Namora\"  data-calculation=\"0\">Namora<\/option><option value=\"San-Juan\"  data-calculation=\"0\">San Juan<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-90\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-90_69db919b372a3\" id=\"forminator-form-71__field--select-90_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Celend\u00edn <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-90_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-90\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Celend\u00edn\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Celend\u00edn\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-90_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Celend\u00edn<\/option><option value=\"one\"  data-calculation=\"0\">Celend\u00edn<\/option><option value=\"two\"  data-calculation=\"0\">Chumuch<\/option><option value=\"Cortegana\"  data-calculation=\"0\">Cortegana<\/option><option value=\"Huasmin\"  data-calculation=\"0\">Huasmin<\/option><option value=\"Jos\u00e9-G\u00e1lvez\"  data-calculation=\"0\">Jos\u00e9 G\u00e1lvez<\/option><option value=\"La-Libertad-de-Pall\u00e1n\"  data-calculation=\"0\">La Libertad de Pall\u00e1n<\/option><option value=\"Miguel-Iglesias\"  data-calculation=\"0\">Miguel Iglesias<\/option><option value=\"Oxamarca\"  data-calculation=\"0\">Oxamarca<\/option><option value=\"Sorochuco\"  data-calculation=\"0\">Sorochuco<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"Utco\"  data-calculation=\"0\">Utco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-91\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-91_69db919b372a3\" id=\"forminator-form-71__field--select-91_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chota <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-91_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-91\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chota\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chota\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-91_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chota<\/option><option value=\"one\"  data-calculation=\"0\">Chota<\/option><option value=\"two\"  data-calculation=\"0\">Angu\u00eda<\/option><option value=\"Chadin\"  data-calculation=\"0\">Chadin<\/option><option value=\"Chiguirip\"  data-calculation=\"0\">Chiguirip<\/option><option value=\"Chimban\"  data-calculation=\"0\">Chimban<\/option><option value=\"Choropampa\"  data-calculation=\"0\">Choropampa<\/option><option value=\"Cochabamba\"  data-calculation=\"0\">Cochabamba<\/option><option value=\"Conchan\"  data-calculation=\"0\">Conchan<\/option><option value=\"Huambos\"  data-calculation=\"0\">Huambos<\/option><option value=\"Lajas\"  data-calculation=\"0\">Lajas<\/option><option value=\"Llama\"  data-calculation=\"0\">Llama<\/option><option value=\"Miracosta\"  data-calculation=\"0\">Miracosta<\/option><option value=\"Paccha\"  data-calculation=\"0\">Paccha<\/option><option value=\"Pion\"  data-calculation=\"0\">Pion<\/option><option value=\"Querocoto\"  data-calculation=\"0\">Querocoto<\/option><option value=\"San-Juan-de-Licupis\"  data-calculation=\"0\">San Juan de Licupis<\/option><option value=\"Tacabamba\"  data-calculation=\"0\">Tacabamba<\/option><option value=\"Tocmoche\"  data-calculation=\"0\">Tocmoche<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-94\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-94_69db919b372a3\" id=\"forminator-form-71__field--select-94_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Contumaz\u00e1 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-94_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-94\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Contumaz\u00e1\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Contumaz\u00e1\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-94_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Contumaz\u00e1<\/option><option value=\"one\"  data-calculation=\"0\">Contumaz\u00e1<\/option><option value=\"two\"  data-calculation=\"0\">Chilete<\/option><option value=\"Cupisnique\"  data-calculation=\"0\">Cupisnique<\/option><option value=\"Guzmango\"  data-calculation=\"0\">Guzmango<\/option><option value=\"San-Benito\"  data-calculation=\"0\">San Benito<\/option><option value=\"Santa-Cruz-de-Toledo\"  data-calculation=\"0\">Santa Cruz de Toledo<\/option><option value=\"Tantarica\"  data-calculation=\"0\">Tantarica<\/option><option value=\"Yonan\"  data-calculation=\"0\">Yonan<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-93\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-93_69db919b372a3\" id=\"forminator-form-71__field--select-93_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cutervo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-93_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-93\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cutervo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cutervo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-93_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cutervo<\/option><option value=\"one\"  data-calculation=\"0\">Cutervo<\/option><option value=\"two\"  data-calculation=\"0\">Callayuc<\/option><option value=\"Choros\"  data-calculation=\"0\">Choros<\/option><option value=\"Cujillo\"  data-calculation=\"0\">Cujillo<\/option><option value=\"La-Ramada\"  data-calculation=\"0\">La Ramada<\/option><option value=\"Pimpingos\"  data-calculation=\"0\">Pimpingos<\/option><option value=\"Querocotillo\"  data-calculation=\"0\">Querocotillo<\/option><option value=\"San-Andr\u00e9s-de-Cutervo\"  data-calculation=\"0\">San Andr\u00e9s de Cutervo<\/option><option value=\"San-Juan-de-Cutervo\"  data-calculation=\"0\">San Juan de Cutervo<\/option><option value=\"San-Luis-de-Lucma\"  data-calculation=\"0\">San Luis de Lucma<\/option><option value=\"Santa-Cruz\"  data-calculation=\"0\">Santa Cruz<\/option><option value=\"Santo-Domingo-de-la-Capilla\"  data-calculation=\"0\">Santo Domingo de la Capilla<\/option><option value=\"Santo-Tom\u00e1s\"  data-calculation=\"0\">Santo Tom\u00e1s<\/option><option value=\"Socota\"  data-calculation=\"0\">Socota<\/option><option value=\"Toribio-Casanova\"  data-calculation=\"0\">Toribio Casanova<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-92\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-92_69db919b372a3\" id=\"forminator-form-71__field--select-92_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Hualgayoc <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-92_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-92\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Hualgayoc\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Hualgayoc\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-92_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Hualgayoc<\/option><option value=\"one\"  data-calculation=\"0\">Bambamarca<\/option><option value=\"two\"  data-calculation=\"0\">Chugur<\/option><option value=\"Hualgayoc\"  data-calculation=\"0\">Hualgayoc<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-95\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-95_69db919b372a3\" id=\"forminator-form-71__field--select-95_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ja\u00e9n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-95_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-95\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ja\u00e9n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ja\u00e9n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-95_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ja\u00e9n<\/option><option value=\"one\"  data-calculation=\"0\">Ja\u00e9n<\/option><option value=\"two\"  data-calculation=\"0\">Bellavista<\/option><option value=\"Chontali\"  data-calculation=\"0\">Chontali<\/option><option value=\"Colasay\"  data-calculation=\"0\">Colasay<\/option><option value=\"Huabal\"  data-calculation=\"0\">Huabal<\/option><option value=\"Las-Pirias\"  data-calculation=\"0\">Las Pirias<\/option><option value=\"Pomahuaca\"  data-calculation=\"0\">Pomahuaca<\/option><option value=\"Pucara\"  data-calculation=\"0\">Pucara<\/option><option value=\"Sallique\"  data-calculation=\"0\">Sallique<\/option><option value=\"San-Felipe\"  data-calculation=\"0\">San Felipe<\/option><option value=\"San-Jos\u00e9-del-Alto\"  data-calculation=\"0\">San Jos\u00e9 del Alto<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-99\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-99_69db919b372a3\" id=\"forminator-form-71__field--select-99_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Ignacio <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-99_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-99\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Ignacio\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Ignacio\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-99_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Ignacio<\/option><option value=\"one\"  data-calculation=\"0\">San Ignacio<\/option><option value=\"two\"  data-calculation=\"0\">Chirinos<\/option><option value=\"Huarango\"  data-calculation=\"0\">Huarango<\/option><option value=\"La-Coipa\"  data-calculation=\"0\">La Coipa<\/option><option value=\"Namballe\"  data-calculation=\"0\">Namballe<\/option><option value=\"San-Jos\u00e9-de-Lourdes\"  data-calculation=\"0\">San Jos\u00e9 de Lourdes<\/option><option value=\"Tabaconas\"  data-calculation=\"0\">Tabaconas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-98\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-98_69db919b372a3\" id=\"forminator-form-71__field--select-98_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Marcos <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-98_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-98\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Marcos\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Marcos\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-98_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Marcos<\/option><option value=\"one\"  data-calculation=\"0\">Pedro G\u00e1lvez<\/option><option value=\"two\"  data-calculation=\"0\">Chancay<\/option><option value=\"Eduardo-Villanueva\"  data-calculation=\"0\">Eduardo Villanueva<\/option><option value=\"Gregorio-Pita\"  data-calculation=\"0\">Gregorio Pita<\/option><option value=\"Ichoc\u00e1n\"  data-calculation=\"0\">Ichoc\u00e1n<\/option><option value=\"Jos\u00e9-Manuel-Quiroz\"  data-calculation=\"0\">Jos\u00e9 Manuel Quiroz<\/option><option value=\"Jos\u00e9-Sabogal\"  data-calculation=\"0\">Jos\u00e9 Sabogal<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-97\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-97_69db919b372a3\" id=\"forminator-form-71__field--select-97_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Miguel <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-97_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-97\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Miguel\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Miguel\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-97_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Miguel<\/option><option value=\"one\"  data-calculation=\"0\">San Miguel<\/option><option value=\"two\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Calquis\"  data-calculation=\"0\">Calquis<\/option><option value=\"Catilluc\"  data-calculation=\"0\">Catilluc<\/option><option value=\"El-Prado\"  data-calculation=\"0\">El Prado<\/option><option value=\"La-Florida\"  data-calculation=\"0\">La Florida<\/option><option value=\"Llapa\"  data-calculation=\"0\">Llapa<\/option><option value=\"Nanchoc\"  data-calculation=\"0\">Nanchoc<\/option><option value=\"Niepos\"  data-calculation=\"0\">Niepos<\/option><option value=\"San-Gregorio\"  data-calculation=\"0\">San Gregorio<\/option><option value=\"San-Silvestre-de-Cochan\"  data-calculation=\"0\">San Silvestre de Cochan<\/option><option value=\"Tongod\"  data-calculation=\"0\">Tongod<\/option><option value=\"Uni\u00f3n-Agua-Blanca\"  data-calculation=\"0\">Uni\u00f3n Agua Blanca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-96\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-96_69db919b372a3\" id=\"forminator-form-71__field--select-96_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Pablo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-96_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-96\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Pablo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Pablo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-96_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Pablo<\/option><option value=\"one\"  data-calculation=\"0\">San Pablo<\/option><option value=\"two\"  data-calculation=\"0\">San Bernardino<\/option><option value=\"San-Luis\"  data-calculation=\"0\">San Luis<\/option><option value=\"Tumbaden\"  data-calculation=\"0\">Tumbaden<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-100\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-100_69db919b372a3\" id=\"forminator-form-71__field--select-100_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Santa Cruz <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-100_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-100\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Santa Cruz\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Santa Cruz\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-100_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Santa Cruz<\/option><option value=\"one\"  data-calculation=\"0\">Santa Cruz<\/option><option value=\"two\"  data-calculation=\"0\">Andabamba<\/option><option value=\"Catache\"  data-calculation=\"0\">Catache<\/option><option value=\"Chancayba\u00f1os\"  data-calculation=\"0\">Chancayba\u00f1os<\/option><option value=\"La-Esperanza\"  data-calculation=\"0\">La Esperanza<\/option><option value=\"Ninabamba\"  data-calculation=\"0\">Ninabamba<\/option><option value=\"Pulan\"  data-calculation=\"0\">Pulan<\/option><option value=\"Saucepampa\"  data-calculation=\"0\">Saucepampa<\/option><option value=\"Sexi\"  data-calculation=\"0\">Sexi<\/option><option value=\"Uticyacu\"  data-calculation=\"0\">Uticyacu<\/option><option value=\"Yauyucan\"  data-calculation=\"0\">Yauyucan<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-8\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Cusco<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-20\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-20_69db919b372a3\" id=\"forminator-form-71__field--select-20_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia - Cusco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-20_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-20\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia - Cusco\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia - Cusco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-20_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia - Cusco<\/option><option value=\"one\"  data-calculation=\"0\">Acomayo<\/option><option value=\"two\"  data-calculation=\"0\">Anta<\/option><option value=\"Calca\"  data-calculation=\"0\">Calca<\/option><option value=\"Canas\"  data-calculation=\"0\">Canas<\/option><option value=\"Canchis\"  data-calculation=\"0\">Canchis<\/option><option value=\"Chumbivilcas\"  data-calculation=\"0\">Chumbivilcas<\/option><option value=\"Cusco\"  data-calculation=\"0\">Cusco<\/option><option value=\"Espinar\"  data-calculation=\"0\">Espinar<\/option><option value=\"La-Convenci\u00f3n\"  data-calculation=\"0\">La Convenci\u00f3n<\/option><option value=\"Paruro\"  data-calculation=\"0\">Paruro<\/option><option value=\"Paucartambo\"  data-calculation=\"0\">Paucartambo<\/option><option value=\"Quispicanchi\"  data-calculation=\"0\">Quispicanchi<\/option><option value=\"Urubamba\"  data-calculation=\"0\">Urubamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-101\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-101_69db919b372a3\" id=\"forminator-form-71__field--select-101_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Acomayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-101_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-101\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Acomayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Acomayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-101_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Acomayo<\/option><option value=\"one\"  data-calculation=\"0\">Acomayo<\/option><option value=\"two\"  data-calculation=\"0\">Acopia<\/option><option value=\"Acos\"  data-calculation=\"0\">Acos<\/option><option value=\"Mosoc-Llacta\"  data-calculation=\"0\">Mosoc Llacta<\/option><option value=\"Pomacanchi\"  data-calculation=\"0\">Pomacanchi<\/option><option value=\"Rondocan\"  data-calculation=\"0\">Rondocan<\/option><option value=\"Sangarar\u00e1\"  data-calculation=\"0\">Sangarar\u00e1<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-103\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-103_69db919b372a3\" id=\"forminator-form-71__field--select-103_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Anta <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-103_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-103\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Anta\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Anta\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-103_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Anta<\/option><option value=\"one\"  data-calculation=\"0\">Anta<\/option><option value=\"two\"  data-calculation=\"0\">Ancahuasi<\/option><option value=\"Cachimayo\"  data-calculation=\"0\">Cachimayo<\/option><option value=\"Chinchaypujio\"  data-calculation=\"0\">Chinchaypujio<\/option><option value=\"Huarocondo\"  data-calculation=\"0\">Huarocondo<\/option><option value=\"Limatambo\"  data-calculation=\"0\">Limatambo<\/option><option value=\"Mollepata\"  data-calculation=\"0\">Mollepata<\/option><option value=\"Pucyura\"  data-calculation=\"0\">Pucyura<\/option><option value=\"Zurite\"  data-calculation=\"0\">Zurite<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-110\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-110_69db919b372a3\" id=\"forminator-form-71__field--select-110_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Calca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-110_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-110\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Calca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Calca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-110_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Calca<\/option><option value=\"one\"  data-calculation=\"0\">Calca<\/option><option value=\"two\"  data-calculation=\"0\">Coya<\/option><option value=\"Lamay\"  data-calculation=\"0\">Lamay<\/option><option value=\"Lares\"  data-calculation=\"0\">Lares<\/option><option value=\"Pisac\"  data-calculation=\"0\">Pisac<\/option><option value=\"San-Salvador\"  data-calculation=\"0\">San Salvador<\/option><option value=\"Taray\"  data-calculation=\"0\">Taray<\/option><option value=\"Yanatile\"  data-calculation=\"0\">Yanatile<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-109\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-109_69db919b372a3\" id=\"forminator-form-71__field--select-109_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Canas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-109_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-109\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Canas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Canas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-109_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Canas<\/option><option value=\"one\"  data-calculation=\"0\">Yanaoca<\/option><option value=\"two\"  data-calculation=\"0\">Checca<\/option><option value=\"Kunturkanki\"  data-calculation=\"0\">Kunturkanki<\/option><option value=\"Langui\"  data-calculation=\"0\">Langui<\/option><option value=\"Layo\"  data-calculation=\"0\">Layo<\/option><option value=\"Pampamarca\"  data-calculation=\"0\">Pampamarca<\/option><option value=\"Quehue\"  data-calculation=\"0\">Quehue<\/option><option value=\"Tupac-Amaru\"  data-calculation=\"0\">Tupac Amaru<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-108\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-108_69db919b372a3\" id=\"forminator-form-71__field--select-108_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Canchis <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-108_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-108\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Canchis\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Canchis\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-108_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Canchis<\/option><option value=\"one\"  data-calculation=\"0\">Sicuani<\/option><option value=\"two\"  data-calculation=\"0\">Checacupe<\/option><option value=\"Combapata\"  data-calculation=\"0\">Combapata<\/option><option value=\"Marangani\"  data-calculation=\"0\">Marangani<\/option><option value=\"Pitumarca\"  data-calculation=\"0\">Pitumarca<\/option><option value=\"San-Pablo\"  data-calculation=\"0\">San Pablo<\/option><option value=\"San-Pedro\"  data-calculation=\"0\">San Pedro<\/option><option value=\"Tinta\"  data-calculation=\"0\">Tinta<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-107\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-107_69db919b372a3\" id=\"forminator-form-71__field--select-107_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chumbivilcas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-107_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-107\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chumbivilcas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chumbivilcas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-107_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chumbivilcas<\/option><option value=\"one\"  data-calculation=\"0\">Santo Tom\u00e1s<\/option><option value=\"two\"  data-calculation=\"0\">Capaccmarca<\/option><option value=\"Chamaca\"  data-calculation=\"0\">Chamaca<\/option><option value=\"Colquemarca\"  data-calculation=\"0\">Colquemarca<\/option><option value=\"Livitaca\"  data-calculation=\"0\">Livitaca<\/option><option value=\"Llusco\"  data-calculation=\"0\">Llusco<\/option><option value=\"Qui\u00f1ota\"  data-calculation=\"0\">Qui\u00f1ota<\/option><option value=\"Velille\"  data-calculation=\"0\">Velille<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-106\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-106_69db919b372a3\" id=\"forminator-form-71__field--select-106_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cusco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-106_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-106\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cusco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cusco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-106_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cusco<\/option><option value=\"one\"  data-calculation=\"0\">Cusco<\/option><option value=\"two\"  data-calculation=\"0\">Ccorca<\/option><option value=\"Poroy\"  data-calculation=\"0\">Poroy<\/option><option value=\"San-Jer\u00f3nimo\"  data-calculation=\"0\">San Jer\u00f3nimo<\/option><option value=\"San-Sebasti\u00e1n\"  data-calculation=\"0\">San Sebasti\u00e1n<\/option><option value=\"Santiago\"  data-calculation=\"0\">Santiago<\/option><option value=\"Saylla\"  data-calculation=\"0\">Saylla<\/option><option value=\"Wanchaq\"  data-calculation=\"0\">Wanchaq<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-113\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-113_69db919b372a3\" id=\"forminator-form-71__field--select-113_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Espinar <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-113_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-113\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Espinar\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Espinar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-113_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Espinar<\/option><option value=\"one\"  data-calculation=\"0\">Espinar<\/option><option value=\"two\"  data-calculation=\"0\">Condoroma<\/option><option value=\"Coporaque\"  data-calculation=\"0\">Coporaque<\/option><option value=\"Ocoruro\"  data-calculation=\"0\">Ocoruro<\/option><option value=\"Pallpata\"  data-calculation=\"0\">Pallpata<\/option><option value=\"Pichigua\"  data-calculation=\"0\">Pichigua<\/option><option value=\"Suykutambo\"  data-calculation=\"0\">Suykutambo<\/option><option value=\"Alto-Pichigua\"  data-calculation=\"0\">Alto Pichigua<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-112\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-112_69db919b372a3\" id=\"forminator-form-71__field--select-112_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - La Convenci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-112_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-112\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - La Convenci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - La Convenci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-112_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - La Convenci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Santa Ana<\/option><option value=\"two\"  data-calculation=\"0\">Echarate<\/option><option value=\"Huayopata\"  data-calculation=\"0\">Huayopata<\/option><option value=\"Inkawasi\"  data-calculation=\"0\">Inkawasi<\/option><option value=\"Kimbiri\"  data-calculation=\"0\">Kimbiri<\/option><option value=\"Maranura\"  data-calculation=\"0\">Maranura<\/option><option value=\"Ocobamba\"  data-calculation=\"0\">Ocobamba<\/option><option value=\"Pichari\"  data-calculation=\"0\">Pichari<\/option><option value=\"Quellouno\"  data-calculation=\"0\">Quellouno<\/option><option value=\"Santa-Teresa\"  data-calculation=\"0\">Santa Teresa<\/option><option value=\"Vilcabamba\"  data-calculation=\"0\">Vilcabamba<\/option><option value=\"Villa-Kintiarina\"  data-calculation=\"0\">Villa Kintiarina<\/option><option value=\"Villa-Virgen\"  data-calculation=\"0\">Villa Virgen<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-111\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-111_69db919b372a3\" id=\"forminator-form-71__field--select-111_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Paruro <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-111_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-111\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Paruro\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Paruro\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-111_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Paruro<\/option><option value=\"one\"  data-calculation=\"0\">Paruro<\/option><option value=\"two\"  data-calculation=\"0\">Accha<\/option><option value=\"Ccapi\"  data-calculation=\"0\">Ccapi<\/option><option value=\"Colcha\"  data-calculation=\"0\">Colcha<\/option><option value=\"Huanoquite\"  data-calculation=\"0\">Huanoquite<\/option><option value=\"Omacha\"  data-calculation=\"0\">Omacha<\/option><option value=\"Paccaritambo\"  data-calculation=\"0\">Paccaritambo<\/option><option value=\"Pillpinto\"  data-calculation=\"0\">Pillpinto<\/option><option value=\"Yaurisque\"  data-calculation=\"0\">Yaurisque<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-116\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-116_69db919b372a3\" id=\"forminator-form-71__field--select-116_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Paucartambo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-116_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-116\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Paucartambo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Paucartambo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-116_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Paucartambo<\/option><option value=\"one\"  data-calculation=\"0\">Paucartambo<\/option><option value=\"two\"  data-calculation=\"0\">Caicay<\/option><option value=\"Challabamba\"  data-calculation=\"0\">Challabamba<\/option><option value=\"Colquepata\"  data-calculation=\"0\">Colquepata<\/option><option value=\"Huancarani\"  data-calculation=\"0\">Huancarani<\/option><option value=\"Kos\u00f1ipata\"  data-calculation=\"0\">Kos\u00f1ipata<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-115\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-115_69db919b372a3\" id=\"forminator-form-71__field--select-115_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Quispicanchi <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-115_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-115\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Quispicanchi\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Quispicanchi\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-115_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Quispicanchi<\/option><option value=\"one\"  data-calculation=\"0\">Urcos<\/option><option value=\"two\"  data-calculation=\"0\">Andahuaylillas<\/option><option value=\"Camanti\"  data-calculation=\"0\">Camanti<\/option><option value=\"Ccarhuayo\"  data-calculation=\"0\">Ccarhuayo<\/option><option value=\"Ccatca\"  data-calculation=\"0\">Ccatca<\/option><option value=\"Cusipata\"  data-calculation=\"0\">Cusipata<\/option><option value=\"Huaro\"  data-calculation=\"0\">Huaro<\/option><option value=\"Lucre\"  data-calculation=\"0\">Lucre<\/option><option value=\"Marcapata\"  data-calculation=\"0\">Marcapata<\/option><option value=\"Ocongate\"  data-calculation=\"0\">Ocongate<\/option><option value=\"Oropesa\"  data-calculation=\"0\">Oropesa<\/option><option value=\"Quiquijana\"  data-calculation=\"0\">Quiquijana<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-114\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-114_69db919b372a3\" id=\"forminator-form-71__field--select-114_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Urubamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-114_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-114\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Urubamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Urubamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-114_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Urubamba<\/option><option value=\"one\"  data-calculation=\"0\">Urubamba<\/option><option value=\"two\"  data-calculation=\"0\">Chinchero<\/option><option value=\"Huayllabamba\"  data-calculation=\"0\">Huayllabamba<\/option><option value=\"Machupicchu\"  data-calculation=\"0\">Machupicchu<\/option><option value=\"Maras\"  data-calculation=\"0\">Maras<\/option><option value=\"Ollantaytambo\"  data-calculation=\"0\">Ollantaytambo<\/option><option value=\"Yucay\"  data-calculation=\"0\">Yucay<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-9\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Huancavelica<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-21\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-21_69db919b372a3\" id=\"forminator-form-71__field--select-21_69db919b372a3-label\" class=\"forminator-label\">Seleccionar provincia - Huancavelica <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-21_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-21\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar provincia - Huancavelica\" data-search=\"false\" data-search-placeholder=\"Seleccionar provincia - Huancavelica\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-21_69db919b372a3-label\"><option value=\"\"  >Seleccionar provincia - Huancavelica<\/option><option value=\"one\"  data-calculation=\"0\">Acobamba<\/option><option value=\"two\"  data-calculation=\"0\">Angaraes<\/option><option value=\"Castrovirreyna\"  data-calculation=\"0\">Castrovirreyna<\/option><option value=\"Churcampa\"  data-calculation=\"0\">Churcampa<\/option><option value=\"Huancavelica\"  data-calculation=\"0\">Huancavelica<\/option><option value=\"Huaytar\u00e1\"  data-calculation=\"0\">Huaytar\u00e1<\/option><option value=\"Tayacaja\"  data-calculation=\"0\">Tayacaja<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-102\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-102_69db919b372a3\" id=\"forminator-form-71__field--select-102_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Acobamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-102_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-102\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Acobamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Acobamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-102_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Acobamba<\/option><option value=\"one\"  data-calculation=\"0\">Acobamba<\/option><option value=\"two\"  data-calculation=\"0\">Andabamba<\/option><option value=\"Anta\"  data-calculation=\"0\">Anta<\/option><option value=\"Caja\"  data-calculation=\"0\">Caja<\/option><option value=\"Marcas\"  data-calculation=\"0\">Marcas<\/option><option value=\"Paucar\u00e1\"  data-calculation=\"0\">Paucar\u00e1<\/option><option value=\"Pomacocha\"  data-calculation=\"0\">Pomacocha<\/option><option value=\"Rosario\"  data-calculation=\"0\">Rosario<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-119\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-119_69db919b372a3\" id=\"forminator-form-71__field--select-119_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Angaraes <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-119_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-119\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Angaraes\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Angaraes\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-119_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Angaraes<\/option><option value=\"one\"  data-calculation=\"0\">Lircay<\/option><option value=\"two\"  data-calculation=\"0\">Anchonga<\/option><option value=\"Callanmarca\"  data-calculation=\"0\">Callanmarca<\/option><option value=\"Ccochaccasa\"  data-calculation=\"0\">Ccochaccasa<\/option><option value=\"Chincho\"  data-calculation=\"0\">Chincho<\/option><option value=\"Congalla\"  data-calculation=\"0\">Congalla<\/option><option value=\"Huanca-Huanca\"  data-calculation=\"0\">Huanca-Huanca<\/option><option value=\"Huayllay-Grande\"  data-calculation=\"0\">Huayllay Grande<\/option><option value=\"Julcamarca\"  data-calculation=\"0\">Julcamarca<\/option><option value=\"San-Antonio-de-Antaparco\"  data-calculation=\"0\">San Antonio de Antaparco<\/option><option value=\"Santo-Tom\u00e1s-de-Pata\"  data-calculation=\"0\">Santo Tom\u00e1s de Pata<\/option><option value=\"Secclla\"  data-calculation=\"0\">Secclla<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-118\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-118_69db919b372a3\" id=\"forminator-form-71__field--select-118_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Castrovirreyna <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-118_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-118\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Castrovirreyna\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Castrovirreyna\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-118_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Castrovirreyna<\/option><option value=\"one\"  data-calculation=\"0\">Castrovirreyna<\/option><option value=\"two\"  data-calculation=\"0\">Arma<\/option><option value=\"Aurahua\"  data-calculation=\"0\">Aurahua<\/option><option value=\"Capillas\"  data-calculation=\"0\">Capillas<\/option><option value=\"Chupamarca\"  data-calculation=\"0\">Chupamarca<\/option><option value=\"Cocas\"  data-calculation=\"0\">Cocas<\/option><option value=\"Huachos\"  data-calculation=\"0\">Huachos<\/option><option value=\"Huamatambo\"  data-calculation=\"0\">Huamatambo<\/option><option value=\"Mollepampa\"  data-calculation=\"0\">Mollepampa<\/option><option value=\"San-Juan\"  data-calculation=\"0\">San Juan<\/option><option value=\"Santa-Ana\"  data-calculation=\"0\">Santa Ana<\/option><option value=\"Tantara\"  data-calculation=\"0\">Tantara<\/option><option value=\"Ticrapo\"  data-calculation=\"0\">Ticrapo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-117\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-117_69db919b372a3\" id=\"forminator-form-71__field--select-117_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Churcampa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-117_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-117\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Churcampa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Churcampa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-117_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Churcampa<\/option><option value=\"one\"  data-calculation=\"0\">Churcampa<\/option><option value=\"two\"  data-calculation=\"0\">Anco<\/option><option value=\"Chinchihuasi\"  data-calculation=\"0\">Chinchihuasi<\/option><option value=\"Cosme\"  data-calculation=\"0\">Cosme<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">El Carmen<\/option><option value=\"La-Merced\"  data-calculation=\"0\">La Merced<\/option><option value=\"Locroja\"  data-calculation=\"0\">Locroja<\/option><option value=\"Pachamarca\"  data-calculation=\"0\">Pachamarca<\/option><option value=\"Paucarbamba\"  data-calculation=\"0\">Paucarbamba<\/option><option value=\"San-Miguel-de-Mayocc\"  data-calculation=\"0\">San Miguel de Mayocc<\/option><option value=\"San-Pedro-de-Coris\"  data-calculation=\"0\">San Pedro de Coris<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-121\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-121_69db919b372a3\" id=\"forminator-form-71__field--select-121_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huancavelica <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-121_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-121\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huancavelica\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huancavelica\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-121_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huancavelica<\/option><option value=\"one\"  data-calculation=\"0\">Huancavelica<\/option><option value=\"two\"  data-calculation=\"0\">Acobambilla<\/option><option value=\"Acoria\"  data-calculation=\"0\">Acoria<\/option><option value=\"Conayca\"  data-calculation=\"0\">Conayca<\/option><option value=\"Cuenca\"  data-calculation=\"0\">Cuenca<\/option><option value=\"Huachocolpa\"  data-calculation=\"0\">Huachocolpa<\/option><option value=\"Huayllahuara\"  data-calculation=\"0\">Huayllahuara<\/option><option value=\"Icha-Cruz\"  data-calculation=\"0\">Icha Cruz<\/option><option value=\"Izcuchaca\"  data-calculation=\"0\">Izcuchaca<\/option><option value=\"Laria\"  data-calculation=\"0\">Laria<\/option><option value=\"Manta\"  data-calculation=\"0\">Manta<\/option><option value=\"Mariscal-C\u00e1ceres\"  data-calculation=\"0\">Mariscal C\u00e1ceres<\/option><option value=\"Mocho\"  data-calculation=\"0\">Mocho<\/option><option value=\"Nuevo-Occoro\"  data-calculation=\"0\">Nuevo Occoro<\/option><option value=\"Palca\"  data-calculation=\"0\">Palca<\/option><option value=\"Pilchaca\"  data-calculation=\"0\">Pilchaca<\/option><option value=\"Vilca\"  data-calculation=\"0\">Vilca<\/option><option value=\"Yauli\"  data-calculation=\"0\">Yauli<\/option><option value=\"Ascensi\u00f3n\"  data-calculation=\"0\">Ascensi\u00f3n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-120\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-120_69db919b372a3\" id=\"forminator-form-71__field--select-120_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huaytar\u00e1 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-120_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-120\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huaytar\u00e1\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huaytar\u00e1\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-120_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huaytar\u00e1<\/option><option value=\"one\"  data-calculation=\"0\">Huaytar\u00e1<\/option><option value=\"two\"  data-calculation=\"0\">Ayavi<\/option><option value=\"C\u00f3rdova\"  data-calculation=\"0\">C\u00f3rdova<\/option><option value=\"Huayacundo-Arma\"  data-calculation=\"0\">Huayacundo Arma<\/option><option value=\"Laramarca\"  data-calculation=\"0\">Laramarca<\/option><option value=\"Ocoyo\"  data-calculation=\"0\">Ocoyo<\/option><option value=\"Pilpichaca\"  data-calculation=\"0\">Pilpichaca<\/option><option value=\"Querco\"  data-calculation=\"0\">Querco<\/option><option value=\"Qquechualla\"  data-calculation=\"0\">Qquechualla<\/option><option value=\"San-Antonio-de-Cusicancha\"  data-calculation=\"0\">San Antonio de Cusicancha<\/option><option value=\"San-Francisco-de-Sangayaico\"  data-calculation=\"0\">San Francisco de Sangayaico<\/option><option value=\"San-Isidro\"  data-calculation=\"0\">San Isidro<\/option><option value=\"Santiago-de-Chocorvos\"  data-calculation=\"0\">Santiago de Chocorvos<\/option><option value=\"Santiago-de-Quirahuara\"  data-calculation=\"0\">Santiago de Quirahuara<\/option><option value=\"Santo-Domingo-de-Capillas\"  data-calculation=\"0\">Santo Domingo de Capillas<\/option><option value=\"Tambo\"  data-calculation=\"0\">Tambo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-122\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-122_69db919b372a3\" id=\"forminator-form-71__field--select-122_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tayacaja <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-122_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-122\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tayacaja\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tayacaja\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-122_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tayacaja<\/option><option value=\"one\"  data-calculation=\"0\">Pampas<\/option><option value=\"two\"  data-calculation=\"0\">Acostambo<\/option><option value=\"Acraquia\"  data-calculation=\"0\">Acraquia<\/option><option value=\"Ahuaycha\"  data-calculation=\"0\">Ahuaycha<\/option><option value=\"Colcabamba\"  data-calculation=\"0\">Colcabamba<\/option><option value=\"Daniel-Hern\u00e1ndez\"  data-calculation=\"0\">Daniel Hern\u00e1ndez<\/option><option value=\"Huachocolpa\"  data-calculation=\"0\">Huachocolpa<\/option><option value=\"Huaribamba\"  data-calculation=\"0\">Huaribamba<\/option><option value=\"\u00d1ahuimpuquio\"  data-calculation=\"0\">\u00d1ahuimpuquio<\/option><option value=\"Pazos\"  data-calculation=\"0\">Pazos<\/option><option value=\"Quichuas\"  data-calculation=\"0\">Quichuas<\/option><option value=\"Quishuar\"  data-calculation=\"0\">Quishuar<\/option><option value=\"Roble\"  data-calculation=\"0\">Roble<\/option><option value=\"Salcabamba\"  data-calculation=\"0\">Salcabamba<\/option><option value=\"Salcahuasi\"  data-calculation=\"0\">Salcahuasi<\/option><option value=\"San-Marcos-de-Rocchac\"  data-calculation=\"0\">San Marcos de Rocchac<\/option><option value=\"Surcubamba\"  data-calculation=\"0\">Surcubamba<\/option><option value=\"Tintay-Puncu\"  data-calculation=\"0\">Tintay Puncu<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-10\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Hu\u00e1nuco<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-22\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-22_69db919b372a3\" id=\"forminator-form-71__field--select-22_69db919b372a3-label\" class=\"forminator-label\">Seleccionar provincia - Hu\u00e1nuco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-22_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-22\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar provincia - Hu\u00e1nuco\" data-search=\"false\" data-search-placeholder=\"Seleccionar provincia - Hu\u00e1nuco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-22_69db919b372a3-label\"><option value=\"\"  >Seleccionar provincia - Hu\u00e1nuco<\/option><option value=\"one\"  data-calculation=\"0\">Ambo<\/option><option value=\"two\"  data-calculation=\"0\">Dos de Mayo<\/option><option value=\"Huacaybamba\"  data-calculation=\"0\">Huacaybamba<\/option><option value=\"Huamal\u00edes\"  data-calculation=\"0\">Huamal\u00edes<\/option><option value=\"Hu\u00e1nuco\"  data-calculation=\"0\">Hu\u00e1nuco<\/option><option value=\"Lauricocha\"  data-calculation=\"0\">Lauricocha<\/option><option value=\"Le\u00f3ncio-Prado\"  data-calculation=\"0\">Le\u00f3ncio Prado<\/option><option value=\"Mara\u00f1\u00f3n\"  data-calculation=\"0\">Mara\u00f1\u00f3n<\/option><option value=\"Pachitea\"  data-calculation=\"0\">Pachitea<\/option><option value=\"Puerto-Inca\"  data-calculation=\"0\">Puerto Inca<\/option><option value=\"Yarowilca\"  data-calculation=\"0\">Yarowilca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-104\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-104_69db919b372a3\" id=\"forminator-form-71__field--select-104_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ambo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-104_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-104\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ambo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ambo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-104_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ambo<\/option><option value=\"one\"  data-calculation=\"0\">Ambo<\/option><option value=\"two\"  data-calculation=\"0\">Cayna<\/option><option value=\"Colpas\"  data-calculation=\"0\">Colpas<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Conchamarca<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Hu\u00e1car<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">San Francisco<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">San Rafael<\/option><option value=\"Tomay-Kichwa\"  data-calculation=\"0\">Tomay Kichwa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-123\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-123_69db919b372a3\" id=\"forminator-form-71__field--select-123_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Dos de Mayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-123_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-123\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Dos de Mayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Dos de Mayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-123_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Dos de Mayo<\/option><option value=\"one\"  data-calculation=\"0\">La Uni\u00f3n<\/option><option value=\"two\"  data-calculation=\"0\">Chuquis<\/option><option value=\"Colpas\"  data-calculation=\"0\">Mar\u00edas<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Pachas<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Quivilla<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">Rip\u00e1n<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">Shunqui<\/option><option value=\"Tomay-Kichwa\"  data-calculation=\"0\">Sillapata<\/option><option value=\"Yanas\"  data-calculation=\"0\">Yanas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-125\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-125_69db919b372a3\" id=\"forminator-form-71__field--select-125_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huacaybamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-125_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-125\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huacaybamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huacaybamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-125_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huacaybamba<\/option><option value=\"one\"  data-calculation=\"0\">Huacaybamba<\/option><option value=\"two\"  data-calculation=\"0\">Cochabamba<\/option><option value=\"Colpas\"  data-calculation=\"0\">Pinra<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Canchabamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-124\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-124_69db919b372a3\" id=\"forminator-form-71__field--select-124_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huamal\u00edes <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-124_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-124\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huamal\u00edes\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huamal\u00edes\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-124_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huamal\u00edes<\/option><option value=\"one\"  data-calculation=\"0\">Llata<\/option><option value=\"two\"  data-calculation=\"0\">Arancay<\/option><option value=\"Colpas\"  data-calculation=\"0\">Chav\u00edn de Pariarca<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Jacas Grande<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Jircan<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">Miraflores<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">Monz\u00f3n<\/option><option value=\"Tomay-Kichwa\"  data-calculation=\"0\">Punchao<\/option><option value=\"Pu\u00f1os\"  data-calculation=\"0\">Pu\u00f1os<\/option><option value=\"Singa\"  data-calculation=\"0\">Singa<\/option><option value=\"Tantamayo\"  data-calculation=\"0\">Tantamayo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-126\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-126_69db919b372a3\" id=\"forminator-form-71__field--select-126_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Hu\u00e1nuco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-126_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-126\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Hu\u00e1nuco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Hu\u00e1nuco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-126_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Hu\u00e1nuco<\/option><option value=\"one\"  data-calculation=\"0\">Hu\u00e1nuco<\/option><option value=\"two\"  data-calculation=\"0\">Amarilis<\/option><option value=\"Colpas\"  data-calculation=\"0\">Chinchao<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Churubamba<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Margos<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">Pillco Marca<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">Quisqui (Kichki)<\/option><option value=\"Tomay-Kichwa\"  data-calculation=\"0\">San Francisco de Cayr\u00e1n<\/option><option value=\"Pu\u00f1os\"  data-calculation=\"0\">San Pedro de Chaul\u00e1n<\/option><option value=\"Singa\"  data-calculation=\"0\">Santa Mar\u00eda del Valle<\/option><option value=\"Tantamayo\"  data-calculation=\"0\">Yacus<\/option><option value=\"Yarumayo\"  data-calculation=\"0\">Yarumayo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-127\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-127_69db919b372a3\" id=\"forminator-form-71__field--select-127_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lauricocha <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-127_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-127\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lauricocha\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lauricocha\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-127_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lauricocha<\/option><option value=\"one\"  data-calculation=\"0\">Jes\u00fas<\/option><option value=\"two\"  data-calculation=\"0\">Ba\u00f1os<\/option><option value=\"Colpas\"  data-calculation=\"0\">Jivia<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Queropalca<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Rondos<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">San Francisco de As\u00eds<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">San Miguel de Cauri<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-128\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-128_69db919b372a3\" id=\"forminator-form-71__field--select-128_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Leoncio Prado <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-128_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-128\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Leoncio Prado\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Leoncio Prado\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-128_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Leoncio Prado<\/option><option value=\"one\"  data-calculation=\"0\">Rupa-Rupa<\/option><option value=\"two\"  data-calculation=\"0\">Castillo Grande<\/option><option value=\"Colpas\"  data-calculation=\"0\">Daniel Alom\u00eda Robles<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Hermilio Valdiz\u00e1n<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Jos\u00e9 Crespo y Castillo<\/option><option value=\"San-Francisco\"  data-calculation=\"0\">Luyando<\/option><option value=\"San-Rafael\"  data-calculation=\"0\">Mariano Damaso Beraun<\/option><option value=\"Tomay-Kichwa\"  data-calculation=\"0\">Pucayacu<\/option><option value=\"Pu\u00f1os\"  data-calculation=\"0\">Santo Domingo de Anda<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-129\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-129_69db919b372a3\" id=\"forminator-form-71__field--select-129_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Mara\u00f1\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-129_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-129\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Mara\u00f1\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Mara\u00f1\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-129_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Mara\u00f1\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Huacrachuco<\/option><option value=\"two\"  data-calculation=\"0\">Cholon<\/option><option value=\"Colpas\"  data-calculation=\"0\">San Buenaventura<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">La Morada<\/option><option value=\"Hu\u00e1car\"  data-calculation=\"0\">Santa Rosa de Alto Yanajanca<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-130\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-130_69db919b372a3\" id=\"forminator-form-71__field--select-130_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pachitea <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-130_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-130\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pachitea\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pachitea\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-130_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pachitea<\/option><option value=\"one\"  data-calculation=\"0\">Panao<\/option><option value=\"two\"  data-calculation=\"0\">Chaglla<\/option><option value=\"Colpas\"  data-calculation=\"0\">Molino<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Umari<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-131\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-131_69db919b372a3\" id=\"forminator-form-71__field--select-131_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Puerto Inca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-131_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-131\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Puerto Inca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Puerto Inca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-131_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Puerto Inca<\/option><option value=\"one\"  data-calculation=\"0\">Puerto Inca<\/option><option value=\"two\"  data-calculation=\"0\">Codo del Pozuzo<\/option><option value=\"Colpas\"  data-calculation=\"0\">Honoria<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Tournavista<\/option><option value=\"Yuyapichis\"  data-calculation=\"0\">Yuyapichis<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-132\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-132_69db919b372a3\" id=\"forminator-form-71__field--select-132_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Yarowilca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-132_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-132\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Yarowilca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Yarowilca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-132_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Yarowilca<\/option><option value=\"one\"  data-calculation=\"0\">Chavinillo<\/option><option value=\"two\"  data-calculation=\"0\">Cahuac<\/option><option value=\"Colpas\"  data-calculation=\"0\">Chacabamba<\/option><option value=\"Conchamarca\"  data-calculation=\"0\">Aparicio Pomares<\/option><option value=\"Yuyapichis\"  data-calculation=\"0\">Jacas Chico<\/option><option value=\"Obas\"  data-calculation=\"0\">Obas<\/option><option value=\"Pampamarca\"  data-calculation=\"0\">Pampamarca<\/option><option value=\"Choras\"  data-calculation=\"0\">Choras<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-11\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Ica<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-23\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-23_69db919b372a3\" id=\"forminator-form-71__field--select-23_69db919b372a3-label\" class=\"forminator-label\">Seleccionar provincia - Ica <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-23_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-23\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar provincia - Ica\" data-search=\"false\" data-search-placeholder=\"Seleccionar provincia - Ica\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-23_69db919b372a3-label\"><option value=\"\"  >Seleccionar provincia - Ica<\/option><option value=\"one\"  data-calculation=\"0\">Chincha<\/option><option value=\"two\"  data-calculation=\"0\">Ica<\/option><option value=\"Nasca\"  data-calculation=\"0\">Nasca<\/option><option value=\"Palpa\"  data-calculation=\"0\">Palpa<\/option><option value=\"Pisco\"  data-calculation=\"0\">Pisco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-105\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-105_69db919b372a3\" id=\"forminator-form-71__field--select-105_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chincha <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-105_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-105\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chincha\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chincha\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-105_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chincha<\/option><option value=\"one\"  data-calculation=\"0\">Chincha Alta<\/option><option value=\"two\"  data-calculation=\"0\">Alto Lar\u00e1n<\/option><option value=\"Chav\u00edn\"  data-calculation=\"0\">Chav\u00edn<\/option><option value=\"Chincha-Baja\"  data-calculation=\"0\">Chincha Baja<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">El Carmen<\/option><option value=\"Grocio-Prado\"  data-calculation=\"0\">Grocio Prado<\/option><option value=\"Pueblo-Nuevo\"  data-calculation=\"0\">Pueblo Nuevo<\/option><option value=\"San-Juan-de-Yanac\"  data-calculation=\"0\">San Juan de Yanac<\/option><option value=\"San-Pedro-de-Huacarpana\"  data-calculation=\"0\">San Pedro de Huacarpana<\/option><option value=\"Sunampe\"  data-calculation=\"0\">Sunampe<\/option><option value=\"Tambo-de-Mora\"  data-calculation=\"0\">Tambo de Mora<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-133\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-133_69db919b372a3\" id=\"forminator-form-71__field--select-133_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ica <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-133_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-133\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ica\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ica\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-133_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ica<\/option><option value=\"one\"  data-calculation=\"0\">Ica<\/option><option value=\"two\"  data-calculation=\"0\">La Tingui\u00f1a<\/option><option value=\"Chav\u00edn\"  data-calculation=\"0\">Los Aquijes<\/option><option value=\"Chincha-Baja\"  data-calculation=\"0\">Ocucaje<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">Pachacutec<\/option><option value=\"Grocio-Prado\"  data-calculation=\"0\">Parcona<\/option><option value=\"Pueblo-Nuevo\"  data-calculation=\"0\">Pueblo Nuevo<\/option><option value=\"San-Juan-de-Yanac\"  data-calculation=\"0\">Salas<\/option><option value=\"San-Pedro-de-Huacarpana\"  data-calculation=\"0\">San Jos\u00e9 de los Molinos<\/option><option value=\"Sunampe\"  data-calculation=\"0\">San Juan Bautista<\/option><option value=\"Tambo-de-Mora\"  data-calculation=\"0\">Santiago<\/option><option value=\"Subtanjalla\"  data-calculation=\"0\">Subtanjalla<\/option><option value=\"Tate\"  data-calculation=\"0\">Tate<\/option><option value=\"Yauca-del-Rosario\"  data-calculation=\"0\">Yauca del Rosario<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-134\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-134_69db919b372a3\" id=\"forminator-form-71__field--select-134_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Nasca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-134_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-134\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Nasca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Nasca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-134_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Nasca<\/option><option value=\"one\"  data-calculation=\"0\">Nasca<\/option><option value=\"two\"  data-calculation=\"0\">Changuillo<\/option><option value=\"Chav\u00edn\"  data-calculation=\"0\">El Ingenio<\/option><option value=\"Chincha-Baja\"  data-calculation=\"0\">Marcona<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">Vista Alegre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-135\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-135_69db919b372a3\" id=\"forminator-form-71__field--select-135_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Palpa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-135_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-135\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Palpa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Palpa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-135_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Palpa<\/option><option value=\"one\"  data-calculation=\"0\">Palpa<\/option><option value=\"two\"  data-calculation=\"0\">Llipata<\/option><option value=\"Chav\u00edn\"  data-calculation=\"0\">R\u00edo Grande<\/option><option value=\"Chincha-Baja\"  data-calculation=\"0\">Santa Cruz<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">Tibillo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-136\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-136_69db919b372a3\" id=\"forminator-form-71__field--select-136_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pisco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-136_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-136\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pisco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pisco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-136_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pisco<\/option><option value=\"one\"  data-calculation=\"0\">Pisco<\/option><option value=\"two\"  data-calculation=\"0\">Huancano<\/option><option value=\"Chav\u00edn\"  data-calculation=\"0\">Humay<\/option><option value=\"Chincha-Baja\"  data-calculation=\"0\">Independencia<\/option><option value=\"El-Carmen\"  data-calculation=\"0\">Paracas<\/option><option value=\"San-Andr\u00e9s\"  data-calculation=\"0\">San Andr\u00e9s<\/option><option value=\"San-Clemente\"  data-calculation=\"0\">San Clemente<\/option><option value=\"T\u00fapac-Amaru-Inca\"  data-calculation=\"0\">T\u00fapac Amaru Inca<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-12\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Junin<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-24\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-24_69db919b372a3\" id=\"forminator-form-71__field--select-24_69db919b372a3-label\" class=\"forminator-label\">Seleccionar provincia - Jun\u00edn <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-24_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-24\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar provincia - Jun\u00edn\" data-search=\"false\" data-search-placeholder=\"Seleccionar provincia - Jun\u00edn\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-24_69db919b372a3-label\"><option value=\"\"  >Seleccionar provincia - Jun\u00edn<\/option><option value=\"one\"  data-calculation=\"0\">Chanchamayo<\/option><option value=\"two\"  data-calculation=\"0\">Chupaca<\/option><option value=\"Concepci\u00f3n\"  data-calculation=\"0\">Concepci\u00f3n<\/option><option value=\"Huancayo\"  data-calculation=\"0\">Huancayo<\/option><option value=\"Jauja\"  data-calculation=\"0\">Jauja<\/option><option value=\"Jun\u00edn\"  data-calculation=\"0\">Jun\u00edn<\/option><option value=\"Satipo\"  data-calculation=\"0\">Satipo<\/option><option value=\"Tarma\"  data-calculation=\"0\">Tarma<\/option><option value=\"Yauli\"  data-calculation=\"0\">Yauli<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-137\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-137_69db919b372a3\" id=\"forminator-form-71__field--select-137_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chanchamayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-137_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-137\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chanchamayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chanchamayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-137_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chanchamayo<\/option><option value=\"one\"  data-calculation=\"0\">Chanchamayo<\/option><option value=\"two\"  data-calculation=\"0\">Perene<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Pichanaqui<\/option><option value=\"San-Luis-de-Shuaro\"  data-calculation=\"0\">San Luis de Shuaro<\/option><option value=\"San-Ram\u00f3n\"  data-calculation=\"0\">San Ram\u00f3n<\/option><option value=\"Vitoc\"  data-calculation=\"0\">Vitoc<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-144\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-144_69db919b372a3\" id=\"forminator-form-71__field--select-144_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chupaca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-144_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-144\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chupaca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chupaca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-144_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chupaca<\/option><option value=\"one\"  data-calculation=\"0\">Chupaca<\/option><option value=\"two\"  data-calculation=\"0\">Ahuac<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Chongos Bajo<\/option><option value=\"San-Luis-de-Shuaro\"  data-calculation=\"0\">Huachac<\/option><option value=\"San-Ram\u00f3n\"  data-calculation=\"0\">Huamancaca Chico<\/option><option value=\"Vitoc\"  data-calculation=\"0\">San Juan de Iscos<\/option><option value=\"San-Juan-de-Jarpa\"  data-calculation=\"0\">San Juan de Jarpa<\/option><option value=\"Tres-de-Diciembre\"  data-calculation=\"0\">Tres de Diciembre<\/option><option value=\"Yanacancha\"  data-calculation=\"0\">Yanacancha<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-145\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-145_69db919b372a3\" id=\"forminator-form-71__field--select-145_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Concepci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-145_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-145\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Concepci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Concepci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-145_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Concepci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Concepci\u00f3n<\/option><option value=\"two\"  data-calculation=\"0\">Aco<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Andamarca<\/option><option value=\"San-Luis-de-Shuaro\"  data-calculation=\"0\">Chambara<\/option><option value=\"San-Ram\u00f3n\"  data-calculation=\"0\">Cochas<\/option><option value=\"Vitoc\"  data-calculation=\"0\">Hero\u00ednas Toledo<\/option><option value=\"San-Juan-de-Jarpa\"  data-calculation=\"0\">Manzanares<\/option><option value=\"Tres-de-Diciembre\"  data-calculation=\"0\">Mariscal Castilla<\/option><option value=\"Yanacancha\"  data-calculation=\"0\">Matahuasi<\/option><option value=\"Mito\"  data-calculation=\"0\">Mito<\/option><option value=\"Nueve-de-Julio\"  data-calculation=\"0\">Nueve de Julio<\/option><option value=\"Orcotuna\"  data-calculation=\"0\">Orcotuna<\/option><option value=\"San-Jos\u00e9-de-Quero\"  data-calculation=\"0\">San Jos\u00e9 de Quero<\/option><option value=\"Santa-Rosa-de-Ocopa\"  data-calculation=\"0\">Santa Rosa de Ocopa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-146\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-146_69db919b372a3\" id=\"forminator-form-71__field--select-146_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huancayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-146_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-146\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huancayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huancayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-146_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huancayo<\/option><option value=\"one\"  data-calculation=\"0\">Huancayo<\/option><option value=\"two\"  data-calculation=\"0\">Carhuacallanga<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Chicche<\/option><option value=\"San-Luis-de-Shuaro\"  data-calculation=\"0\">Chongos Alto<\/option><option value=\"San-Ram\u00f3n\"  data-calculation=\"0\">Chupuro<\/option><option value=\"Vitoc\"  data-calculation=\"0\">Colca<\/option><option value=\"San-Juan-de-Jarpa\"  data-calculation=\"0\">Cullhuas<\/option><option value=\"Tres-de-Diciembre\"  data-calculation=\"0\">Chacapampa<\/option><option value=\"Yanacancha\"  data-calculation=\"0\">Hualhuas<\/option><option value=\"Mito\"  data-calculation=\"0\">Huanc\u00e1n<\/option><option value=\"Nueve-de-Julio\"  data-calculation=\"0\">Huasicancha<\/option><option value=\"Orcotuna\"  data-calculation=\"0\">Huayucachi<\/option><option value=\"San-Jos\u00e9-de-Quero\"  data-calculation=\"0\">Ingenio<\/option><option value=\"Santa-Rosa-de-Ocopa\"  data-calculation=\"0\">Pariahuanca<\/option><option value=\"Pilcomayo\"  data-calculation=\"0\">Pilcomayo<\/option><option value=\"Pucar\u00e1\"  data-calculation=\"0\">Pucar\u00e1<\/option><option value=\"Quilcas\"  data-calculation=\"0\">Quilcas<\/option><option value=\"San-Agust\u00edn-de-Cajas\"  data-calculation=\"0\">San Agust\u00edn de Cajas<\/option><option value=\"San-Jer\u00f3nimo-de-Tun\u00e1n\"  data-calculation=\"0\">San Jer\u00f3nimo de Tun\u00e1n<\/option><option value=\"San-Pedro-de-Sa\u00f1o\"  data-calculation=\"0\">San Pedro de Sa\u00f1o<\/option><option value=\"Sapallanga\"  data-calculation=\"0\">Sapallanga<\/option><option value=\"Sicaya\"  data-calculation=\"0\">Sicaya<\/option><option value=\"Santo-Domingo-de-Acobamba\"  data-calculation=\"0\">Santo Domingo de Acobamba<\/option><option value=\"Viques\"  data-calculation=\"0\">Viques<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-147\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-147_69db919b372a3\" id=\"forminator-form-71__field--select-147_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Jauja <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-147_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-147\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Jauja\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Jauja\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-147_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Jauja<\/option><option value=\"one\"  data-calculation=\"0\">Jauja<\/option><option value=\"two\"  data-calculation=\"0\">Acolla<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Apata<\/option><option value=\"San-Luis-de-Shuaro\"  data-calculation=\"0\">Ataura<\/option><option value=\"San-Ram\u00f3n\"  data-calculation=\"0\">Canchayllo<\/option><option value=\"Vitoc\"  data-calculation=\"0\">Curicaca<\/option><option value=\"San-Juan-de-Jarpa\"  data-calculation=\"0\">El Mantaro<\/option><option value=\"Tres-de-Diciembre\"  data-calculation=\"0\">Huamali<\/option><option value=\"Yanacancha\"  data-calculation=\"0\">Huaripampa<\/option><option value=\"Mito\"  data-calculation=\"0\">Huertas<\/option><option value=\"Nueve-de-Julio\"  data-calculation=\"0\">Janjaillo<\/option><option value=\"Orcotuna\"  data-calculation=\"0\">Jasa<\/option><option value=\"San-Jos\u00e9-de-Quero\"  data-calculation=\"0\">Leonor Ord\u00f3\u00f1ez<\/option><option value=\"Santa-Rosa-de-Ocopa\"  data-calculation=\"0\">Llocllapampa<\/option><option value=\"Pilcomayo\"  data-calculation=\"0\">Marco<\/option><option value=\"Pucar\u00e1\"  data-calculation=\"0\">Masma<\/option><option value=\"Quilcas\"  data-calculation=\"0\">Masma Chicche<\/option><option value=\"San-Agust\u00edn-de-Cajas\"  data-calculation=\"0\">Molinos<\/option><option value=\"San-Jer\u00f3nimo-de-Tun\u00e1n\"  data-calculation=\"0\">Monobamba<\/option><option value=\"San-Pedro-de-Sa\u00f1o\"  data-calculation=\"0\">Muqui<\/option><option value=\"Sapallanga\"  data-calculation=\"0\">Muquiyauyo<\/option><option value=\"Sicaya\"  data-calculation=\"0\">Paca<\/option><option value=\"Santo-Domingo-de-Acobamba\"  data-calculation=\"0\">Paccha<\/option><option value=\"Viques\"  data-calculation=\"0\">Pancan<\/option><option value=\"Parco\"  data-calculation=\"0\">Parco<\/option><option value=\"Pomacancha\"  data-calculation=\"0\">Pomacancha<\/option><option value=\"Ricran\"  data-calculation=\"0\">Ricran<\/option><option value=\"San-Lorenzo\"  data-calculation=\"0\">San Lorenzo<\/option><option value=\"San-Pedro-de-Chunan\"  data-calculation=\"0\">San Pedro de Chunan<\/option><option value=\"Sapallanga2\"  data-calculation=\"0\">Sapallanga<\/option><option value=\"Sausa\"  data-calculation=\"0\">Sausa<\/option><option value=\"Sincos\"  data-calculation=\"0\">Sincos<\/option><option value=\"Tunan-Marca\"  data-calculation=\"0\">Tunan Marca<\/option><option value=\"Yauli\"  data-calculation=\"0\">Yauli<\/option><option value=\"Yauyos\"  data-calculation=\"0\">Yauyos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-148\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-148_69db919b372a3\" id=\"forminator-form-71__field--select-148_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Junin <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-148_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-148\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Junin\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Junin\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-148_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Junin<\/option><option value=\"one\"  data-calculation=\"0\">Jun\u00edn<\/option><option value=\"two\"  data-calculation=\"0\">Carhuamayo<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Ondores<\/option><option value=\"Tunan-Marca\"  data-calculation=\"0\">Ulcumayo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-149\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-149_69db919b372a3\" id=\"forminator-form-71__field--select-149_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Satipo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-149_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-149\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Satipo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Satipo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-149_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Satipo<\/option><option value=\"one\"  data-calculation=\"0\">Satipo<\/option><option value=\"two\"  data-calculation=\"0\">Coviriali<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Llaylla<\/option><option value=\"Tunan-Marca\"  data-calculation=\"0\">Mazamari<\/option><option value=\"Pampa-Hermosa\"  data-calculation=\"0\">Pampa Hermosa<\/option><option value=\"Pangoa\"  data-calculation=\"0\">Pangoa<\/option><option value=\"R\u00edo-Negro\"  data-calculation=\"0\">R\u00edo Negro<\/option><option value=\"R\u00edo-Tambo\"  data-calculation=\"0\">R\u00edo Tambo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-150\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-150_69db919b372a3\" id=\"forminator-form-71__field--select-150_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tarma <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-150_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-150\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tarma\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tarma\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-150_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tarma<\/option><option value=\"one\"  data-calculation=\"0\">Tarma<\/option><option value=\"two\"  data-calculation=\"0\">Acobamba<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Huaricolca<\/option><option value=\"Tunan-Marca\"  data-calculation=\"0\">Huasahuasi<\/option><option value=\"Pampa-Hermosa\"  data-calculation=\"0\">La Uni\u00f3n<\/option><option value=\"Pangoa\"  data-calculation=\"0\">Palca<\/option><option value=\"R\u00edo-Negro\"  data-calculation=\"0\">Palcamayo<\/option><option value=\"R\u00edo-Tambo\"  data-calculation=\"0\">San Pedro de Cajas<\/option><option value=\"Tapo\"  data-calculation=\"0\">Tapo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-151\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-151_69db919b372a3\" id=\"forminator-form-71__field--select-151_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Yauli <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-151_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-151\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Yauli\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Yauli\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-151_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Yauli<\/option><option value=\"one\"  data-calculation=\"0\">La Oroya<\/option><option value=\"two\"  data-calculation=\"0\">Chacapalpa<\/option><option value=\"Pichanaqui\"  data-calculation=\"0\">Huay-Huay<\/option><option value=\"Tunan-Marca\"  data-calculation=\"0\">Marcapomacocha<\/option><option value=\"Pampa-Hermosa\"  data-calculation=\"0\">Morococha<\/option><option value=\"Pangoa\"  data-calculation=\"0\">Paccha<\/option><option value=\"R\u00edo-Negro\"  data-calculation=\"0\">Santa B\u00e1rbara de Carhuacayan<\/option><option value=\"R\u00edo-Tambo\"  data-calculation=\"0\">Santa Rosa de Sacco<\/option><option value=\"Tapo\"  data-calculation=\"0\">Suitucancha<\/option><option value=\"Yauli\"  data-calculation=\"0\">Yauli<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-13\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">La Libertad<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-25\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-25_69db919b372a3\" id=\"forminator-form-71__field--select-25_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia La Libertad <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-25_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-25\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia La Libertad\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia La Libertad\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-25_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia La Libertad<\/option><option value=\"one\"  data-calculation=\"0\">Ascope<\/option><option value=\"two\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Chep\u00e9n\"  data-calculation=\"0\">Chep\u00e9n<\/option><option value=\"Gran-Chim\u00fa\"  data-calculation=\"0\">Gran Chim\u00fa<\/option><option value=\"Julc\u00e1n\"  data-calculation=\"0\">Julc\u00e1n<\/option><option value=\"Otuzco\"  data-calculation=\"0\">Otuzco<\/option><option value=\"Pacasmayo\"  data-calculation=\"0\">Pacasmayo<\/option><option value=\"Pataz\"  data-calculation=\"0\">Pataz<\/option><option value=\"S\u00e1nchez-Carri\u00f3n\"  data-calculation=\"0\">S\u00e1nchez Carri\u00f3n<\/option><option value=\"Santiago-de-Chuco\"  data-calculation=\"0\">Santiago de Chuco<\/option><option value=\"Trujillo\"  data-calculation=\"0\">Trujillo<\/option><option value=\"Vir\u00fa\"  data-calculation=\"0\">Vir\u00fa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-142\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-142_69db919b372a3\" id=\"forminator-form-71__field--select-142_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ascope <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-142_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-142\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ascope\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ascope\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-142_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ascope<\/option><option value=\"one\"  data-calculation=\"0\">Ascope<\/option><option value=\"two\"  data-calculation=\"0\">Casa Grande<\/option><option value=\"Chicama\"  data-calculation=\"0\">Chicama<\/option><option value=\"Chocope\"  data-calculation=\"0\">Chocope<\/option><option value=\"Magdalena-de-Cao\"  data-calculation=\"0\">Magdalena de Cao<\/option><option value=\"Paij\u00e1n\"  data-calculation=\"0\">Paij\u00e1n<\/option><option value=\"R\u00e1zuri\"  data-calculation=\"0\">R\u00e1zuri<\/option><option value=\"Santiago-de-Cao\"  data-calculation=\"0\">Santiago de Cao<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-152\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-152_69db919b372a3\" id=\"forminator-form-71__field--select-152_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Bol\u00edvar <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-152_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-152\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Bol\u00edvar\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Bol\u00edvar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-152_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Bol\u00edvar<\/option><option value=\"one\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"two\"  data-calculation=\"0\">Bambamarca<\/option><option value=\"Chicama\"  data-calculation=\"0\">Condormarca<\/option><option value=\"Chocope\"  data-calculation=\"0\">Longotea<\/option><option value=\"Magdalena-de-Cao\"  data-calculation=\"0\">Uchumarca<\/option><option value=\"Paij\u00e1n\"  data-calculation=\"0\">Ucuncha<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-154\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-154_69db919b372a3\" id=\"forminator-form-71__field--select-154_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chep\u00e9n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-154_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-154\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chep\u00e9n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chep\u00e9n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-154_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chep\u00e9n<\/option><option value=\"one\"  data-calculation=\"0\">Chep\u00e9n<\/option><option value=\"two\"  data-calculation=\"0\">Pacanga<\/option><option value=\"Chicama\"  data-calculation=\"0\">Pueblo Nuevo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-153\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-153_69db919b372a3\" id=\"forminator-form-71__field--select-153_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Gran Chim\u00fa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-153_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-153\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Gran Chim\u00fa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Gran Chim\u00fa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-153_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Gran Chim\u00fa<\/option><option value=\"one\"  data-calculation=\"0\">Cascas<\/option><option value=\"two\"  data-calculation=\"0\">Lucma<\/option><option value=\"Chicama\"  data-calculation=\"0\">Marmot<\/option><option value=\"Chocope\"  data-calculation=\"0\">Sayapullo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-155\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-155_69db919b372a3\" id=\"forminator-form-71__field--select-155_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Julc\u00e1n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-155_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-155\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Julc\u00e1n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Julc\u00e1n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-155_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Julc\u00e1n<\/option><option value=\"one\"  data-calculation=\"0\">Julc\u00e1n<\/option><option value=\"two\"  data-calculation=\"0\">Calamarca<\/option><option value=\"Chicama\"  data-calculation=\"0\">Carabamba<\/option><option value=\"Chocope\"  data-calculation=\"0\">Huaso<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-156\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-156_69db919b372a3\" id=\"forminator-form-71__field--select-156_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Otuzco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-156_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-156\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Otuzco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Otuzco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-156_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Otuzco<\/option><option value=\"one\"  data-calculation=\"0\">Otuzco<\/option><option value=\"two\"  data-calculation=\"0\">Agallpampa<\/option><option value=\"Chicama\"  data-calculation=\"0\">Charat<\/option><option value=\"Chocope\"  data-calculation=\"0\">Huaranchal<\/option><option value=\"La-Cuesta\"  data-calculation=\"0\">La Cuesta<\/option><option value=\"Mache\"  data-calculation=\"0\">Mache<\/option><option value=\"Paranday\"  data-calculation=\"0\">Paranday<\/option><option value=\"Salpo\"  data-calculation=\"0\">Salpo<\/option><option value=\"Sinsicap\"  data-calculation=\"0\">Sinsicap<\/option><option value=\"Usquil\"  data-calculation=\"0\">Usquil<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-157\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-157_69db919b372a3\" id=\"forminator-form-71__field--select-157_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pacasmayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-157_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-157\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pacasmayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pacasmayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-157_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pacasmayo<\/option><option value=\"one\"  data-calculation=\"0\">San Pedro de Lloc<\/option><option value=\"two\"  data-calculation=\"0\">Guadalupe<\/option><option value=\"Chicama\"  data-calculation=\"0\">Jequetepeque<\/option><option value=\"Chocope\"  data-calculation=\"0\">Pacasmayo<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">San Jos\u00e9<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-158\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-158_69db919b372a3\" id=\"forminator-form-71__field--select-158_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pataz <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-158_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-158\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pataz\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pataz\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-158_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pataz<\/option><option value=\"one\"  data-calculation=\"0\">Tayabamba<\/option><option value=\"two\"  data-calculation=\"0\">Buldibuyo<\/option><option value=\"Chicama\"  data-calculation=\"0\">Chillia<\/option><option value=\"Chocope\"  data-calculation=\"0\">Huancaspata<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">Huaylillas<\/option><option value=\"Huayo\"  data-calculation=\"0\">Huayo<\/option><option value=\"Ong\u00f3n\"  data-calculation=\"0\">Ong\u00f3n<\/option><option value=\"Parcoy\"  data-calculation=\"0\">Parcoy<\/option><option value=\"Pataz\"  data-calculation=\"0\">Pataz<\/option><option value=\"P\u00edas\"  data-calculation=\"0\">P\u00edas<\/option><option value=\"Santiago-de-Challas\"  data-calculation=\"0\">Santiago de Challas<\/option><option value=\"Taurija\"  data-calculation=\"0\">Taurija<\/option><option value=\"Urpay\"  data-calculation=\"0\">Urpay<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-160\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-160_69db919b372a3\" id=\"forminator-form-71__field--select-160_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - S\u00e1nchez Carri\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-160_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-160\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - S\u00e1nchez Carri\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - S\u00e1nchez Carri\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-160_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - S\u00e1nchez Carri\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Huamachuco<\/option><option value=\"two\"  data-calculation=\"0\">Chugay<\/option><option value=\"Chicama\"  data-calculation=\"0\">Curgos<\/option><option value=\"Chocope\"  data-calculation=\"0\">Marcabal<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">Sanagor\u00e1n<\/option><option value=\"Sar\u00edn\"  data-calculation=\"0\">Sar\u00edn<\/option><option value=\"Sartimbamba\"  data-calculation=\"0\">Sartimbamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-159\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-159_69db919b372a3\" id=\"forminator-form-71__field--select-159_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Santiago de Chuco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-159_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-159\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Santiago de Chuco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Santiago de Chuco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-159_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Santiago de Chuco<\/option><option value=\"one\"  data-calculation=\"0\">Santiago de Chuco<\/option><option value=\"two\"  data-calculation=\"0\">Angasmarca<\/option><option value=\"Chicama\"  data-calculation=\"0\">Cachicad\u00e1n<\/option><option value=\"Chocope\"  data-calculation=\"0\">Mollebamba<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">Mollepata<\/option><option value=\"Quiruvilca\"  data-calculation=\"0\">Quiruvilca<\/option><option value=\"Santa-Cruz-de-Chuca\"  data-calculation=\"0\">Santa Cruz de Chuca<\/option><option value=\"Sitabamba\"  data-calculation=\"0\">Sitabamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-161\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-161_69db919b372a3\" id=\"forminator-form-71__field--select-161_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Trujillo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-161_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-161\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Trujillo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Trujillo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-161_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Trujillo<\/option><option value=\"one\"  data-calculation=\"0\">Trujillo<\/option><option value=\"two\"  data-calculation=\"0\">El Porvenir<\/option><option value=\"Chicama\"  data-calculation=\"0\">Florencia de Mora<\/option><option value=\"Chocope\"  data-calculation=\"0\">Huanchaco<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">La Esperanza<\/option><option value=\"Quiruvilca\"  data-calculation=\"0\">Laredo<\/option><option value=\"Santa-Cruz-de-Chuca\"  data-calculation=\"0\">Moche<\/option><option value=\"Sitabamba\"  data-calculation=\"0\">Poroto<\/option><option value=\"Salaverry\"  data-calculation=\"0\">Salaverry<\/option><option value=\"Simbal\"  data-calculation=\"0\">Simbal<\/option><option value=\"V\u00edctor-Larco-Herrera\"  data-calculation=\"0\">V\u00edctor Larco Herrera<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-162\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-162_69db919b372a3\" id=\"forminator-form-71__field--select-162_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Vir\u00fa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-162_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-162\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Vir\u00fa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Vir\u00fa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-162_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Vir\u00fa<\/option><option value=\"one\"  data-calculation=\"0\">Vir\u00fa<\/option><option value=\"two\"  data-calculation=\"0\">Chao<\/option><option value=\"Chicama\"  data-calculation=\"0\">Guadalupito<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-14\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Lambayeque<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-26\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-26_69db919b372a3\" id=\"forminator-form-71__field--select-26_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Lambayeque <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-26_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-26\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Lambayeque\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Lambayeque\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-26_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Lambayeque<\/option><option value=\"one\"  data-calculation=\"0\">Chiclayo<\/option><option value=\"two\"  data-calculation=\"0\">Ferre\u00f1afe<\/option><option value=\"Lambayeque\"  data-calculation=\"0\">Lambayeque<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-138\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-138_69db919b372a3\" id=\"forminator-form-71__field--select-138_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chiclayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-138_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-138\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chiclayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chiclayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-138_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chiclayo<\/option><option value=\"one\"  data-calculation=\"0\">Chiclayo<\/option><option value=\"two\"  data-calculation=\"0\">Chongoyape<\/option><option value=\"Eten\"  data-calculation=\"0\">Eten<\/option><option value=\"Puerto-Eten\"  data-calculation=\"0\">Puerto Eten<\/option><option value=\"Jos\u00e9-Leonardo-Ortiz\"  data-calculation=\"0\">Jos\u00e9 Leonardo Ortiz<\/option><option value=\"La-Victoria\"  data-calculation=\"0\">La Victoria<\/option><option value=\"Lagunas\"  data-calculation=\"0\">Lagunas<\/option><option value=\"Monsef\u00fa\"  data-calculation=\"0\">Monsef\u00fa<\/option><option value=\"Nueva-Arica\"  data-calculation=\"0\">Nueva Arica<\/option><option value=\"Oyot\u00fan\"  data-calculation=\"0\">Oyot\u00fan<\/option><option value=\"Patapo\"  data-calculation=\"0\">Patapo<\/option><option value=\"Picsi\"  data-calculation=\"0\">Picsi<\/option><option value=\"Pimentel\"  data-calculation=\"0\">Pimentel<\/option><option value=\"Reque\"  data-calculation=\"0\">Reque<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Sa\u00f1a\"  data-calculation=\"0\">Sa\u00f1a<\/option><option value=\"Tum\u00e1n\"  data-calculation=\"0\">Tum\u00e1n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-163\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-163_69db919b372a3\" id=\"forminator-form-71__field--select-163_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ferre\u00f1afe <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-163_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-163\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ferre\u00f1afe\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ferre\u00f1afe\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-163_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ferre\u00f1afe<\/option><option value=\"one\"  data-calculation=\"0\">Ferre\u00f1afe<\/option><option value=\"two\"  data-calculation=\"0\">Ca\u00f1aris<\/option><option value=\"Eten\"  data-calculation=\"0\">Incahuasi<\/option><option value=\"Puerto-Eten\"  data-calculation=\"0\">Manuel Antonio Mesones Muro<\/option><option value=\"Jos\u00e9-Leonardo-Ortiz\"  data-calculation=\"0\">P\u00edtipo<\/option><option value=\"La-Victoria\"  data-calculation=\"0\">Pueblo Nuevo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-164\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-164_69db919b372a3\" id=\"forminator-form-71__field--select-164_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lambayeque <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-164_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-164\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lambayeque\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lambayeque\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-164_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lambayeque<\/option><option value=\"one\"  data-calculation=\"0\">Lambayeque<\/option><option value=\"two\"  data-calculation=\"0\">Chochope<\/option><option value=\"Eten\"  data-calculation=\"0\">Illimo<\/option><option value=\"Puerto-Eten\"  data-calculation=\"0\">Jayanca<\/option><option value=\"Jos\u00e9-Leonardo-Ortiz\"  data-calculation=\"0\">Mochumi<\/option><option value=\"La-Victoria\"  data-calculation=\"0\">Morrope<\/option><option value=\"Motupe\"  data-calculation=\"0\">Motupe<\/option><option value=\"Olmos\"  data-calculation=\"0\">Olmos<\/option><option value=\"Pacora\"  data-calculation=\"0\">Pacora<\/option><option value=\"Salas\"  data-calculation=\"0\">Salas<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">San Jos\u00e9<\/option><option value=\"T\u00facume\"  data-calculation=\"0\">T\u00facume<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-15\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Lima<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-27\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-27_69db919b372a3\" id=\"forminator-form-71__field--select-27_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Lima <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-27_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-27\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Lima\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Lima\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-27_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Lima<\/option><option value=\"Lima\"  data-calculation=\"0\">Lima<\/option><option value=\"one\"  data-calculation=\"0\">Barranca<\/option><option value=\"two\"  data-calculation=\"0\">Cajatambo<\/option><option value=\"Canta\"  data-calculation=\"0\">Canta<\/option><option value=\"Ca\u00f1ete\"  data-calculation=\"0\">Ca\u00f1ete<\/option><option value=\"Huaral\"  data-calculation=\"0\">Huaral<\/option><option value=\"Huarochir\u00ed\"  data-calculation=\"0\">Huarochir\u00ed<\/option><option value=\"Huaura\"  data-calculation=\"0\">Huaura<\/option><option value=\"Oy\u00f3n\"  data-calculation=\"0\">Oy\u00f3n<\/option><option value=\"Yauyos\"  data-calculation=\"0\">Yauyos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-139\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-139_69db919b372a3\" id=\"forminator-form-71__field--select-139_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lima <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-139_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-139\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lima\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lima\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-139_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lima<\/option><option value=\"one\"  data-calculation=\"0\">Anc\u00f3n<\/option><option value=\"two\"  data-calculation=\"0\">Ate<\/option><option value=\"Barranco\"  data-calculation=\"0\">Barranco<\/option><option value=\"Bre\u00f1a\"  data-calculation=\"0\">Bre\u00f1a<\/option><option value=\"Carabayllo\"  data-calculation=\"0\">Carabayllo<\/option><option value=\"Chaclacayo\"  data-calculation=\"0\">Chaclacayo<\/option><option value=\"Chorrillos\"  data-calculation=\"0\">Chorrillos<\/option><option value=\"Cieneguilla\"  data-calculation=\"0\">Cieneguilla<\/option><option value=\"Comas\"  data-calculation=\"0\">Comas<\/option><option value=\"El-Agustino\"  data-calculation=\"0\">El Agustino<\/option><option value=\"Independencia\"  data-calculation=\"0\">Independencia<\/option><option value=\"Jes\u00fas-Mar\u00eda\"  data-calculation=\"0\">Jes\u00fas Mar\u00eda<\/option><option value=\"La-Molina\"  data-calculation=\"0\">La Molina<\/option><option value=\"La-Victoria\"  data-calculation=\"0\">La Victoria<\/option><option value=\"Lince\"  data-calculation=\"0\">Lince<\/option><option value=\"Los-Olivos\"  data-calculation=\"0\">Los Olivos<\/option><option value=\"Lurigancho\"  data-calculation=\"0\">Lurigancho<\/option><option value=\"Lur\u00edn\"  data-calculation=\"0\">Lur\u00edn<\/option><option value=\"Magdalena-del-Mar\"  data-calculation=\"0\">Magdalena del Mar<\/option><option value=\"Miraflores\"  data-calculation=\"0\">Miraflores<\/option><option value=\"Pachac\u00e1mac\"  data-calculation=\"0\">Pachac\u00e1mac<\/option><option value=\"Pucusana\"  data-calculation=\"0\">Pucusana<\/option><option value=\"Pueblo-Libre\"  data-calculation=\"0\">Pueblo Libre<\/option><option value=\"Puente-Piedra\"  data-calculation=\"0\">Puente Piedra<\/option><option value=\"Punta-Hermosa\"  data-calculation=\"0\">Punta Hermosa<\/option><option value=\"Punta-Negra\"  data-calculation=\"0\">Punta Negra<\/option><option value=\"R\u00edmac\"  data-calculation=\"0\">R\u00edmac<\/option><option value=\"San-Bartolo\"  data-calculation=\"0\">San Bartolo<\/option><option value=\"San-Borja\"  data-calculation=\"0\">San Borja<\/option><option value=\"San-Isidro\"  data-calculation=\"0\">San Isidro<\/option><option value=\"San-Juan-de-Lurigancho\"  data-calculation=\"0\">San Juan de Lurigancho<\/option><option value=\"San-Juan-de-Miraflores\"  data-calculation=\"0\">San Juan de Miraflores<\/option><option value=\"San-Luis\"  data-calculation=\"0\">San Luis<\/option><option value=\"San-Mart\u00edn-de-Porres\"  data-calculation=\"0\">San Mart\u00edn de Porres<\/option><option value=\"San-Miguel\"  data-calculation=\"0\">San Miguel<\/option><option value=\"Santa-Anita\"  data-calculation=\"0\">Santa Anita<\/option><option value=\"Santa-Mar\u00eda-del-Mar\"  data-calculation=\"0\">Santa Mar\u00eda del Mar<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Santiago-de-Surco\"  data-calculation=\"0\">Santiago de Surco<\/option><option value=\"Surquillo\"  data-calculation=\"0\">Surquillo<\/option><option value=\"Villa-El-Salvador\"  data-calculation=\"0\">Villa El Salvador<\/option><option value=\"Villa-Mar\u00eda-del-Triunfo\"  data-calculation=\"0\">Villa Mar\u00eda del Triunfo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-165\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-165_69db919b372a3\" id=\"forminator-form-71__field--select-165_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Barranca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-165_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-165\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Barranca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Barranca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-165_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Barranca<\/option><option value=\"one\"  data-calculation=\"0\">Barranca<\/option><option value=\"Paramonga\"  data-calculation=\"0\">Paramonga<\/option><option value=\"Pativilca\"  data-calculation=\"0\">Pativilca<\/option><option value=\"Supe\"  data-calculation=\"0\">Supe<\/option><option value=\"Supe-Puerto\"  data-calculation=\"0\">Supe Puerto<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-166\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-166_69db919b372a3\" id=\"forminator-form-71__field--select-166_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Cajatambo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-166_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-166\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Cajatambo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Cajatambo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-166_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Cajatambo<\/option><option value=\"Cajatambo\"  data-calculation=\"0\">Cajatambo<\/option><option value=\"Copa\"  data-calculation=\"0\">Copa<\/option><option value=\"Gorgor\"  data-calculation=\"0\">Gorgor<\/option><option value=\"Huancap\u00f3n\"  data-calculation=\"0\">Huancap\u00f3n<\/option><option value=\"Man\u00e1s\"  data-calculation=\"0\">Man\u00e1s<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-167\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-167_69db919b372a3\" id=\"forminator-form-71__field--select-167_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Canta <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-167_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-167\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Canta\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Canta\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-167_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Canta<\/option><option value=\"Canta\"  data-calculation=\"0\">Canta<\/option><option value=\"Arahuay\"  data-calculation=\"0\">Arahuay<\/option><option value=\"Huamantanga\"  data-calculation=\"0\">Huamantanga<\/option><option value=\"Huaros\"  data-calculation=\"0\">Huaros<\/option><option value=\"Lachaqui\"  data-calculation=\"0\">Lachaqui<\/option><option value=\"San-Buenaventura\"  data-calculation=\"0\">San Buenaventura<\/option><option value=\"Santa-Rosa-de-Quives\"  data-calculation=\"0\">Santa Rosa de Quives<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-168\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-168_69db919b372a3\" id=\"forminator-form-71__field--select-168_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ca\u00f1ete <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-168_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-168\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ca\u00f1ete\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ca\u00f1ete\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-168_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ca\u00f1ete<\/option><option value=\"San-Vicente-de-Ca\u00f1ete\"  data-calculation=\"0\">San Vicente de Ca\u00f1ete<\/option><option value=\"Asia\"  data-calculation=\"0\">Asia<\/option><option value=\"Calango\"  data-calculation=\"0\">Calango<\/option><option value=\"Cerro-Azul\"  data-calculation=\"0\">Cerro Azul<\/option><option value=\"Chilca\"  data-calculation=\"0\">Chilca<\/option><option value=\"Coayllo\"  data-calculation=\"0\">Coayllo<\/option><option value=\"Imperial\"  data-calculation=\"0\">Imperial<\/option><option value=\"Lunahuan\u00e1\"  data-calculation=\"0\">Lunahuan\u00e1<\/option><option value=\"Mala\"  data-calculation=\"0\">Mala<\/option><option value=\"Nuevo-Imperial\"  data-calculation=\"0\">Nuevo Imperial<\/option><option value=\"Pacar\u00e1n\"  data-calculation=\"0\">Pacar\u00e1n<\/option><option value=\"Quilman\u00e1\"  data-calculation=\"0\">Quilman\u00e1<\/option><option value=\"San-Antonio\"  data-calculation=\"0\">San Antonio<\/option><option value=\"San-Luis\"  data-calculation=\"0\">San Luis<\/option><option value=\"Santa-Cruz-de-Flores\"  data-calculation=\"0\">Santa Cruz de Flores<\/option><option value=\"Z\u00fa\u00f1iga\"  data-calculation=\"0\">Z\u00fa\u00f1iga<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-169\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-169_69db919b372a3\" id=\"forminator-form-71__field--select-169_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huaral <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-169_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-169\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huaral\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huaral\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-169_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huaral<\/option><option value=\"Huaral\"  data-calculation=\"0\">Huaral<\/option><option value=\"Atavillos-Alto\"  data-calculation=\"0\">Atavillos Alto<\/option><option value=\"Atavillos-Bajo\"  data-calculation=\"0\">Atavillos Bajo<\/option><option value=\"Aucallama\"  data-calculation=\"0\">Aucallama<\/option><option value=\"Chancay\"  data-calculation=\"0\">Chancay<\/option><option value=\"Ihuari\"  data-calculation=\"0\">Ihuari<\/option><option value=\"Lampian\"  data-calculation=\"0\">Lampian<\/option><option value=\"Pacaraos\"  data-calculation=\"0\">Pacaraos<\/option><option value=\"Santa-Cruz-de-Andamarca\"  data-calculation=\"0\">Santa Cruz de Andamarca<\/option><option value=\"Sumbilca\"  data-calculation=\"0\">Sumbilca<\/option><option value=\"Veintisiete-de-Noviembre\"  data-calculation=\"0\">Veintisiete de Noviembre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-170\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-170_69db919b372a3\" id=\"forminator-form-71__field--select-170_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huarochir\u00ed <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-170_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-170\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huarochir\u00ed\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huarochir\u00ed\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-170_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huarochir\u00ed<\/option><option value=\"Matucana\"  data-calculation=\"0\">Matucana<\/option><option value=\"Antioqu\u00eda\"  data-calculation=\"0\">Antioqu\u00eda<\/option><option value=\"Callahuanca\"  data-calculation=\"0\">Callahuanca<\/option><option value=\"Carampoma\"  data-calculation=\"0\">Carampoma<\/option><option value=\"Chicla\"  data-calculation=\"0\">Chicla<\/option><option value=\"Cuenca\"  data-calculation=\"0\">Cuenca<\/option><option value=\"Huachupampa\"  data-calculation=\"0\">Huachupampa<\/option><option value=\"Huanza\"  data-calculation=\"0\">Huanza<\/option><option value=\"Huarochir\u00ed\"  data-calculation=\"0\">Huarochir\u00ed<\/option><option value=\"Lahuaytambo\"  data-calculation=\"0\">Lahuaytambo<\/option><option value=\"Langa\"  data-calculation=\"0\">Langa<\/option><option value=\"Laraos\"  data-calculation=\"0\">Laraos<\/option><option value=\"Mariatana\"  data-calculation=\"0\">Mariatana<\/option><option value=\"Ricardo-Palma\"  data-calculation=\"0\">Ricardo Palma<\/option><option value=\"San-Andr\u00e9s-de-Tupicocha\"  data-calculation=\"0\">San Andr\u00e9s de Tupicocha<\/option><option value=\"San-Antonio\"  data-calculation=\"0\">San Antonio<\/option><option value=\"San-Bartolom\u00e9\"  data-calculation=\"0\">San Bartolom\u00e9<\/option><option value=\"San-Dami\u00e1n\"  data-calculation=\"0\">San Dami\u00e1n<\/option><option value=\"San-Juan-de-Iris\"  data-calculation=\"0\">San Juan de Iris<\/option><option value=\"San-Juan-de-Tantaranche\"  data-calculation=\"0\">San Juan de Tantaranche<\/option><option value=\"San-Lorenzo-de-Quinti\"  data-calculation=\"0\">San Lorenzo de Quinti<\/option><option value=\"San-Mateo\"  data-calculation=\"0\">San Mateo<\/option><option value=\"San-Mateo-de-Otao\"  data-calculation=\"0\">San Mateo de Otao<\/option><option value=\"San-Pedro-de-Casta\"  data-calculation=\"0\">San Pedro de Casta<\/option><option value=\"San-Pedro-de-Huancayre\"  data-calculation=\"0\">San Pedro de Huancayre<\/option><option value=\"Sangallaya\"  data-calculation=\"0\">Sangallaya<\/option><option value=\"Santa-Cruz-de-Cocachacra\"  data-calculation=\"0\">Santa Cruz de Cocachacra<\/option><option value=\"Santa-Eulalia\"  data-calculation=\"0\">Santa Eulalia<\/option><option value=\"Santiago-de-Anchucaya\"  data-calculation=\"0\">Santiago de Anchucaya<\/option><option value=\"Santiago-de-Tuna\"  data-calculation=\"0\">Santiago de Tuna<\/option><option value=\"Santo-Domingo-de-Los-Olleros\"  data-calculation=\"0\">Santo Domingo de Los Olleros<\/option><option value=\"Surco\"  data-calculation=\"0\">Surco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-171\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-171_69db919b372a3\" id=\"forminator-form-71__field--select-171_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huaura <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-171_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-171\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huaura\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huaura\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-171_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huaura<\/option><option value=\"Surco\"  data-calculation=\"0\">Huaura<\/option><option value=\"Ambar\"  data-calculation=\"0\">Ambar<\/option><option value=\"Caleta-de-Carqu\u00edn\"  data-calculation=\"0\">Caleta de Carqu\u00edn<\/option><option value=\"Checras\"  data-calculation=\"0\">Checras<\/option><option value=\"Hualmay\"  data-calculation=\"0\">Hualmay<\/option><option value=\"Huaura\"  data-calculation=\"0\">Huaura<\/option><option value=\"Leoncio-Prado\"  data-calculation=\"0\">Leoncio Prado<\/option><option value=\"Paccho\"  data-calculation=\"0\">Paccho<\/option><option value=\"Santa-Leonor\"  data-calculation=\"0\">Santa Leonor<\/option><option value=\"Santa-Mar\u00eda\"  data-calculation=\"0\">Santa Mar\u00eda<\/option><option value=\"Say\u00e1n\"  data-calculation=\"0\">Say\u00e1n<\/option><option value=\"V\u00e9gueta\"  data-calculation=\"0\">V\u00e9gueta<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-172\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-172_69db919b372a3\" id=\"forminator-form-71__field--select-172_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Oyon <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-172_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-172\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Oyon\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Oyon\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-172_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Oyon<\/option><option value=\"Oy\u00f3n\"  data-calculation=\"0\">Oy\u00f3n<\/option><option value=\"Andajes\"  data-calculation=\"0\">Andajes<\/option><option value=\"Caujul\"  data-calculation=\"0\">Caujul<\/option><option value=\"Cochamarca\"  data-calculation=\"0\">Cochamarca<\/option><option value=\"Nav\u00e1n\"  data-calculation=\"0\">Nav\u00e1n<\/option><option value=\"Pachangara\"  data-calculation=\"0\">Pachangara<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-173\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-173_69db919b372a3\" id=\"forminator-form-71__field--select-173_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Yauyos <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-173_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-173\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Yauyos\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Yauyos\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-173_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Yauyos<\/option><option value=\"Yauyos\"  data-calculation=\"0\">Yauyos<\/option><option value=\"Alis\"  data-calculation=\"0\">Alis<\/option><option value=\"Ayauca\"  data-calculation=\"0\">Ayauca<\/option><option value=\"Ayaviri\"  data-calculation=\"0\">Ayaviri<\/option><option value=\"Az\u00e1ngaro\"  data-calculation=\"0\">Az\u00e1ngaro<\/option><option value=\"Cacra\"  data-calculation=\"0\">Cacra<\/option><option value=\"Carania\"  data-calculation=\"0\">Carania<\/option><option value=\"Catahuasi\"  data-calculation=\"0\">Catahuasi<\/option><option value=\"Chocos\"  data-calculation=\"0\">Chocos<\/option><option value=\"Cochas\"  data-calculation=\"0\">Cochas<\/option><option value=\"Colonia\"  data-calculation=\"0\">Colonia<\/option><option value=\"Hongos\"  data-calculation=\"0\">Hongos<\/option><option value=\"Huampara\"  data-calculation=\"0\">Huampara<\/option><option value=\"Huancaya\"  data-calculation=\"0\">Huancaya<\/option><option value=\"Huang\u00e1scar\"  data-calculation=\"0\">Huang\u00e1scar<\/option><option value=\"Hu\u00e1ntan\"  data-calculation=\"0\">Hu\u00e1ntan<\/option><option value=\"Laraos\"  data-calculation=\"0\">Laraos<\/option><option value=\"Lincha\"  data-calculation=\"0\">Lincha<\/option><option value=\"Madean\"  data-calculation=\"0\">Madean<\/option><option value=\"Miraflores\"  data-calculation=\"0\">Miraflores<\/option><option value=\"Omas\"  data-calculation=\"0\">Omas<\/option><option value=\"Putinza\"  data-calculation=\"0\">Putinza<\/option><option value=\"Quinches\"  data-calculation=\"0\">Quinches<\/option><option value=\"Quinocay\"  data-calculation=\"0\">Quinocay<\/option><option value=\"San-Joaqu\u00edn\"  data-calculation=\"0\">San Joaqu\u00edn<\/option><option value=\"San-Pedro-de-Pilas\"  data-calculation=\"0\">San Pedro de Pilas<\/option><option value=\"Tanta\"  data-calculation=\"0\">Tanta<\/option><option value=\"Tauripampa\"  data-calculation=\"0\">Tauripampa<\/option><option value=\"Tomas\"  data-calculation=\"0\">Tomas<\/option><option value=\"Tupe\"  data-calculation=\"0\">Tupe<\/option><option value=\"Vi\u00f1ac\"  data-calculation=\"0\">Vi\u00f1ac<\/option><option value=\"Vitis\"  data-calculation=\"0\">Vitis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-16\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Loreto<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-28\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-28_69db919b372a3\" id=\"forminator-form-71__field--select-28_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Loreto <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-28_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-28\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Loreto\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Loreto\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-28_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Loreto<\/option><option value=\"one\"  data-calculation=\"0\">Alto Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">Datem del Mara\u00f1\u00f3n<\/option><option value=\"Loreto\"  data-calculation=\"0\">Loreto<\/option><option value=\"Mariscal-Ram\u00f3n-Castilla\"  data-calculation=\"0\">Mariscal Ram\u00f3n Castilla<\/option><option value=\"Maynas\"  data-calculation=\"0\">Maynas<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"Requena\"  data-calculation=\"0\">Requena<\/option><option value=\"Ucayali\"  data-calculation=\"0\">Ucayali<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-140\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-140_69db919b372a3\" id=\"forminator-form-71__field--select-140_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Alto Amazonas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-140_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-140\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Alto Amazonas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Alto Amazonas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-140_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Alto Amazonas<\/option><option value=\"one\"  data-calculation=\"0\">Yurimaguas<\/option><option value=\"two\"  data-calculation=\"0\">Balsapuerto<\/option><option value=\"Jeberos\"  data-calculation=\"0\">Jeberos<\/option><option value=\"Lagunas\"  data-calculation=\"0\">Lagunas<\/option><option value=\"Santa-Cruz\"  data-calculation=\"0\">Santa Cruz<\/option><option value=\"Teniente-C\u00e9sar-L\u00f3pez-Rojas\"  data-calculation=\"0\">Teniente C\u00e9sar L\u00f3pez Rojas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-174\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-174_69db919b372a3\" id=\"forminator-form-71__field--select-174_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Datem del Mara\u00f1\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-174_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-174\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Datem del Mara\u00f1\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Datem del Mara\u00f1\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-174_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Datem del Mara\u00f1\u00f3n<\/option><option value=\"San-Lorenzo\"  data-calculation=\"0\">San Lorenzo<\/option><option value=\"Barranca\"  data-calculation=\"0\">Barranca<\/option><option value=\"Cahuapanas\"  data-calculation=\"0\">Cahuapanas<\/option><option value=\"Manseriche\"  data-calculation=\"0\">Manseriche<\/option><option value=\"Morona\"  data-calculation=\"0\">Morona<\/option><option value=\"Pastaza\"  data-calculation=\"0\">Pastaza<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-176\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-176_69db919b372a3\" id=\"forminator-form-71__field--select-176_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Loreto <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-176_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-176\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Loreto\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Loreto\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-176_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Loreto<\/option><option value=\"one\"  data-calculation=\"0\">Nauta<\/option><option value=\"two\"  data-calculation=\"0\">Parinari<\/option><option value=\"Jeberos\"  data-calculation=\"0\">Tigre<\/option><option value=\"Lagunas\"  data-calculation=\"0\">Trompeteros<\/option><option value=\"Santa-Cruz\"  data-calculation=\"0\">Urarinas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-175\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-175_69db919b372a3\" id=\"forminator-form-71__field--select-175_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Mariscal Ram\u00f3n Castilla <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-175_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-175\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Mariscal Ram\u00f3n Castilla\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Mariscal Ram\u00f3n Castilla\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-175_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Mariscal Ram\u00f3n Castilla<\/option><option value=\"one\"  data-calculation=\"0\">Caballococha<\/option><option value=\"Pebas\"  data-calculation=\"0\">Pebas<\/option><option value=\"Ram\u00f3n-Castilla\"  data-calculation=\"0\">Ram\u00f3n Castilla<\/option><option value=\"San-Pablo\"  data-calculation=\"0\">San Pablo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-177\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-177_69db919b372a3\" id=\"forminator-form-71__field--select-177_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Maynas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-177_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-177\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Maynas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Maynas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-177_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Maynas<\/option><option value=\"Iquitos\"  data-calculation=\"0\">Iquitos<\/option><option value=\"Alto-Nanay\"  data-calculation=\"0\">Alto Nanay<\/option><option value=\"Fernando-Lores\"  data-calculation=\"0\">Fernando Lores<\/option><option value=\"Indiana\"  data-calculation=\"0\">Indiana<\/option><option value=\"Las-Amazonas\"  data-calculation=\"0\">Las Amazonas<\/option><option value=\"Maz\u00e1n\"  data-calculation=\"0\">Maz\u00e1n<\/option><option value=\"Napo\"  data-calculation=\"0\">Napo<\/option><option value=\"Punchana\"  data-calculation=\"0\">Punchana<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"San-Juan-Bautista\"  data-calculation=\"0\">San Juan Bautista<\/option><option value=\"Torres-Causana\"  data-calculation=\"0\">Torres Causana<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-178\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-178_69db919b372a3\" id=\"forminator-form-71__field--select-178_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Putumayo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-178_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-178\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Putumayo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Putumayo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-178_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Putumayo<\/option><option value=\"Iquitos\"  data-calculation=\"0\">San Antonio del Estrecho<\/option><option value=\"Punchana\"  data-calculation=\"0\">Rosa Panduro<\/option><option value=\"San-Juan-Bautista\"  data-calculation=\"0\">Teniente Manuel Clavero<\/option><option value=\"Torres-Causana\"  data-calculation=\"0\">Yaguas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-179\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-179_69db919b372a3\" id=\"forminator-form-71__field--select-179_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Requena <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-179_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-179\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Requena\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Requena\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-179_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Requena<\/option><option value=\"Iquitos\"  data-calculation=\"0\">Requena<\/option><option value=\"Alto-Tapiche\"  data-calculation=\"0\">Alto Tapiche<\/option><option value=\"Capelo\"  data-calculation=\"0\">Capelo<\/option><option value=\"Emilio-San-Mart\u00edn\"  data-calculation=\"0\">Emilio San Mart\u00edn<\/option><option value=\"Maqu\u00eda\"  data-calculation=\"0\">Maqu\u00eda<\/option><option value=\"Puinahua\"  data-calculation=\"0\">Puinahua<\/option><option value=\"Saquena\"  data-calculation=\"0\">Saquena<\/option><option value=\"Soplin\"  data-calculation=\"0\">Soplin<\/option><option value=\"Tapiche\"  data-calculation=\"0\">Tapiche<\/option><option value=\"Jenaro-Herrera\"  data-calculation=\"0\">Jenaro Herrera<\/option><option value=\"Yaquerana\"  data-calculation=\"0\">Yaquerana<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-180\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-180_69db919b372a3\" id=\"forminator-form-71__field--select-180_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ucayali <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-180_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-180\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ucayali\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ucayali\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-180_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ucayali<\/option><option value=\"Contamana\"  data-calculation=\"0\">Contamana<\/option><option value=\"Inahuaya\"  data-calculation=\"0\">Inahuaya<\/option><option value=\"Padre-M\u00e1rquez\"  data-calculation=\"0\">Padre M\u00e1rquez<\/option><option value=\"Pampa-Hermosa\"  data-calculation=\"0\">Pampa Hermosa<\/option><option value=\"Sarayacu\"  data-calculation=\"0\">Sarayacu<\/option><option value=\"Vargas-Guerra\"  data-calculation=\"0\">Vargas Guerra<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-17\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Madre de Dios<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-29\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-29_69db919b372a3\" id=\"forminator-form-71__field--select-29_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Madre de Dios <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-29_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-29\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Madre de Dios\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Madre de Dios\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-29_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Madre de Dios<\/option><option value=\"one\"  data-calculation=\"0\">Manu<\/option><option value=\"two\"  data-calculation=\"0\">Tahuamanu<\/option><option value=\"Tambopata\"  data-calculation=\"0\">Tambopata<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-18\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Moquegua<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-141\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-141_69db919b372a3\" id=\"forminator-form-71__field--select-141_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Manu <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-141_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-141\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Manu\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Manu\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-141_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Manu<\/option><option value=\"one\"  data-calculation=\"0\">Manu<\/option><option value=\"two\"  data-calculation=\"0\">Fitzcarrald<\/option><option value=\"Madre-de-Dios\"  data-calculation=\"0\">Madre de Dios<\/option><option value=\"Huepetuhe\"  data-calculation=\"0\">Huepetuhe<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-181\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-181_69db919b372a3\" id=\"forminator-form-71__field--select-181_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tahuamanu <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-181_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-181\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tahuamanu\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tahuamanu\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-181_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tahuamanu<\/option><option value=\"one\"  data-calculation=\"0\">I\u00f1apari<\/option><option value=\"two\"  data-calculation=\"0\">Iberia<\/option><option value=\"Madre-de-Dios\"  data-calculation=\"0\">Tahuamanu<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-182\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-182_69db919b372a3\" id=\"forminator-form-71__field--select-182_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tambopata <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-182_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-182\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tambopata\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tambopata\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-182_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tambopata<\/option><option value=\"Tambopata\"  data-calculation=\"0\">Tambopata<\/option><option value=\"Inambari\"  data-calculation=\"0\">Inambari<\/option><option value=\"Las-Piedras\"  data-calculation=\"0\">Las Piedras<\/option><option value=\"Laberinto\"  data-calculation=\"0\">Laberinto<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-30\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-30_69db919b372a3\" id=\"forminator-form-71__field--select-30_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Moquegua <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-30_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-30\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Moquegua\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Moquegua\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-30_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Moquegua<\/option><option value=\"one\"  data-calculation=\"0\">General S\u00e1nchez Cerro<\/option><option value=\"two\"  data-calculation=\"0\">Ilo<\/option><option value=\"Mariscal-Nieto\"  data-calculation=\"0\">Mariscal Nieto<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-143\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-143_69db919b372a3\" id=\"forminator-form-71__field--select-143_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - General S\u00e1nchez Cerro <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-143_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-143\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - General S\u00e1nchez Cerro\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - General S\u00e1nchez Cerro\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-143_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - General S\u00e1nchez Cerro<\/option><option value=\"one\"  data-calculation=\"0\">Omate<\/option><option value=\"two\"  data-calculation=\"0\">Chojata<\/option><option value=\"Coalaque\"  data-calculation=\"0\">Coalaque<\/option><option value=\"Ichu\u00f1a\"  data-calculation=\"0\">Ichu\u00f1a<\/option><option value=\"La-Capilla\"  data-calculation=\"0\">La Capilla<\/option><option value=\"Lloque\"  data-calculation=\"0\">Lloque<\/option><option value=\"Matalaque\"  data-calculation=\"0\">Matalaque<\/option><option value=\"Puquina\"  data-calculation=\"0\">Puquina<\/option><option value=\"Quinistaquillas\"  data-calculation=\"0\">Quinistaquillas<\/option><option value=\"Ubinas\"  data-calculation=\"0\">Ubinas<\/option><option value=\"Yunga\"  data-calculation=\"0\">Yunga<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-183\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-183_69db919b372a3\" id=\"forminator-form-71__field--select-183_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ilo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-183_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-183\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ilo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ilo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-183_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ilo<\/option><option value=\"Ilo\"  data-calculation=\"0\">Ilo<\/option><option value=\"El-Algarrobal\"  data-calculation=\"0\">El Algarrobal<\/option><option value=\"Pacocha\"  data-calculation=\"0\">Pacocha<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-184\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-184_69db919b372a3\" id=\"forminator-form-71__field--select-184_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Mariscal Nieto <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-184_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-184\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Mariscal Nieto\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Mariscal Nieto\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-184_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Mariscal Nieto<\/option><option value=\"Moquegua\"  data-calculation=\"0\">Moquegua<\/option><option value=\"Carumas\"  data-calculation=\"0\">Carumas<\/option><option value=\"Cuchumbaya\"  data-calculation=\"0\">Cuchumbaya<\/option><option value=\"Samegua\"  data-calculation=\"0\">Samegua<\/option><option value=\"San-Crist\u00f3bal\"  data-calculation=\"0\">San Crist\u00f3bal<\/option><option value=\"Torata\"  data-calculation=\"0\">Torata<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-19\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Pasco<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-31\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-31_69db919b372a3\" id=\"forminator-form-71__field--select-31_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Pasco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-31_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-31\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Pasco\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Pasco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-31_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Pasco<\/option><option value=\"one\"  data-calculation=\"0\">Daniel Alcides Carri\u00f3n<\/option><option value=\"two\"  data-calculation=\"0\">Oxapampa<\/option><option value=\"Pasco\"  data-calculation=\"0\">Pasco<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-185\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-185_69db919b372a3\" id=\"forminator-form-71__field--select-185_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Daniel Alcides Carri\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-185_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-185\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Daniel Alcides Carri\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Daniel Alcides Carri\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-185_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Daniel Alcides Carri\u00f3n<\/option><option value=\"Yanahuanca\"  data-calculation=\"0\">Yanahuanca<\/option><option value=\"Chacayan\"  data-calculation=\"0\">Chacayan<\/option><option value=\"Goyllarisquizga\"  data-calculation=\"0\">Goyllarisquizga<\/option><option value=\"Paucar\"  data-calculation=\"0\">Paucar<\/option><option value=\"San-Pedro-de-Pillao\"  data-calculation=\"0\">San Pedro de Pillao<\/option><option value=\"Santa-Ana-de-Tusi\"  data-calculation=\"0\">Santa Ana de Tusi<\/option><option value=\"Tapuc\"  data-calculation=\"0\">Tapuc<\/option><option value=\"Vilcabamba\"  data-calculation=\"0\">Vilcabamba<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-186\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-186_69db919b372a3\" id=\"forminator-form-71__field--select-186_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Oxapampa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-186_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-186\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Oxapampa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Oxapampa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-186_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Oxapampa<\/option><option value=\"Oxapampa\"  data-calculation=\"0\">Oxapampa<\/option><option value=\"Chontabamba\"  data-calculation=\"0\">Chontabamba<\/option><option value=\"Huancabamba\"  data-calculation=\"0\">Huancabamba<\/option><option value=\"Palcaz\u00fa\"  data-calculation=\"0\">Palcaz\u00fa<\/option><option value=\"Pozuzo\"  data-calculation=\"0\">Pozuzo<\/option><option value=\"Puerto-Berm\u00fadez\"  data-calculation=\"0\">Puerto Berm\u00fadez<\/option><option value=\"Villa-Rica\"  data-calculation=\"0\">Villa Rica<\/option><option value=\"Constituci\u00f3n\"  data-calculation=\"0\">Constituci\u00f3n<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-188\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-188_69db919b372a3\" id=\"forminator-form-71__field--select-188_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pasco <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-188_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-188\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pasco\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pasco\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-188_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pasco<\/option><option value=\"Chaupimarca\"  data-calculation=\"0\">Chaupimarca<\/option><option value=\"Huach\u00f3n\"  data-calculation=\"0\">Huach\u00f3n<\/option><option value=\"Huariaca\"  data-calculation=\"0\">Huariaca<\/option><option value=\"Huayllay\"  data-calculation=\"0\">Huayllay<\/option><option value=\"Ninacaca\"  data-calculation=\"0\">Ninacaca<\/option><option value=\"Pallanchacra\"  data-calculation=\"0\">Pallanchacra<\/option><option value=\"Paucartambo\"  data-calculation=\"0\">Paucartambo<\/option><option value=\"San-Francisco-de-As\u00eds-de-Yarusyac\u00e1n\"  data-calculation=\"0\">San Francisco de As\u00eds de Yarusyac\u00e1n<\/option><option value=\"Sim\u00f3n-Bol\u00edvar\"  data-calculation=\"0\">Sim\u00f3n Bol\u00edvar<\/option><option value=\"Ticlacay\u00e1n\"  data-calculation=\"0\">Ticlacay\u00e1n<\/option><option value=\"Tinyahuarco\"  data-calculation=\"0\">Tinyahuarco<\/option><option value=\"Vicco\"  data-calculation=\"0\">Vicco<\/option><option value=\"Yanacancha\"  data-calculation=\"0\">Yanacancha<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-20\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Piura<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-32\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-32_69db919b372a3\" id=\"forminator-form-71__field--select-32_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Piura <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-32_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-32\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Piura\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Piura\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-32_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Piura<\/option><option value=\"one\"  data-calculation=\"0\">Ayabaca<\/option><option value=\"two\"  data-calculation=\"0\">Huancabamba<\/option><option value=\"Morrop\u00f3n\"  data-calculation=\"0\">Morrop\u00f3n<\/option><option value=\"Paita\"  data-calculation=\"0\">Paita<\/option><option value=\"Piura\"  data-calculation=\"0\">Piura<\/option><option value=\"Sechura\"  data-calculation=\"0\">Sechura<\/option><option value=\"Sullana\"  data-calculation=\"0\">Sullana<\/option><option value=\"Talara\"  data-calculation=\"0\">Talara<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-189\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-189_69db919b372a3\" id=\"forminator-form-71__field--select-189_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Ayabaca <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-189_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-189\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Ayabaca\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Ayabaca\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-189_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Ayabaca<\/option><option value=\"Seleccionar-distrito---Ayabaca\"  data-calculation=\"0\">Ayabaca<\/option><option value=\"Fr\u00edas\"  data-calculation=\"0\">Fr\u00edas<\/option><option value=\"Jilil\u00ed\"  data-calculation=\"0\">Jilil\u00ed<\/option><option value=\"Lagunas\"  data-calculation=\"0\">Lagunas<\/option><option value=\"Montero\"  data-calculation=\"0\">Montero<\/option><option value=\"Pacaipampa\"  data-calculation=\"0\">Pacaipampa<\/option><option value=\"Paimas\"  data-calculation=\"0\">Paimas<\/option><option value=\"Sapillica\"  data-calculation=\"0\">Sapillica<\/option><option value=\"Sicchez\"  data-calculation=\"0\">Sicchez<\/option><option value=\"Suyo\"  data-calculation=\"0\">Suyo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-190\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-190_69db919b372a3\" id=\"forminator-form-71__field--select-190_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huancabamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-190_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-190\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huancabamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huancabamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-190_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huancabamba<\/option><option value=\"Huancabamba\"  data-calculation=\"0\">Huancabamba<\/option><option value=\"Canchaque\"  data-calculation=\"0\">Canchaque<\/option><option value=\"El-Carmen-de-la-Frontera\"  data-calculation=\"0\">El Carmen de la Frontera<\/option><option value=\"Huarmaca\"  data-calculation=\"0\">Huarmaca<\/option><option value=\"Lalaquiz\"  data-calculation=\"0\">Lalaquiz<\/option><option value=\"San-Miguel-de-El-Faique\"  data-calculation=\"0\">San Miguel de El Faique<\/option><option value=\"S\u00f3ndor\"  data-calculation=\"0\">S\u00f3ndor<\/option><option value=\"Sondorillo\"  data-calculation=\"0\">Sondorillo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-191\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-191_69db919b372a3\" id=\"forminator-form-71__field--select-191_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Morrop\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-191_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-191\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Morrop\u00f3n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Morrop\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-191_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Morrop\u00f3n<\/option><option value=\"Suyo\"  data-calculation=\"0\">Chulucanas<\/option><option value=\"Buenos-Aires\"  data-calculation=\"0\">Buenos Aires<\/option><option value=\"Chalaco\"  data-calculation=\"0\">Chalaco<\/option><option value=\"La-Matanza\"  data-calculation=\"0\">La Matanza<\/option><option value=\"Morrop\u00f3n\"  data-calculation=\"0\">Morrop\u00f3n<\/option><option value=\"Salitral\"  data-calculation=\"0\">Salitral<\/option><option value=\"San-Juan-de-Bigote\"  data-calculation=\"0\">San Juan de Bigote<\/option><option value=\"Santa-Catalina-de-Mossa\"  data-calculation=\"0\">Santa Catalina de Mossa<\/option><option value=\"Santo-Domingo\"  data-calculation=\"0\">Santo Domingo<\/option><option value=\"Yamango\"  data-calculation=\"0\">Yamango<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-192\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-192_69db919b372a3\" id=\"forminator-form-71__field--select-192_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Paita <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-192_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-192\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Paita\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Paita\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-192_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Paita<\/option><option value=\"Suyo\"  data-calculation=\"0\">Paita<\/option><option value=\"Buenos-Aires\"  data-calculation=\"0\">Amotape<\/option><option value=\"Chalaco\"  data-calculation=\"0\">Arenal<\/option><option value=\"La-Matanza\"  data-calculation=\"0\">Col\u00e1n<\/option><option value=\"Morrop\u00f3n\"  data-calculation=\"0\">El Arenal<\/option><option value=\"Salitral\"  data-calculation=\"0\">La Huaca<\/option><option value=\"San-Juan-de-Bigote\"  data-calculation=\"0\">Tamarindo<\/option><option value=\"Santa-Catalina-de-Mossa\"  data-calculation=\"0\">Vichayal<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-194\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-194_69db919b372a3\" id=\"forminator-form-71__field--select-194_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Piura <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-194_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-194\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Piura\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Piura\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-194_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Piura<\/option><option value=\"Piura\"  data-calculation=\"0\">Piura<\/option><option value=\"Castilla\"  data-calculation=\"0\">Castilla<\/option><option value=\"Catacaos\"  data-calculation=\"0\">Catacaos<\/option><option value=\"Cura-Mori\"  data-calculation=\"0\">Cura Mori<\/option><option value=\"El-Tall\u00e1n\"  data-calculation=\"0\">El Tall\u00e1n<\/option><option value=\"La-Arena\"  data-calculation=\"0\">La Arena<\/option><option value=\"La-Uni\u00f3n\"  data-calculation=\"0\">La Uni\u00f3n<\/option><option value=\"Las-Lomas\"  data-calculation=\"0\">Las Lomas<\/option><option value=\"Tambo-Grande\"  data-calculation=\"0\">Tambo Grande<\/option><option value=\"Veintis\u00e9is-de-Octubre\"  data-calculation=\"0\">Veintis\u00e9is de Octubre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-193\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-193_69db919b372a3\" id=\"forminator-form-71__field--select-193_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sechura <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-193_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-193\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sechura\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sechura\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-193_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sechura<\/option><option value=\"Suyo\"  data-calculation=\"0\">Sechura<\/option><option value=\"Buenos-Aires\"  data-calculation=\"0\">Bellavista de la Uni\u00f3n<\/option><option value=\"Chalaco\"  data-calculation=\"0\">Bernal<\/option><option value=\"La-Matanza\"  data-calculation=\"0\">Cristo Nos Valga<\/option><option value=\"Morrop\u00f3n\"  data-calculation=\"0\">Rinconada Llicuar<\/option><option value=\"Salitral\"  data-calculation=\"0\">Vice<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-195\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-195_69db919b372a3\" id=\"forminator-form-71__field--select-195_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sullana <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-195_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-195\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sullana\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sullana\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-195_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sullana<\/option><option value=\"Sullana\"  data-calculation=\"0\">Sullana<\/option><option value=\"Bellavista\"  data-calculation=\"0\">Bellavista<\/option><option value=\"Ignacio-Escudero\"  data-calculation=\"0\">Ignacio Escudero<\/option><option value=\"Lancones\"  data-calculation=\"0\">Lancones<\/option><option value=\"Marcavelica\"  data-calculation=\"0\">Marcavelica<\/option><option value=\"Miguel-Checa\"  data-calculation=\"0\">Miguel Checa<\/option><option value=\"Querecotillo\"  data-calculation=\"0\">Querecotillo<\/option><option value=\"Salitral\"  data-calculation=\"0\">Salitral<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-196\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-196_69db919b372a3\" id=\"forminator-form-71__field--select-196_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sechura <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-196_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-196\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sechura\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sechura\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-196_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sechura<\/option><option value=\"Suyo\"  data-calculation=\"0\">Sechura<\/option><option value=\"Buenos-Aires\"  data-calculation=\"0\">Bellavista de la Uni\u00f3n<\/option><option value=\"Chalaco\"  data-calculation=\"0\">Bernal<\/option><option value=\"La-Matanza\"  data-calculation=\"0\">Cristo Nos Valga<\/option><option value=\"Morrop\u00f3n\"  data-calculation=\"0\">Rinconada Llicuar<\/option><option value=\"Salitral\"  data-calculation=\"0\">Vice<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-197\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-197_69db919b372a3\" id=\"forminator-form-71__field--select-197_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Talara <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-197_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-197\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Talara\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Talara\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-197_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Talara<\/option><option value=\"Pari\u00f1as\"  data-calculation=\"0\">Pari\u00f1as<\/option><option value=\"El-Alto\"  data-calculation=\"0\">El Alto<\/option><option value=\"La-Brea\"  data-calculation=\"0\">La Brea<\/option><option value=\"Lobitos\"  data-calculation=\"0\">Lobitos<\/option><option value=\"Los-\u00d3rganos\"  data-calculation=\"0\">Los \u00d3rganos<\/option><option value=\"M\u00e1ncora\"  data-calculation=\"0\">M\u00e1ncora<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-21\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Puno<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-34\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-34_69db919b372a3\" id=\"forminator-form-71__field--select-34_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Puno <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-34_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-34\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Puno\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Puno\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-34_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Puno<\/option><option value=\"one\"  data-calculation=\"0\">Az\u00e1ngaro<\/option><option value=\"two\"  data-calculation=\"0\">Carabaya<\/option><option value=\"Chucuito\"  data-calculation=\"0\">Chucuito<\/option><option value=\"El-Collao\"  data-calculation=\"0\">El Collao<\/option><option value=\"Huancan\u00e9\"  data-calculation=\"0\">Huancan\u00e9<\/option><option value=\"Lampa\"  data-calculation=\"0\">Lampa<\/option><option value=\"Melgar\"  data-calculation=\"0\">Melgar<\/option><option value=\"Moho\"  data-calculation=\"0\">Moho<\/option><option value=\"Puno\"  data-calculation=\"0\">Puno<\/option><option value=\"San-Antonio-de-Putina\"  data-calculation=\"0\">San Antonio de Putina<\/option><option value=\"San-Rom\u00e1n\"  data-calculation=\"0\">San Rom\u00e1n<\/option><option value=\"Sandia\"  data-calculation=\"0\">Sandia<\/option><option value=\"Yunguyo\"  data-calculation=\"0\">Yunguyo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-198\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-198_69db919b372a3\" id=\"forminator-form-71__field--select-198_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Az\u00e1ngaro <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-198_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-198\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Az\u00e1ngaro\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Az\u00e1ngaro\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-198_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Az\u00e1ngaro<\/option><option value=\"one\"  data-calculation=\"0\">Az\u00e1ngaro<\/option><option value=\"two\"  data-calculation=\"0\">Achaya<\/option><option value=\"Ayrampuni\"  data-calculation=\"0\">Ayrampuni<\/option><option value=\"Caminaca\"  data-calculation=\"0\">Caminaca<\/option><option value=\"Chupa\"  data-calculation=\"0\">Chupa<\/option><option value=\"Az\u00e1ngaro\"  data-calculation=\"0\">Jos\u00e9 Domingo Choquehuanca<\/option><option value=\"Mu\u00f1ani\"  data-calculation=\"0\">Mu\u00f1ani<\/option><option value=\"Potoni\"  data-calculation=\"0\">Potoni<\/option><option value=\"Sam\u00e1n\"  data-calculation=\"0\">Sam\u00e1n<\/option><option value=\"San-Ant\u00f3n\"  data-calculation=\"0\">San Ant\u00f3n<\/option><option value=\"San-Jos\u00e9\"  data-calculation=\"0\">San Jos\u00e9<\/option><option value=\"San-Juan-de-Salinas\"  data-calculation=\"0\">San Juan de Salinas<\/option><option value=\"Santiago-de-Pupuja\"  data-calculation=\"0\">Santiago de Pupuja<\/option><option value=\"Tirapata\"  data-calculation=\"0\">Tirapata<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-199\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-199_69db919b372a3\" id=\"forminator-form-71__field--select-199_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Carabaya <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-199_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-199\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Carabaya\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Carabaya\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-199_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Carabaya<\/option><option value=\"Macusani\"  data-calculation=\"0\">Macusani<\/option><option value=\"Ajoyani\"  data-calculation=\"0\">Ajoyani<\/option><option value=\"Ayapata\"  data-calculation=\"0\">Ayapata<\/option><option value=\"Coasa\"  data-calculation=\"0\">Coasa<\/option><option value=\"Corani\"  data-calculation=\"0\">Corani<\/option><option value=\"Crucero\"  data-calculation=\"0\">Crucero<\/option><option value=\"Ituata\"  data-calculation=\"0\">Ituata<\/option><option value=\"Ollachea\"  data-calculation=\"0\">Ollachea<\/option><option value=\"San-Gab\u00e1n\"  data-calculation=\"0\">San Gab\u00e1n<\/option><option value=\"Usicayos\"  data-calculation=\"0\">Usicayos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-200\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-200_69db919b372a3\" id=\"forminator-form-71__field--select-200_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Chucuito <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-200_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-200\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Chucuito\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Chucuito\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-200_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Chucuito<\/option><option value=\"Juli\"  data-calculation=\"0\">Juli<\/option><option value=\"Desaguadero\"  data-calculation=\"0\">Desaguadero<\/option><option value=\"Huacullani\"  data-calculation=\"0\">Huacullani<\/option><option value=\"Kelluyo\"  data-calculation=\"0\">Kelluyo<\/option><option value=\"Pisacoma\"  data-calculation=\"0\">Pisacoma<\/option><option value=\"Pomata\"  data-calculation=\"0\">Pomata<\/option><option value=\"Zepita\"  data-calculation=\"0\">Zepita<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-201\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-201_69db919b372a3\" id=\"forminator-form-71__field--select-201_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - El Collao <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-201_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-201\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - El Collao\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - El Collao\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-201_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - El Collao<\/option><option value=\"Ilave\"  data-calculation=\"0\">Ilave<\/option><option value=\"Capazo\"  data-calculation=\"0\">Capazo<\/option><option value=\"Pilcuyo\"  data-calculation=\"0\">Pilcuyo<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Conduriri\"  data-calculation=\"0\">Conduriri<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-203\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-203_69db919b372a3\" id=\"forminator-form-71__field--select-203_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huancan\u00e9 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-203_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-203\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huancan\u00e9\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huancan\u00e9\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-203_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huancan\u00e9<\/option><option value=\"Huancan\u00e9\"  data-calculation=\"0\">Huancan\u00e9<\/option><option value=\"Cojata\"  data-calculation=\"0\">Cojata<\/option><option value=\"Huatasani\"  data-calculation=\"0\">Huatasani<\/option><option value=\"Inchupalla\"  data-calculation=\"0\">Inchupalla<\/option><option value=\"Pusi\"  data-calculation=\"0\">Pusi<\/option><option value=\"Rosaspata\"  data-calculation=\"0\">Rosaspata<\/option><option value=\"Taraco\"  data-calculation=\"0\">Taraco<\/option><option value=\"Vilque-Chico\"  data-calculation=\"0\">Vilque Chico<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-202\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-202_69db919b372a3\" id=\"forminator-form-71__field--select-202_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lampa <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-202_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-202\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lampa\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lampa\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-202_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lampa<\/option><option value=\"Lampa\"  data-calculation=\"0\">Lampa<\/option><option value=\"Cabanilla\"  data-calculation=\"0\">Cabanilla<\/option><option value=\"Calapuja\"  data-calculation=\"0\">Calapuja<\/option><option value=\"Nicasio\"  data-calculation=\"0\">Nicasio<\/option><option value=\"Ocuviri\"  data-calculation=\"0\">Ocuviri<\/option><option value=\"Palca\"  data-calculation=\"0\">Palca<\/option><option value=\"Paratia\"  data-calculation=\"0\">Paratia<\/option><option value=\"Pucar\u00e1\"  data-calculation=\"0\">Pucar\u00e1<\/option><option value=\"Santa-Luc\u00eda\"  data-calculation=\"0\">Santa Luc\u00eda<\/option><option value=\"Vilavila\"  data-calculation=\"0\">Vilavila<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-204\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-204_69db919b372a3\" id=\"forminator-form-71__field--select-204_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Melgar <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-204_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-204\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Melgar\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Melgar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-204_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Melgar<\/option><option value=\"Ayaviri\"  data-calculation=\"0\">Ayaviri<\/option><option value=\"Antauta\"  data-calculation=\"0\">Antauta<\/option><option value=\"Cupi\"  data-calculation=\"0\">Cupi<\/option><option value=\"Llalli\"  data-calculation=\"0\">Llalli<\/option><option value=\"Macari\"  data-calculation=\"0\">Macari<\/option><option value=\"Nu\u00f1oa\"  data-calculation=\"0\">Nu\u00f1oa<\/option><option value=\"Orurillo\"  data-calculation=\"0\">Orurillo<\/option><option value=\"Santa-Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Umachiri\"  data-calculation=\"0\">Umachiri<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-210\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-210_69db919b372a3\" id=\"forminator-form-71__field--select-210_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Moho <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-210_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-210\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Moho\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Moho\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-210_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Moho<\/option><option value=\"Moho\"  data-calculation=\"0\">Moho<\/option><option value=\"Conima\"  data-calculation=\"0\">Conima<\/option><option value=\"Huayrapata\"  data-calculation=\"0\">Huayrapata<\/option><option value=\"Tilali\"  data-calculation=\"0\">Tilali<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-209\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-209_69db919b372a3\" id=\"forminator-form-71__field--select-209_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Puno <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-209_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-209\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Puno\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Puno\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-209_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Puno<\/option><option value=\"Puno\"  data-calculation=\"0\">Puno<\/option><option value=\"Acora\"  data-calculation=\"0\">Acora<\/option><option value=\"Amantani\"  data-calculation=\"0\">Amantani<\/option><option value=\"Atuncolla\"  data-calculation=\"0\">Atuncolla<\/option><option value=\"Capachica\"  data-calculation=\"0\">Capachica<\/option><option value=\"Chucuito\"  data-calculation=\"0\">Chucuito<\/option><option value=\"Coata\"  data-calculation=\"0\">Coata<\/option><option value=\"Huata\"  data-calculation=\"0\">Huata<\/option><option value=\"Ma\u00f1azo\"  data-calculation=\"0\">Ma\u00f1azo<\/option><option value=\"Paucarcolla\"  data-calculation=\"0\">Paucarcolla<\/option><option value=\"Pichacani\"  data-calculation=\"0\">Pichacani<\/option><option value=\"Plater\u00eda\"  data-calculation=\"0\">Plater\u00eda<\/option><option value=\"San-Antonio\"  data-calculation=\"0\">San Antonio<\/option><option value=\"Tiquillaca\"  data-calculation=\"0\">Tiquillaca<\/option><option value=\"Vilque\"  data-calculation=\"0\">Vilque<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-208\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-208_69db919b372a3\" id=\"forminator-form-71__field--select-208_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Antonio de Putina <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-208_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-208\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Antonio de Putina\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Antonio de Putina\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-208_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Antonio de Putina<\/option><option value=\"Putina\"  data-calculation=\"0\">Putina<\/option><option value=\"Ananea\"  data-calculation=\"0\">Ananea<\/option><option value=\"Pedro-Vilca-Apaza\"  data-calculation=\"0\">Pedro Vilca Apaza<\/option><option value=\"Quilcapuncu\"  data-calculation=\"0\">Quilcapuncu<\/option><option value=\"Sina\"  data-calculation=\"0\">Sina<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-207\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-207_69db919b372a3\" id=\"forminator-form-71__field--select-207_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Rom\u00e1n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-207_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-207\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Rom\u00e1n\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Rom\u00e1n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-207_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Rom\u00e1n<\/option><option value=\"Juliaca\"  data-calculation=\"0\">Juliaca<\/option><option value=\"Cabana\"  data-calculation=\"0\">Cabana<\/option><option value=\"Cabanillas\"  data-calculation=\"0\">Cabanillas<\/option><option value=\"Caracoto\"  data-calculation=\"0\">Caracoto<\/option><option value=\"San Miguel\"  data-calculation=\"0\">San Miguel<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-206\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-206_69db919b372a3\" id=\"forminator-form-71__field--select-206_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Sandia <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-206_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-206\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Sandia\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Sandia\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-206_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Sandia<\/option><option value=\"Sandia\"  data-calculation=\"0\">Sandia<\/option><option value=\"Cuyocuyo\"  data-calculation=\"0\">Cuyocuyo<\/option><option value=\"Limbani\"  data-calculation=\"0\">Limbani<\/option><option value=\"Patambuco\"  data-calculation=\"0\">Patambuco<\/option><option value=\"Phara\"  data-calculation=\"0\">Phara<\/option><option value=\"Quiaca\"  data-calculation=\"0\">Quiaca<\/option><option value=\"San Juan del Oro\"  data-calculation=\"0\">San Juan del Oro<\/option><option value=\"Yanahuaya\"  data-calculation=\"0\">Yanahuaya<\/option><option value=\"Alto Inambari\"  data-calculation=\"0\">Alto Inambari<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-205\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-205_69db919b372a3\" id=\"forminator-form-71__field--select-205_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Yunguyo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-205_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-205\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Yunguyo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Yunguyo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-205_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Yunguyo<\/option><option value=\"Yunguyo\"  data-calculation=\"0\">Yunguyo<\/option><option value=\"Anapia\"  data-calculation=\"0\">Anapia<\/option><option value=\"Copani\"  data-calculation=\"0\">Copani<\/option><option value=\"Cuturapi\"  data-calculation=\"0\">Cuturapi<\/option><option value=\"Ollaraya\"  data-calculation=\"0\">Ollaraya<\/option><option value=\"Tinicachi\"  data-calculation=\"0\">Tinicachi<\/option><option value=\"Unicachi\"  data-calculation=\"0\">Unicachi<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-22\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">San Mart\u00edn<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-33\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-33_69db919b372a3\" id=\"forminator-form-71__field--select-33_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia San Martin <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-33_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-33\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia San Martin\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia San Martin\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-33_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia San Martin<\/option><option value=\"one\"  data-calculation=\"0\">Bellavista<\/option><option value=\"two\"  data-calculation=\"0\">El Dorado<\/option><option value=\"Huallaga\"  data-calculation=\"0\">Huallaga<\/option><option value=\"Lamas\"  data-calculation=\"0\">Lamas<\/option><option value=\"Mariscal-C\u00e1ceres\"  data-calculation=\"0\">Mariscal C\u00e1ceres<\/option><option value=\"Moyobamba\"  data-calculation=\"0\">Moyobamba<\/option><option value=\"Picota\"  data-calculation=\"0\">Picota<\/option><option value=\"Rioja\"  data-calculation=\"0\">Rioja<\/option><option value=\"San-Mart\u00edn\"  data-calculation=\"0\">San Mart\u00edn<\/option><option value=\"Tocache\"  data-calculation=\"0\">Tocache<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-211\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-211_69db919b372a3\" id=\"forminator-form-71__field--select-211_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Bellavista <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-211_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-211\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Bellavista\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Bellavista\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-211_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Bellavista<\/option><option value=\"Bellavista\"  data-calculation=\"0\">Bellavista<\/option><option value=\"Alto Biavo\"  data-calculation=\"0\">Alto Biavo<\/option><option value=\"Bajo Biavo\"  data-calculation=\"0\">Bajo Biavo<\/option><option value=\"Huallaga\"  data-calculation=\"0\">Huallaga<\/option><option value=\"San Pablo\"  data-calculation=\"0\">San Pablo<\/option><option value=\"San Rafael\"  data-calculation=\"0\">San Rafael<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-212\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-212_69db919b372a3\" id=\"forminator-form-71__field--select-212_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - El Dorado <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-212_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-212\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - El Dorado\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - El Dorado\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-212_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - El Dorado<\/option><option value=\"San Jos\u00e9 de Sisa\"  data-calculation=\"0\">San Jos\u00e9 de Sisa<\/option><option value=\"Agua Blanca\"  data-calculation=\"0\">Agua Blanca<\/option><option value=\"San Mart\u00edn\"  data-calculation=\"0\">San Mart\u00edn<\/option><option value=\"Santa Rosa\"  data-calculation=\"0\">Santa Rosa<\/option><option value=\"Shatoja\"  data-calculation=\"0\">Shatoja<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-213\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-213_69db919b372a3\" id=\"forminator-form-71__field--select-213_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Huallaga <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-213_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-213\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Huallaga\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Huallaga\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-213_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Huallaga<\/option><option value=\"Saposoa\"  data-calculation=\"0\">Saposoa<\/option><option value=\"Alto Saposoa\"  data-calculation=\"0\">Alto Saposoa<\/option><option value=\"El Eslab\u00f3n\"  data-calculation=\"0\">El Eslab\u00f3n<\/option><option value=\"Piscoyacu\"  data-calculation=\"0\">Piscoyacu<\/option><option value=\"Sacanche\"  data-calculation=\"0\">Sacanche<\/option><option value=\"Tingo de Saposoa\"  data-calculation=\"0\">Tingo de Saposoa<\/option><option value=\"Provincia de Lamas\"  data-calculation=\"0\">Provincia de Lamas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-214\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-214_69db919b372a3\" id=\"forminator-form-71__field--select-214_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Lamas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-214_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-214\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Lamas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Lamas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-214_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Lamas<\/option><option value=\"Lamas\"  data-calculation=\"0\">Lamas<\/option><option value=\"Alonso de Alvarado\"  data-calculation=\"0\">Alonso de Alvarado<\/option><option value=\"Barranquita\"  data-calculation=\"0\">Barranquita<\/option><option value=\"Caynarachi\"  data-calculation=\"0\">Caynarachi<\/option><option value=\"Cu\u00f1umbuqui\"  data-calculation=\"0\">Cu\u00f1umbuqui<\/option><option value=\"Pinto Recodo\"  data-calculation=\"0\">Pinto Recodo<\/option><option value=\"Rumisapa\"  data-calculation=\"0\">Rumisapa<\/option><option value=\"San Roque de Cumbaza\"  data-calculation=\"0\">San Roque de Cumbaza<\/option><option value=\"Shanao\"  data-calculation=\"0\">Shanao<\/option><option value=\"Tabalosos\"  data-calculation=\"0\">Tabalosos<\/option><option value=\"Zapatero\"  data-calculation=\"0\">Zapatero<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-215\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-215_69db919b372a3\" id=\"forminator-form-71__field--select-215_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Mariscal C\u00e1ceres <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-215_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-215\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Mariscal C\u00e1ceres\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Mariscal C\u00e1ceres\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-215_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Mariscal C\u00e1ceres<\/option><option value=\"Juanju\u00ed\"  data-calculation=\"0\">Juanju\u00ed<\/option><option value=\"Campanilla\"  data-calculation=\"0\">Campanilla<\/option><option value=\"Huicungo\"  data-calculation=\"0\">Huicungo<\/option><option value=\"Pachiza\"  data-calculation=\"0\">Pachiza<\/option><option value=\"Pajarillo\"  data-calculation=\"0\">Pajarillo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-217\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-217_69db919b372a3\" id=\"forminator-form-71__field--select-217_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Moyobamba <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-217_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-217\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Moyobamba\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Moyobamba\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-217_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Moyobamba<\/option><option value=\"Moyobamba\"  data-calculation=\"0\">Moyobamba<\/option><option value=\"Calzada\"  data-calculation=\"0\">Calzada<\/option><option value=\"Habana\"  data-calculation=\"0\">Habana<\/option><option value=\"Jepelacio\"  data-calculation=\"0\">Jepelacio<\/option><option value=\"Soritor\"  data-calculation=\"0\">Soritor<\/option><option value=\"Yantalo\"  data-calculation=\"0\">Yantalo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-216\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-216_69db919b372a3\" id=\"forminator-form-71__field--select-216_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Picota <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-216_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-216\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Picota\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Picota\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-216_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Picota<\/option><option value=\"Picota\"  data-calculation=\"0\">Picota<\/option><option value=\"Buenos Aires\"  data-calculation=\"0\">Buenos Aires<\/option><option value=\"Caspizapa\"  data-calculation=\"0\">Caspizapa<\/option><option value=\"Pilluana\"  data-calculation=\"0\">Pilluana<\/option><option value=\"Pucacaca\"  data-calculation=\"0\">Pucacaca<\/option><option value=\"San Crist\u00f3bal\"  data-calculation=\"0\">San Crist\u00f3bal<\/option><option value=\"San Hilari\u00f3n\"  data-calculation=\"0\">San Hilari\u00f3n<\/option><option value=\"Shamboyacu\"  data-calculation=\"0\">Shamboyacu<\/option><option value=\"Tingo de Ponasa\"  data-calculation=\"0\">Tingo de Ponasa<\/option><option value=\"Tres Unidos\"  data-calculation=\"0\">Tres Unidos<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-218\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-218_69db919b372a3\" id=\"forminator-form-71__field--select-218_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Rioja <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-218_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-218\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Rioja\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Rioja\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-218_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Rioja<\/option><option value=\"Rioja\"  data-calculation=\"0\">Rioja<\/option><option value=\"Awajun\"  data-calculation=\"0\">Awajun<\/option><option value=\"El\u00edas Sopl\u00edn Vargas\"  data-calculation=\"0\">El\u00edas Sopl\u00edn Vargas<\/option><option value=\"Nueva Cajamarca\"  data-calculation=\"0\">Nueva Cajamarca<\/option><option value=\"Pardo Miguel\"  data-calculation=\"0\">Pardo Miguel<\/option><option value=\"Posic\"  data-calculation=\"0\">Posic<\/option><option value=\"San Fernando\"  data-calculation=\"0\">San Fernando<\/option><option value=\"Yorongos\"  data-calculation=\"0\">Yorongos<\/option><option value=\"Yuracyacu\"  data-calculation=\"0\">Yuracyacu<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-219\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-219_69db919b372a3\" id=\"forminator-form-71__field--select-219_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - San Mart\u00edn <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-219_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-219\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - San Mart\u00edn\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - San Mart\u00edn\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-219_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - San Mart\u00edn<\/option><option value=\"Tarapoto\"  data-calculation=\"0\">Tarapoto<\/option><option value=\"Alberto Leveau\"  data-calculation=\"0\">Alberto Leveau<\/option><option value=\"Cacatachi\"  data-calculation=\"0\">Cacatachi<\/option><option value=\"Chazuta\"  data-calculation=\"0\">Chazuta<\/option><option value=\"Chipurana\"  data-calculation=\"0\">Chipurana<\/option><option value=\"El Porvenir\"  data-calculation=\"0\">El Porvenir<\/option><option value=\"Huimbayoc\"  data-calculation=\"0\">Huimbayoc<\/option><option value=\"Juan Guerra\"  data-calculation=\"0\">Juan Guerra<\/option><option value=\"La Banda de Shilcayo\"  data-calculation=\"0\">La Banda de Shilcayo<\/option><option value=\"Morales\"  data-calculation=\"0\">Morales<\/option><option value=\"Papaplaya\"  data-calculation=\"0\">Papaplaya<\/option><option value=\"San Antonio\"  data-calculation=\"0\">San Antonio<\/option><option value=\"Sauce\"  data-calculation=\"0\">Sauce<\/option><option value=\"Shapaja\"  data-calculation=\"0\">Shapaja<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-220\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-220_69db919b372a3\" id=\"forminator-form-71__field--select-220_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tocache <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-220_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-220\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tocache\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tocache\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-220_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tocache<\/option><option value=\"Tocache\"  data-calculation=\"0\">Tocache<\/option><option value=\"Nuevo Progreso\"  data-calculation=\"0\">Nuevo Progreso<\/option><option value=\"P\u00f3lvora\"  data-calculation=\"0\">P\u00f3lvora<\/option><option value=\"Shunte\"  data-calculation=\"0\">Shunte<\/option><option value=\"Uchiza\"  data-calculation=\"0\">Uchiza<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-23\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Tacna<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-35\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-35_69db919b372a3\" id=\"forminator-form-71__field--select-35_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Tacna <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-35_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-35\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Tacna\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Tacna\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-35_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Tacna<\/option><option value=\"one\"  data-calculation=\"0\">Candarave<\/option><option value=\"two\"  data-calculation=\"0\">Jorge Basadre<\/option><option value=\"Tacna\"  data-calculation=\"0\">Tacna<\/option><option value=\"Tarata\"  data-calculation=\"0\">Tarata<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-221\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-221_69db919b372a3\" id=\"forminator-form-71__field--select-221_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Tacna <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-221_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-221\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Tacna\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Tacna\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-221_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Tacna<\/option><option value=\"Tacna\"  data-calculation=\"0\">Tacna<\/option><option value=\"Alto de la Alianza\"  data-calculation=\"0\">Alto de la Alianza<\/option><option value=\"Calana\"  data-calculation=\"0\">Calana<\/option><option value=\"Ciudad Nueva\"  data-calculation=\"0\">Ciudad Nueva<\/option><option value=\"Incl\u00e1n\"  data-calculation=\"0\">Incl\u00e1n<\/option><option value=\"Pach\u00eda\"  data-calculation=\"0\">Pach\u00eda<\/option><option value=\"Palca\"  data-calculation=\"0\">Palca<\/option><option value=\"Pocollay\"  data-calculation=\"0\">Pocollay<\/option><option value=\"Sama\"  data-calculation=\"0\">Sama<\/option><option value=\"Coronel Gregorio Albarrac\u00edn Lanchipa\"  data-calculation=\"0\">Coronel Gregorio Albarrac\u00edn Lanchipa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-222\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-222_69db919b372a3\" id=\"forminator-form-71__field--select-222_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Candarave <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-222_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-222\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Candarave\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Candarave\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-222_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Candarave<\/option><option value=\"Candarave\"  data-calculation=\"0\">Candarave<\/option><option value=\"Cairani\"  data-calculation=\"0\">Cairani<\/option><option value=\"Camilaca\"  data-calculation=\"0\">Camilaca<\/option><option value=\"Curibaya\"  data-calculation=\"0\">Curibaya<\/option><option value=\"Huanuara\"  data-calculation=\"0\">Huanuara<\/option><option value=\"Quilahuani\"  data-calculation=\"0\">Quilahuani<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-223\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-223_69db919b372a3\" id=\"forminator-form-71__field--select-223_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Jorge Basadre <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-223_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-223\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Jorge Basadre\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Jorge Basadre\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-223_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Jorge Basadre<\/option><option value=\"Locumba\"  data-calculation=\"0\">Locumba<\/option><option value=\"Ilabaya\"  data-calculation=\"0\">Ilabaya<\/option><option value=\"Ite\"  data-calculation=\"0\">Ite<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-224\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-224_69db919b372a3\" id=\"forminator-form-71__field--select-224_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Tarata <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-224_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-224\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Tarata\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Tarata\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-224_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Tarata<\/option><option value=\"Tarata\"  data-calculation=\"0\">Tarata<\/option><option value=\"Chucatamani\"  data-calculation=\"0\">Chucatamani<\/option><option value=\"Estique\"  data-calculation=\"0\">Estique<\/option><option value=\"Estique-Pampa\"  data-calculation=\"0\">Estique-Pampa<\/option><option value=\"Sitajara\"  data-calculation=\"0\">Sitajara<\/option><option value=\"Susapaya\"  data-calculation=\"0\">Susapaya<\/option><option value=\"Ticaco\"  data-calculation=\"0\">Ticaco<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-24\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Tumbes<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-39\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-39_69db919b372a3\" id=\"forminator-form-71__field--select-39_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Tumbes <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-39_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-39\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Tumbes\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Tumbes\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-39_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Tumbes<\/option><option value=\"one\"  data-calculation=\"0\">Contralmirante Villar<\/option><option value=\"two\"  data-calculation=\"0\">Tumbes<\/option><option value=\"Zarumilla\"  data-calculation=\"0\">Zarumilla<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-225\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-225_69db919b372a3\" id=\"forminator-form-71__field--select-225_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Tumbes <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-225_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-225\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Tumbes\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Tumbes\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-225_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Tumbes<\/option><option value=\"Tumbes\"  data-calculation=\"0\">Tumbes<\/option><option value=\"Corrales\"  data-calculation=\"0\">Corrales<\/option><option value=\"La Cruz\"  data-calculation=\"0\">La Cruz<\/option><option value=\"Pampas de Hospital\"  data-calculation=\"0\">Pampas de Hospital<\/option><option value=\"San Jacinto\"  data-calculation=\"0\">San Jacinto<\/option><option value=\"San Juan de la Virgen\"  data-calculation=\"0\">San Juan de la Virgen<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-226\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-226_69db919b372a3\" id=\"forminator-form-71__field--select-226_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Contralmirante Villar <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-226_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-226\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Contralmirante Villar\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Contralmirante Villar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-226_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Contralmirante Villar<\/option><option value=\"Zorritos\"  data-calculation=\"0\">Zorritos<\/option><option value=\"Casitas\"  data-calculation=\"0\">Casitas<\/option><option value=\"Canoas de Punta Sal\"  data-calculation=\"0\">Canoas de Punta Sal<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-227\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-227_69db919b372a3\" id=\"forminator-form-71__field--select-227_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Zarumilla <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-227_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-227\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Zarumilla\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Zarumilla\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-227_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Zarumilla<\/option><option value=\"Zarumilla\"  data-calculation=\"0\">Zarumilla<\/option><option value=\"Aguas Verdes\"  data-calculation=\"0\">Aguas Verdes<\/option><option value=\"Matapalo\"  data-calculation=\"0\">Matapalo<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-25\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Ucayali<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-41\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-41_69db919b372a3\" id=\"forminator-form-71__field--select-41_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia Ucayali <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-41_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-41\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Ucayali\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Ucayali\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-41_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Ucayali<\/option><option value=\"one\"  data-calculation=\"0\">Atalaya<\/option><option value=\"two\"  data-calculation=\"0\">Coronel Portillo<\/option><option value=\"Padre-Abad\"  data-calculation=\"0\">Padre Abad<\/option><option value=\"Pur\u00fas\"  data-calculation=\"0\">Pur\u00fas<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-228\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-228_69db919b372a3\" id=\"forminator-form-71__field--select-228_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Coronel Portillo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-228_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-228\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Coronel Portillo\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Coronel Portillo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-228_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Coronel Portillo<\/option><option value=\"Caller\u00eda\"  data-calculation=\"0\">Caller\u00eda<\/option><option value=\"Campoverde\"  data-calculation=\"0\">Campoverde<\/option><option value=\"Ipar\u00eda\"  data-calculation=\"0\">Ipar\u00eda<\/option><option value=\"Manantay\"  data-calculation=\"0\">Manantay<\/option><option value=\"Masisea\"  data-calculation=\"0\">Masisea<\/option><option value=\"Nueva Requena\"  data-calculation=\"0\">Nueva Requena<\/option><option value=\"Yarinacocha\"  data-calculation=\"0\">Yarinacocha<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-229\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-229_69db919b372a3\" id=\"forminator-form-71__field--select-229_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Atalaya <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-229_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-229\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Atalaya\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Atalaya\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-229_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Atalaya<\/option><option value=\"Raymondi\"  data-calculation=\"0\">Raymondi<\/option><option value=\"Sepahua\"  data-calculation=\"0\">Sepahua<\/option><option value=\"Tahuan\u00eda\"  data-calculation=\"0\">Tahuan\u00eda<\/option><option value=\"Yur\u00faa\"  data-calculation=\"0\">Yur\u00faa<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-230\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-230_69db919b372a3\" id=\"forminator-form-71__field--select-230_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Padre Abad <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-230_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-230\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Padre Abad\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Padre Abad\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-230_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Padre Abad<\/option><option value=\"Padre Abad\"  data-calculation=\"0\">Padre Abad<\/option><option value=\"Curimana\"  data-calculation=\"0\">Curimana<\/option><option value=\"Neshuya\"  data-calculation=\"0\">Neshuya<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-231\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-231_69db919b372a3\" id=\"forminator-form-71__field--select-231_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Pur\u00fas <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-231_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-231\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Pur\u00fas\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Pur\u00fas\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-231_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Pur\u00fas<\/option><option value=\"Yarinacocha\"  data-calculation=\"0\">Pur\u00fas<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-26\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Callao<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;A\\u00f1adir elemento&quot;,&quot;remove_text&quot;:&quot;Eliminar art\\u00edculo&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-40\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-40_69db919b372a3\" id=\"forminator-form-71__field--select-40_69db919b372a3-label\" class=\"forminator-label\">Seleccionar Provincia <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-40_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-40\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar Provincia Callao\" data-search=\"false\" data-search-placeholder=\"Seleccionar Provincia Callao\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-40_69db919b372a3-label\"><option value=\"\"  >Seleccionar Provincia Callao<\/option><option value=\"one\"  data-calculation=\"0\">Callao<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-232\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-232_69db919b372a3\" id=\"forminator-form-71__field--select-232_69db919b372a3-label\" class=\"forminator-label\">Seleccionar distrito - Callao <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-232_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-232\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar distrito - Callao\" data-search=\"false\" data-search-placeholder=\"Seleccionar distrito - Callao\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-232_69db919b372a3-label\"><option value=\"\"  >Seleccionar distrito - Callao<\/option><option value=\"Bellavista\"  data-calculation=\"0\">Bellavista<\/option><option value=\"Callao\"  data-calculation=\"0\">Callao<\/option><option value=\"Carmen de la Legua Reynoso\"  data-calculation=\"0\">Carmen de la Legua Reynoso<\/option><option value=\"La Perla\"  data-calculation=\"0\">La Perla<\/option><option value=\"La Punta\"  data-calculation=\"0\">La Punta<\/option><option value=\"Ventanilla\"  data-calculation=\"0\">Ventanilla<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_69db919b372a3\" id=\"forminator-field-number-4_69db919b372a3-label\" class=\"forminator-label\">Tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-4\" value=\"\" placeholder=\"900000000\" id=\"forminator-field-number-4_69db919b372a3\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"900000000\" max=\"999999999999\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69db919b372a3\" id=\"forminator-field-date-1-picker_69db919b372a3-label\" class=\"forminator-label\">Fecha <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Elegir la fecha\" id=\"forminator-field-date-1-picker_69db919b372a3\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-71__field--select-4_69db919b372a3\" id=\"forminator-form-71__field--select-4_69db919b372a3-label\" class=\"forminator-label\">Planta de Incidencia <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-71__field--select-4_69db919b372a3\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Planta de Incidencia\" data-search=\"false\" data-search-placeholder=\"Planta de Incidencia\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-71__field--select-4_69db919b372a3-label\"><option value=\"\"  >Planta de Incidencia<\/option><option value=\"Independencia\"  data-calculation=\"0\">Independencia<\/option><option value=\"Surquillo\"  data-calculation=\"0\">Surquillo<\/option><option value=\"Derby\"  data-calculation=\"0\">Derby<\/option><option value=\"Surco\"  data-calculation=\"0\">Surco<\/option><option value=\"Treneman\"  data-calculation=\"0\">Treneman<\/option><option value=\"Ate\"  data-calculation=\"0\">Ate<\/option><\/select><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69db919b372a3\" id=\"forminator-field-text-4_69db919b372a3-label\" class=\"forminator-label\">Placa<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"ABC123\" id=\"forminator-field-text-4_69db919b372a3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69db919b372a3-label\"><span id=\"forminator-radiogroup-radio-2-69db919b372a3-label\" class=\"forminator-label\">Queja o reclamo <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69db919b372a3\" class=\"forminator-radio\" title=\"Queja (Malestar o descontento con respecto a la atenci\u00f3n al p\u00fablico)\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69db919b372a3\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Queja (Malestar o descontento con respecto a la atenci\u00f3n al p\u00fablico)<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69db919b372a3\" class=\"forminator-radio\" title=\"Reclamo (Disconformidad relacionada a los productos y\/o servicios)\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69db919b372a3\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Reclamo (Disconformidad relacionada a los productos y\/o servicios)<\/span><\/label><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69db919b372a3\" id=\"forminator-field-text-3_69db919b372a3-label\" class=\"forminator-label\">Pedido del cliente o usuario<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Ejemplo: solicitud\" id=\"forminator-field-text-3_69db919b372a3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69db919b372a3\" id=\"forminator-field-textarea-1_69db919b372a3-label\" class=\"forminator-label\">Detalla aqu\u00ed tu queja\/ reclamo <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"Detalla aqu\u00ed tu queja\/ reclamo\" id=\"forminator-field-textarea-1_69db919b372a3\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69db919b372a3\" id=\"forminator-field-textarea-2_69db919b372a3-label\" class=\"forminator-label\">Descargo de la empresa<\/label><textarea name=\"textarea-2\" placeholder=\"Descargo realizado por Farenet...\" id=\"forminator-field-textarea-2_69db919b372a3\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" aria-describedby=\"forminator-field-textarea-2_69db919b372a3-description\" ><\/textarea><span id=\"forminator-field-textarea-2_69db919b372a3-description\" class=\"forminator-description\">Este campo solo debe ser llenado por alg\u00fan trabajador de Farenet<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69db919b372a3-label\"><label id=\"forminator-field-checkbox-2-1-69db919b372a3-label\" for=\"forminator-field-checkbox-2-1-69db919b372a3\" class=\"forminator-checkbox\" title=\"Acepto el contenido del presente formulario manifestando bajo Declaraci\u00f3n Jurada la veracidad de los datos\/hechos descritos.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-69db919b372a3\" aria-labelledby=\"forminator-field-checkbox-2-1-69db919b372a3-label\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto el contenido del presente formulario manifestando bajo Declaraci\u00f3n Jurada la veracidad de los datos\/hechos descritos.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-69db919b372a3-label\"><label id=\"forminator-field-checkbox-3-1-69db919b372a3-label\" for=\"forminator-field-checkbox-3-1-69db919b372a3\" class=\"forminator-checkbox\" title=\"Otorgo permiso para que la respuesta pueda ser v\u00eda correo electr\u00f3nico.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-1-69db919b372a3\" aria-labelledby=\"forminator-field-checkbox-3-1-69db919b372a3-label\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otorgo permiso para que la respuesta pueda ser v\u00eda correo electr\u00f3nico.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-69db919b372a3-label\"><label id=\"forminator-field-checkbox-4-1-69db919b372a3-label\" for=\"forminator-field-checkbox-4-1-69db919b372a3\" class=\"forminator-checkbox\" title=\"En caso su reclamo obtenga una respuesta positiva, acepta que la respuesta se d\u00e9 a trav\u00e9s de WhatsApp o v\u00eda telef\u00f3nica.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"En-caso-su-reclamo-obtenga-una-respuesta-positiva,-acepta-que-la-respuesta-se-d\u00e9-a-trav\u00e9s-de-WhatsApp-o-v\u00eda-telef\u00f3nica.\" id=\"forminator-field-checkbox-4-1-69db919b372a3\" aria-labelledby=\"forminator-field-checkbox-4-1-69db919b372a3-label\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">En caso su reclamo obtenga una respuesta positiva, acepta que la respuesta se d\u00e9 a trav\u00e9s de WhatsApp o v\u00eda telef\u00f3nica.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-2\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature69db919b4e304\" id=\"forminator-field-ctlSignature69db919b4e304-label\" class=\"forminator-label\">Firma en caso de consentimiento<\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature69db919b4e304_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Firma<\/span><div id=\"ctlSignature69db919b4e304_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature69db919b4e304\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-2\" value=\"69db919b4e304\" class=\"signature-prefix\"><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Enviar Reclamo<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"3df65fd4bc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F33\" \/><input type=\"hidden\" name=\"form_id\" value=\"71\"><input type=\"hidden\" name=\"page_id\" value=\"33\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/reclamacionescambridge.farenet.com.pe\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"class_list":["post-33","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/pages\/33","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33"}],"version-history":[{"count":13,"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/pages\/33\/revisions"}],"predecessor-version":[{"id":74,"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=\/wp\/v2\/pages\/33\/revisions\/74"}],"wp:attachment":[{"href":"https:\/\/reclamacionescambridge.farenet.com.pe\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}