______________________________________________________________________________

|
|
| ...................
Depus decontul (numrul i data)
|
|
(Unitatea)
.....................................
|
|
|
|
ORDIN DE DEPLASARE (DELEGAIE)
|
|
Nr. ...................
|
|
|
| Domnul/Doamna .............................................................. |
| avnd funcia de ........................................................... |
| este delegat pentru ........................................................ |
| ............................................................................ |
| ............................................................................ |
| ............................................................................ |
| la ......................................................................... |
| ............................................................................ |
| ............................................................................ |
|
Durata deplasrii de la ................... la .......................... |
|
Se legitimeaz cu ....................................................... |
|
tampila unitii i semntura
|
|
|
|
|
|
Data .................
|
|______________________________________________________________________________|
| Sosit *) ........................... | Sosit *) ............................ |
| Plecat *) .......................... | Plecat *) ........................... |
| Cu (fr) cazare
| Cu (fr) cazare
|
|
tampila unitii
|
tampila unitii
|
|
i semntura
|
i semntura
|
|______________________________________|_______________________________________|
| Sosit *) ........................... | Sosit *) ............................ |
| Plecat *) .......................... | Plecat *) ........................... |
| Cu (fr) cazare
| Cu (fr) cazare
|
|
tampila unitii
|
tampila unitii
|
|
i semntura
|
i semntura
|
|______________________________________|_______________________________________|
*) Se va completa ziua, luna, anul i ora.
14-5-4
A5
t2

(verso)
______________________________________________________________________________
| Ziua i ora plecrii ............... | Avans spre decontare:
|
| Ziua i ora sosirii ................ | - Primit la plecare ............. lei |
| Data depunerii decontului .......... | - Primit n timpul
|
| Penalizri calculate ............... |
deplasrii .................... lei |
|
| TOTAL ........................... lei |
|______________________________________|_______________________________________|
|
CHELTUIELI EFECTUATE CONFORM DOCUMENTELOR ANEXATE
|
|______________________________________________________________________________|
|
Felul actului i emitentul
|
Nr. i data actului
|
Suma
|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|
TOTAL CHELTUIELI
|
|
|__________________________________________________________________|___________|
| Diferena de restituit s-a depus cu |
primit
|
| chitana nr. ....... din .......... | Diferena de ----------- lei ........ |
|
|
restituit
|
|______________________________________|_______________________________________|
| Semntura |
Aprobat,
| Control
| Verificat |
ef
| Titular
|
|
| conductorul |financiar- | decont
| compartiment |
avans
|
|
|
unitii
|preventiv |
|
|
|
|
|______________|___________|___________|______________|____________|
|___________|______________|___________|___________|______________|____________|