Bolivia SIGEMIG form (Declaracion Jurada de Domicilio)

<div class="alert alert-primary summary-class" style="width: 100%; margin: 0px auto; background: rgb(244, 249, 254); color: rgb(33, 37, 41); border-color: rgb(204, 204, 204);"><div class="col-md-5"><strong>Entry:</strong> Air and Land<br><strong>Validity:</strong> 30 Days<br><strong>Purpose:</strong> Tourism</div><div class="col-md-5"><strong>Entries:</strong> Single<br><strong>Delivery:</strong> Email and Dashboard</div><div class="col-md-2 pullRight"><a class="shopperlink" href="https://www.shopperapproved.com/reviews/Natvisa.com/"><img style="border: 0px; margin-top: 10px;" src="https://www.shopperapproved.com/seals/33079-r.gif" alt="Customer Reviews"></a></div></div>