FECHA: ___ /___ / ___

NOMBRE: ____________________________________________________________

OSHA: ______________ IKOFA: _______________ AWOFAKA:____________

ODU AMOLU ODU TOYALE

OPON

OPELE OPELE

IBI IRE OMO NI: ___________________

IRE´S:______ ARIKU AIKU OMA BUYOCO ISEGUN OTA SUSU AJE

IBI´S:_______ IKU ARUN OFO EYO IÑA ACOBA ARAYE OGU

PROFECIA

EBO: _________________________________________________________________

ADIMU: ______________________________________________________________

SARAYENYE: _________________________________________________________

EBOMISI: ____________________________________________________________

OBORI ELEDA: _______________________________________________________

OBSERVACIONES: