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SESIZARE

Subsemnatul(a)*___________________________________________________________
identificat() cu buletin /carte de identitate seria_______ nr.__________________________,
CNP * [__]__]__]__]__]__]__]__]__]__]__]__]__], vrsta ____ani, domiciliat()* n jud.
___________________________loc._________________________str.______________________
_ nr. ___ bl._______ sc._______ et.____ ap._______ angajat()/fost() angajat() n perioada
_______________-______________la S.C.* _________________________________________
S.R.L./S.A. cu sediul n loc. __________________ str.__________________ nr.____ bl._____
reprezentat prin _______________________________________; nr. de telefon la firm
_______________.
Punct de lucru situat n ____________________________________________________________
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Numr

de

telefon

la

care

pot

fi

contactat()

pentru

informaii

suplimentare

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Prin prezenta v relatez urmtoarele:
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Data: _____________ Semntura:_________________

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