Adres:

Str. Stoian Militaru, nr. 71,

sector 4, Bucuresti
cod potal: 040718

Tel.: 021.311.51.55
021.440.13.51
021.440.13.52
Fax: 021.440.13.51

E-mail: secretariat@copsi.ro
juridic@copsi.ro
Web: www.copsi.ro

Dosar nr. _________/________________

Nr. __________/_________________
(se completeaza de catre Secretariatul CPR)

Inventar
1. _________________________________________________________________________
(numele si prenumele/denumirea petentului), cu domiciliul/sediul in _________________,
str. _____________________________________________, nr. _______, judetul/sectorul
__________________________, CNP/Numar de inregistrare fiscal/Cod unic de inregistrare:
______________________, e-mail: _______________________________, tel/fax. ________
____________________________________________________________ reprezentata prin
____________________________________,
2._________________________________________________________________________
(numele si prenumele psihologului cu drept de libera practica reclamat) cu domiciliul in
____________________________, str. __________________________________________,
nr.
_______, judetul/sectorul
__________________________, Cod personal :
________________, CNP: ______________________________,
3.

Rezolutia de mediere/conciliere;
Inaintare potrivit procedurii art. 55 prevazut in Legea nr. 213/2004;

4. Avizul juridic al Departamentului juridic si de comunicare

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Adres:
Str. Stoian Militaru, nr. 71,
sector 4, Bucuresti
cod potal: 040718

Tel.: 021.311.51.55
021.440.13.51
021.440.13.52
Fax: 021.440.13.51

E-mail: secretariat@copsi.ro
juridic@copsi.ro
Web: www.copsi.ro

5. Rezolutia/rezolutiile Comisiei/comisiilor de specialitate (dupa caz)

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