2001 LISTE DES HOTELS DE GENEVE ET ENVIRONS ACCORDANT DES TARIFS PREFERENTIELS A L'UIT LIST OF HOTELS IN GENEVA AND AREA ACCORDING SPECIAL RATES TO ITU Ces tarifs spéciaux ne peuvent être obtenus que si la réservation est faite directement auprès de l'hôtel, et sans aucun intermédiaire. Special ITU tariffs can only be obtained when the booking is made without intermediary directly at the hotel. HOTELS ***** HOTEL D'ANGLETERRE 17, quai du Mont-Blanc 1201 GENEVE tel +41 22 906 55 55 fax +41 22 906 55 56 HOTEL BEAU RIVAGE 13, quai du Mont-Blanc 1201 GENEVE tel +41 22 716 68 25 fax +41 22 716 60 65 email: reservation@beau-rivage.ch HOTEL INTERCONTINENTAL 7-9, Petit-Saconnex 1211 GENEVE tel +41 22 919 39 39 fax +41 22 919 38 38 - tlx 412921 HOTEL NOGA-HILTON 19, quai du Mont-Blanc 1201 GENEVE tel +41 22 908 90 81 fax +41 22 908 90 90 - tx 412337 http://www.hiltongeneve.ch HOTEL DE LA PAIX 11, quai du Mont-Blanc 1201 GENEVE tel +41 22 909 60 00 fax +41 22 909 60 01 http://www.hoteldelapaix.ch HOTEL PRESIDENT WILSON 47, quai Wilson 1211 GENEVE 21 tel +41 22 906 66 66 fax +41 22 906 66 67 - tx 412 328 http://www.hotelpwilson.com HOTEL LA RESERVE 301, route de Lausanne 1293 BELLEVUE-GENEVE tel +41 22 959.86.57 fax +41 22 959.86.39 Classic Superior Deluxe Breakfast CHF 350 CHF 430 CHF 520 CHF 32 Service, VAT included. City tax CHF 2,40 per day and per person not included. free entrance to fitness/sauna included. Suite on request. SGL DBL Junior suite Breakfast CHF 280 to 550 CHF 330 to 710 CHF 850 CHF 27 to 36 Service and VAT included. City tax CHF 3.- per day and per person not included. SGL DBL Breakfast Buffet breakfast CHF 215 to 275 CHF 265 to 325 CHF 26 CHF 34 Service and VAT included. City tax CHF 3.- per day and per person not included. Walking distance from ITU. CHF 255 CHF 305 Service and VAT included. City tax CHF 3.- per day and per person not included. SGL DBL Junior suite CHF 220 to 300 CHF 280 to 360 CHF 520 Breakfast, service, VAT (3,5%) and city tax included. SGL DBL Executive Junior suite lake Breakfast CHF 280 to 320 CHF 310 to 370 CHF 420 to 540 CHF 850 CHF 29 to 35 Service and VAT included. City tax CHF 3.- per person/day not included. SGL DBL Closed during 2001 MANDARIN ORIENTAL HOTEL DU RHONE Quai Turrettini, 1 1201 GENEVE tel +41 22 909 00 01 fax +41 22 909 00 10 http://www.mandarinoriental.com HOTEL LE RICHEMOND Jardin Brunswick 1211 GENEVE 1 tel + 41 22 715 70 00 fax + 41 22 715 70 01 http://www.RICHEMOND.CH email: reservation@richemond.ch HOTEL SOFITEL GENEVE 18-20, rue du Cendrier 1201 GENEVE tel +41 22 908 80 80 fax +41 22 908 80 81 SGL DBL Junior business suite Breakfast SGL/DBL Junior suite Breakfast CHF 350 to 520 Service and VAT included. CHF 420 to 550 City tax CHF 3.- per day and per person not included. CHF 550 to 600 CHF 25 to 35 CHF 280 to 340 CHF 650 to 920 CHF 31 to 37 SGL DBL Service and VAT included. City tax CHF 3.- per day and per person not included. Free entrance to swimming pool, sauna, jacuzzi. Tennis - free parking. CHF 225 CHF 275 Service, VAT and buffet breakfast included. City tax CHF 2,40 per day and per person not included. SGL DBL TRIPLE CHF 150 CHF 185 CHF 208 Service, taxes, VAT, buffet breakfast included. Shuttle airport/hotel or return CHF 12,-. SGL DBL CHF 145 CHF 190 Service, taxes and buffet breakfast included. City tax from CHF 2,40 to CHF 4,80 per day and per person not included. HOTELS **** HOTEL AUTEUIL 33, rue de Lausanne 1201 GENEVE tel +41 22 544 22 22 fax +41 22 544 22 99 http://www.manotel.com/location.htm HOTEL DE BERNE 26, rue de Berne 1201 GENEVE tel +41 22 731 60 00 fax +41 22 731 11 73 http://www.bernehotel.ch HOTEL BRISTOL 10, rue du Mont-Blanc 1201 GENEVE tel +41 22 716 57 00 fax +41 22 738 90 39 http://www.bristol.ch HOTEL CARLTON 22, rue Amat 1202 GENEVE tel +41 22 908 68 50 fax +41 22 908 68 68 HOTEL CHURCHILL 15, rue du Simplon 1207 GENEVE tel +41 22 700 88 88 fax +41 22 700 88 78 HOTEL CORNAVIN Place de la Gare 1201 GENEVE tel +41 22 716 12 12 fax +41 22 716 12 00 http://www.fassbind-hotels.ch SGL DBL Junior Suite Breakfast CHF 225 CHF 260 CHF 335 CHF 22 to 28 SGL DBL CHF 145 to 155 CHF 165 to 175 SGL DBL CHF 158 CHF 178 SGL DBL Breakfast CHF 176 to 220 CHF 216 to 260 CHF 9 to 18 Service and VAT included. City tax CHF 2,40 per day and per person not included. Rooms refurbished (air-conditioning Fitness) Service, VAT and breakfast included. Shuttle from airport or railway station or International Organisations to hotel and return CHF 5 to 8. Kitchenette as from 6 days (+ CHF 20 per day VAT and breakfast included. City tax, service and VAT included. HOTEL DIPLOMATE 46, rue Terrassière 1207 GENEVE tel +41 22 735 30 79 fax +41 22 735 06 61 HOTEL EPSOM 18-20, rue Richemont 1202 GENEVE tel +41 22 544 66 66 fax +41 22 544 66 99 http://www.manotel.com/location.htm FORUM PARK HOTEL GENEVE (ex Penta) 75-77, avenue Louis Casai 1216 COINTRIN - GENEVE tel +41 22 710 30 00 fax +41 22 710 31 00 http://www.forumparkhotel.ch HOTEL GRAND-PRE 35, rue du Grand-Pré 1202 GENEVE tel +41 22 918 11 11 fax +41 22 734 76 91 email: grand-pre@cnsa.ch HOLIDAY INN CROWNE PLAZA 26, Voie de Moëns 1218 GRAND-SACONNEX - GE tel +41 22 791 00 11 fax +41 22 798 92 73 - tx 415695 HOTEL LE MONTBRILLANT 2, rue de Montbrillant 1201 GENEVE tel +41 22 733 77 84 fax +41 22 733 25 11 http://www.montbrillant.ch email: contact@montbrillant.ch MÖVENPICK HOTEL 20, route de Pré-Bois 1215 GENEVE 15 AEROPORT tel +41 22 717 16 05 fax +41 22 717 18 05 http://www.movenpick.geneva.ch email: reservations@movenpickgeneva.ch NOVOTEL GENEVE-CENTRE 19, rue de Zurich CH - 1211 Geneva tel +41 22 909 91 20 fax +41 22 909 90 02 HOTEL REX MANOTEL 44, avenue Wendt 1203 GENEVE tel +41 22 544 74 74 fax +41 22 544 74 99 http://www.manotel.com/location.htm SGL DBL CHF 118 CHF 138 Service, VAT, continental breakfast included. SGL DBL Executive CHF 176 CHF 216 CHF 241 Service, VAT, taxes, buffet breakfast included. Shuttle airport/hotel CHF 12,-. SGL DBL Room “Club” CHF 185 CHF 220 CHF 250 Service, VAT and buffet breakfast included. Free shuttle between airport and hotel from 6:05 am to 11:30 pm. Free entrance to sauna and fitness. City tax CHF 2,40 per day and per person not included. SGL DBL CHF 153 to 173 CHF 220 to 240 Service, tax, VAT and breakfast included. Free shuttle every day from 7 am to 9 pm between airport, hotel and Cornavin railway station. SGL/DBL Executive Junior suite Deluxe Breakfast CHF 160 to 180 CHF 200 CHF 250 CHF 560 CHF 28 Service and VAT included. City tax CHF 2,75 per day and per person not included. Free shuttle between airport and hotel. Free entrance to fitness and swimming pool.< Free soft drink service in each room. SGL DBL Triple Studio CHF 125 to 260 CHF 190 to 280 CHF 260 to 330 CHF 155 to 350 Service, VAT, city tax, buffet breakfast included. (Breakfast not included when staying in studio) Special rate on request when staying in Studio over 7 days Standard Superior* Deluxe Plaza Buffet breakfast SGL Standard DBL Standard Executive Breakfast SGL Shower SGL Bath DBL Bath CHF 240 CHF 280 CHF 370 CHF 26 CHF 165 CHF 205 CHF 225 to 240 CHF 24 CHF 115 CHF 140 CHF 178 Service, taxes, VAT continental breakfast included. *if available Free shuttle between airport and hotel. Free entrance to fitness. Service, VAT (3,6%) included. City tax CHF 2,4 per day and per person not included. Service, taxes VAT and buffet breakfast included. Shuttle airport/hotel CHF 12,-. Direct bus to ITU (No 11). HOTEL-ROTISSERIE DU LAC Grand-Rue 1296 COPPET - VD tel +41 22 776 15 21 fax +41 22 776 53 46 HOTEL ROYAL 41, rue de Lausanne 1202 GENEVE tel +41 22 906 14 14 fax +41 22 906 14 99 http://www.manotel.com/location.htm SGL DBL Suite Breakfast CHF135 to 155 CHF 150 to 185 CHF290 to 340 CHF 22 SGL DLB Executive CHF 187 CHF 227 CHF 252 VOLTAIRE PALACE HOTEL - FERNEY-VOLTAIRE (France) SGL Avenue du Jura DBL F-01212 FERNEY-VOLTAIRE Suite tel +33 4 50 40 77 90 fax +33 4 50 40 98 36 http://voltaire-palace-hotel@.com HOTEL WARWICK 14, rue de Lausanne 1201 GENEVE tel +41 22 716 81 57/58 fax +41 22 716 80 01 - tx 412731 reservation via email : res.geneva@warwickhotels.com SGL/DBL Suite (- 30% of the official rates) service first Breakfast FRF 540 FRF 695 FRF 1390 Service and VAT included. Service, taxes, VAT, and buffet breakfast included. Shuttle airport/hotel CHF 12,-. Service, taxes and buffet breakfast included. Free shuttle between hotel/airport/railway station and Palexpo. Free parking. CHF 180 Service , VAT included. City tax CHF 2,40 per day and per person not included. CHF 9 to 28 HOTELS *** HOTEL ASCOT 55, rue Rothschild 1202 GENEVE tel +41 22 544 38 38 fax +41 22 544 38 99 http://www.manotel.com/location.htm HOTEL CHANTILLY 27, rue de la Navigation 1201 GENEVE tel +41 22 544 40 40 fax +41 22 544 40 99 http://www.manotel.com/location.htm HOTEL CHAVANNES DE BOGIS Les Champs Blancs 1279 CHAVANNES DE BOGIS - VD tel +41 22 776 47 11 fax +41 22 776 49 80 HOTEL COMEDIE 12, rue de Carouge 1205 GENEVE tel +41 22 322 23 24 fax +41 22 322 23 23 http://www.hotel-comedie.ch HOTEL CRISTAL - FASSBIND 4, rue Pradier 1201 GENEVE tel +41 22 731 34 00 fax +41 22 731 70 78 http://www.fassbind-hotels.ch SGL DBL TPL CHF 129 CHF 160 CHF 184 Service, VAT, taxes continental breakfast included. Shuttle airport/hotel and back CHF 12,- SGL DBL TPL CHF 129 CHF 160 CHF 184 Service, taxes VAT, continental breakfast included. Shuttle airport/hotel and back CHF 12,- SGL DBL TPL Suite CHF 100 to 115 CHF 120 to 135 CHF 155 CHF 215 to 245 Service, VAT, city tax and buffet breakfast included. Free shuttle between airport, railway station, Palexpo and hotel. SGL DBL Breakfast CHF 119 to 159 CHF 149 to 199 CHF 10 Service, taxes ,VAT included. Over one week of booking the continental breakfast is included. City tax CHF 1,80 per day and per person. SGL DBL Breakfast CHF 123 to 148 CHF 163 to 202 CHF 9 to 18 Service, VAT included. HOTEL LES ARCADES 14-16, place Cornavin 1201 GENEVE tel +41 22 732 59 48 fax +41 22 738 39 46 email: hotel_arcades@hotmail.com SGL DBL HOTEL LONGCHAMP SGL 7, rue Butini DBL 1202 GENEVE tel +41 22 716 48 48 fax +41 22 738 00 07 http://www.tophotels.ch/drake/index.asp email: longchamp@span.ch HOTEL EDELWEISS 2, place de la Navigation 1201 GENEVE tel +41 22 544 51 51 fax +41 22 544 51 99 http://www.manotel.com/location.htm HOTEL EDEN 135, rue de Lausanne 1202 GENEVE tel +41 22 716 37 00 fax +41 22 731 52 60 http://www.eden.ch eden@eden.ch SGL DBL TPL SGL DBL HOTEL INTERNATIONAL ET TERMINUS SGL 20, rue des Alpes DBL 1201 GENEVE tel +41 22 732 80 95 fax+41 22 732 18 43 http://www.international-terminus.ch HOTEL MEDIAN Chemin de Colovrex F - 01210 FERNEY-VOLTAIRE tel + 33 4 50 28 00 50 fax+ 33 4 50 42 88 93 http://www.jjfrance.com HOTEL MODERNE 1, rue de Berne 1201 GENEVE tel +41 22 732 81 00 fax +41 22 738 26 58 email: info@hotelmoderne.ch http://www.hotelmoderne.ch HOTEL MON REPOS 131, rue de Lausanne 1202 GENEVE tel +41 22 909 39 09 fax +41 22 909 39 93 reservations@hmrge.ch http://www.hmrge.ch HOTEL MONTANA 23, rue des Alpes 1201 GENEVE tel +41 22 732 08 40 fax +41 22 738 25 11 email: hotel.montana@span.ch CHF 108 CHF 138 Service, taxes, VAT, breakfast included. CHF 140 CHF 170 Service, VAT, buffet breakfast included. City tax CHF 1,80 per day and per person not included. CHF 144 CHF 175 CHF 200 Service, taxes, VAT, continental breakfast included. Shuttle airport/hotel CHF 12,-. Swiss atmosphere. CHF 150 to 165 CHF 195 CHF 99 to 130 CHF 150 Service, VAT and buffet breakfast included. City tax CHF 1,80 per day and per person not included. Air conditioned rooms. Internet access & modem connection. Service, VAT and buffet breakfast included. Standard Junior suite Breakfast FRF 350 to 390 Service, VAT and buffet breakfast included. FRF 575 to 635 FRF 48 SGL DBL Extra bed CHF 65 to 120 Service, taxes, VAT and buffet breakfast CHF 156 to 166 included. CHF 25 SGL DBL Junior suite SGL DBL CHF 140 Service, taxes, VAT and buffet breakfast CHF 185 included. CHF 250 City tax CHF 1,80 per day and per person not included. Shuttle between hotel/airport and ITU on request. CHF 108 to 118 Service, taxes and buffet breakfast included. CHF 130 to140 Special rates on request for long stay. HOTEL NOVOTEL GENEVEAEROPORT FRANCE Route de meyrin 01210 FERNEY-VOLTAIRE -F tel +33 450 40 85 23 fax +33 450 40 76 33 SGL/DBL Breakfast HOTEL RESIDENCE LES NATIONS 62, rue du Grand-Pré 1211 GENEVE 16 tel +41 22 748 08 08 fax +41 22 734 38 84 http://www.hotel-les-nations.com email: info@hotel-les-nations.com HOTEL STRASBOURG-UNIVERS 10, rue Pradier 1201 GENEVE tel +41 22 906 58 00 fax +41 22 738 42 08 http://www.strasbourg-geneva.ch email: info@hotel-strasbourg-geneva.ch HOTEL SUISSE SA 10, place Cornavin 1201 GENEVE tel +41 22 732 66 30 fax +41 22 732 62 39 http://www.hotel-suisse.ch email: reservation@hotel-suisse.ch HOTEL TRENTE-TROIS (33) 82 avenue Louis-Casaï tel: +41 22 798 02 00 fax: +41 22 798 63 60 http://www.hotel33.com email: hotel33@bluewin.ch SAGITTA HOTEL 6, rue de la Flèche 1207 GENEVE tel +41 22 786 33 61 fax +41 22 849 81 10 email : sagitta@span.ch HOTEL WINDSOR 31, rue de Berne 1201 GENEVE tel +41 22 731 71 30 fax +41 22 731 93 25 http://www.hotel-windsor.ch email: contact@hotel-windsor.ch CHF 137 CHF 190 CHF 220 CHF 170 to 200 CHF 300 SGL TWIN TPL Suite Apartment 2 rooms Service, VAT and continental breakfast included Free entrance to fitness and swimming pool included SGL DBL CHF 140 Service, VAT , city tax and buffet breakfast CHF 180 included. SGL DBL CHF 145 CHF 175 Service, taxes, VAT and continental breakfast included. SGL DBL TRIPLE CHF 120 CHF 155 CHF 195 Service, VAT and buffet breakfast Included. DBL CHF 179 CHF 219 CHF 299 Service, taxes, VAT and breakfast included weekly and monthly rates available. * breakfast not included when staying in Residence Standard Superior Breakfast CHF 135 CHF 180 CHF 21 Service taxes ,VAT included. City tax CHF 1,80 per day and per person not included. Monthly rate on request. Free shuttle between airport/hotel, railway station and Palexpo. SGL DBL CHF 110 CHF 150 Service, VAT and breakfast included. Studio Junior Suite Apartment* TULIP INN GENEVA AIRPORT 21, avenue de Mategnin 1217 MEYRIN - GENEVE tel +41 22 989 90 00 fax +41 22 989 99 99 http://www.goldentulip.ch email: info@tigeneva.goldentulip.nl. FRF 505 Service, VAT included. FRF 63 Free shuttle between hotel/airport. SGL CHF 143 CHF 183 CHF 263 HOTELS ** HOTEL LUSERNA 12, avenue de Luserna 1203 GENEVE tel +41 22 345 46 76 fax +41 22 344 49 36 SGL DBL 3 beds 4 beds *CHF 70 to 120 *CHF 90 to 140 *CHF 110 to 150 *CHF 120 to 160 Prices for winter season are CHF 10.- less per th st night from 15 November 2001 to 1 March 2002, service, taxes, VAT and continental breakfast included direct bus to ITU (N. 11).Free parking. HOTEL RIO 1, Place Isaac-Mercier 1204 GENEVE tel + 41 22 732 32 64 fax + 41 22 732 82 64 http//geneva.yop.ch/hotels/rio SGL DBL TPL Studio CHF 65 to 87 CHF 85 to 115 CHF 95 to 130 CHF 125 to 150 Service, taxes, VAT and breakfast included RESIDENCES A.B. JAKIR - STUDIOS-APPARTEMENTS Studio 1 16, rue Gautier or 2 people 1201 GENEVE tel & fax +41 22 731 49 46 Mobile : +41 79 60 62 751 email : jakir@bluewin.ch AUBERGE DU GRAND SACONNEX Studio 1 175, route de Ferney or 2 people 1218 GRAND SACONNEX tel + 41 22 798 06 98 Apartment fax + 41 22 798 08 58 (6 people) RESIDENCE ST-JAMES 3, rue Versonnex 1207 GENEVE tel + 41 22 849 91 00 fax + 41 22 736 43 74 email: stjames@gic.ch *Studio small and large *Apartment (1 to 6 people) CHF 1800 CHF 1600 CHF 1500 per month per month (stay of 2 months) per month (stay of more than 2 months) CHF 140 to 160 CHF 875 to 1015 CHF 2625 to 3045 CHF 250 CHF 1500 CHF 4500 per night (32 to 37 m2) per week per month per day per week per month CHF 150 to 200 CHF 1015 to 1330 CHF 3810 to 4950 CHF 300 to 450 CHF 1890 to 2905 CHF 6750 to 10950 per night per week per month per day per week per month *10% off can be deducted from the above rates RESIDENCE LES CITADINES -FERNEY-VOLTAIRE - FRANCE Studio 34, route de Genève FRF 400 F-01210 FERNEY-VOLTAIRE FRF 2732 tel +33 825 010 346 FRF 8438 2 rooms or +33 450 42 68 00 FRF 521 fax +33 450 40 91 24 FRF 3581 email: ferney@citadines.com FRF 10574 per day (from 1 to 6 nights) per week per month per day per week per month RESIDENCE LES CITADINES - GAILLARD (France) Studio 102, rue de Genève F-74240 GAILLARD tel +33 825 010 347 2 rooms or +33 4 50 31 81 00 fax +33 4 50 31 81 01 or 059/4 50 31 81 01 http://www.citadines.com gaillard@citadines.com FRF 249 FRF 1676 FRF 6202 FRF 341 FRF 2295 FRF 7117 per day (from 1 to 6 nights) per week per month per day per week per month Reduced rate for stay of more than 3 months FRF 229 FRF 1538 FRF 5592 FRF 308 FRF 2100 FRF 6300 per day (from 1 to 6 nights) per week per month per day per week per month Reduced rate for stay of more than 3 months RESIDENCE PORTE DE GENEVE - GAILLARD - FRANCE Studio 1 place Porte de France F-74240 GAILLARD tel +33 450.84.33.00 2 rooms fax +33 450.87.04.74 geneve@citadines.com RESIDENCE LA RESERVE -FERNEY-VOLTAIRE - FRANCE Studio 3, avenue du Jura FRF 585 to 700 2 rooms F-01210 FERNEY-VOLTAIRE FRF 990 to 1675 3 rooms tel +33 4 50 40 30 20 FRF2255 *Studio fax +33 4 50 40 30 00 - tx 309517 FRF 295 to 450 *2 rooms FRF 505 to 800 *3 rooms FRF 1190 per day (from 1 to 3 nights) (Customer official rate) per day (as from 4 nights) Free entrance to swimming pool, sauna, fitness, car park RAMADA HOTEL - RESIDENCE 19, rue de Zurich 1211 GENEVE 1 tel +41 22 909 91 20 fax +41 22 909 90 02 email: info@ramada.ch SAGITTA HOTEL - RESIDENCE 6, rue de la Flèche 1207 GENEVE tel +41 22 786 33 61 fax +41 22 849.81.10 email : sagitta@span.ch Studio (17m2) CHF 100 CHF 600 CHF 1950 per night per week per month Studio (22m2) CHF 100 to 107 CHF 749 CHF 3000 CHF 133 to 144 CHF 1008 CHF 3990 CHF 165 to 180 CHF 1260 CHF4950 per night per week per month per night per week per month per day per week per month Junior Studio (40m2) Apartment (54m2) UNION INTERNATIONALE DES TÉLÉCOMMUNICATIONS INTERNATIONAL TELECOMMUNICATION UNION UNIÓN INTERNACIONAL DE TELECOMUNICACIONES Ce formulaire de confirmation est à adresser directement à l'hôtel de votre choix This confirmation form should be sent directly to the hotel of your choice Dirija directamente este formulario de confirmación al hotel de su elección. Session de 2001 du Conseil (18-29 juin 2001) 2001 Session of the Council (18-29 June 2001) Sesión de 2001 del Consejo (18-29 de junio de 2001) Confirmation de la réservation faite le Confirmation of the reservation made on ------------------------Confirmación de la reserva efectuada el à l'hôtel to hotel al hotel -------------------------------------------- au prix préferentiel offert à l'UIT / at ITU preferential tariff / al precio preferencial ofrecido a la UIT -------------- chambre simple/double single/double room habitación ind./doble du from --------------------del heure d'arrivée time of arrival -----------------hora de llegada au to --------al Nom / Name / Apellido --------------------------------------------------------------------------Prénom / First name / Nombre ----------------------------------------------------------------Adresse / Address / Dirección ----------------------------------------------------------------- Tel : ------------------ ------------------------------------------------------------------------------------------------------------ Fax : ----------------- -----------------------------------------------------------------------------------------------------------Carte de crédit en garantie de la réservation Credit card to guarantee this reservation AX/VISA/DINERS/EC --------------------------------------------Tarjeta de crédito que garantiza la reserva autre/other/otras No ---------------------------------------------------------- validité/validity/validez ------------------------------------------ Date/Date/Fecha ------------------------------------ Signature/Signature/Firma --------------------------------------