NEXA Nr.

6
la procedur
FORMULAR DE DECONT*1)
Denumirea solicitantului/operatorului economic .......................
Semnificaia coloanei F din tabelul de mai jos este urmtoarea:
F - Felul documentului
- lei ______________________________________________________________________________
|Nr. |Denumirea |
Factura
|
Instrumente
|Valoarea
|
|crt.|activitii|
|
de plat*2)
|alocaiei
|
|
|
|__________________________|___________________|financiare
|
|
|
|Nr.
|Data
|Valoarea|F|Nr.|Data|Valoarea|nerambursabile|
|
|
|facturii|facturii|facturii| |
|
|cu TVA |
|
|
|
|
|
|cu/fr | |
|
|
|
|
|
|
|
|
|TVA
| |
|
|
|
|
|____|___________|________|________|________|_|___|____|________|______________|
| 1.|
|
|
| ...... | |
|
|
|
|
|____|___________|________|________|________|_|___|____|________|______________|
| 2.|
|
|
| ...... | |
|
|
|
|
|____|___________|________|________|________|_|___|____|________|______________|
| 3.|
|
|
| ...... | |
|
|
|
|
|____|___________|________|________|________|_|___|____|________|______________|
| 4.|
|
|
| ...... | |
|
|
|
|
|____|___________|________|________|________|_|___|____|________|______________|
|TOTAL: | ...... |
|
|
|
|________|________|__________|________|______________|
Figura 2Lex: Formular de decont
Reprezentantul legal/mputernicitul operatorului economic*)
Numele ........................
Funcia .......................
Semntura .....................
Data semnrii .................

tampila

-----------*1) La prezentul decont se vor anexa documentele justificative n original i n

copie certificat (facturi, chitane).
*2) Chitan.
*) Cererile i toate celelalte documente vor fi semnate de aceeai persoan
(reprezentant legal sau mputernicit).
Viza UIP**)
**) Se va completa de OTIMMC.
_____________________________________________________________
|
| Coordonator | Verificator | Verificator|
|____________________|_____________|_____________|____________|
| Numele i prenume |
|
|
|
|____________________|_____________|_____________|____________|
| Semntura
|
|
|
|
|____________________|_____________|_____________|____________|
| Data
|
|
|
|
|____________________|_____________|_____________|____________|
| Bun de plat (lei) |
|
|
|
|____________________|_____________|_____________|____________|