CASA DE ASIGURARI DE SANATATE CALARASI

CAS CALRASI

CALARASI ,8500 , STR. INDEPENDENTEI , nr. 51 , TEL / FAX 0242-316.717 / 0242-318.464.

e-mail info@casacl.ro

Nr_________/_____________

DOMNULE PRESEDINTE,

Subsemnatul _______________________________ in calitate de ____________

pentru numitul ______________________________ in varsta de ___________ ani ,cu
domiciliul in ____________________________________________________________
CNP_____________________ ,va rog sa-mi aprobati procurarea/inchirierea de:
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_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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Rog ca decizia sa fie:
trimisa prin posta la adresa _________________________________________
ridicata personal.

Nr. telefon ____________

Data _______________

Semnatura ______________

Cu multumiri,

Domnului Presedinte Director General al CJAS Calarasi