IMPUTERNICIRE

NR. ______/_________

Subsemnatul/a__________________________________________, legitimat cu
C.I.,
seria
SZ
nr.________,
domiciliat
in
______________,
strada
____________________ nr. _____, in calitate de _____________ al
_____________________________.,
cu
sediul
in
_______________,
str._______________ ,nr. ___, imputernicesc pe:
Dl./Dna.______________________________________________________,
legitimat cu B.I./C.I., seria ______, nr. ________________, cu domiciliul in
___________________________________________________________, sa reprezinte
interesele
societatii
la
_______________________________________________________________________
___ .

Data,
Stampila,

Semnatura si

Prezenta imputernicire are o valabilitate de 30 de zile de la data emiterii.