___________________________

Depus decontul (numrul i data)

___________________________

(Unitatea)

Depus decontul (numrul i data)

(Unitatea)

___________________________

___________________________

ORDIN DE DEPLASARE (DELEGAIE) NR.

____________________

ORDIN DE DEPLASARE (DELEGAIE) NR.

____________________

Dl./D-na ____________________________________________________________
avnd funcia de __________________________________________________________
este delegat() pentru ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
la _____________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Dl./D-na ____________________________________________________________
avnd funcia de __________________________________________________________
este delegat() pentru ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
la _____________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Durata deplasrii de la ______________________ la ________________________

Se legitimeaz cu ____________________________________________________

Durata deplasrii de la ______________________ la ________________________

Se legitimeaz cu ____________________________________________________

tampila unitii i semntura

tampila unitii i semntura

Data ___________________________

Sosit*___________________________
Plecat* __________________________
Cu / Fr cazare __________________
tampila unitii
i semntura

Sosit*___________________________
Plecat* _________________________
Cu / Fr cazare __________________
tampila unitii
i semntura

Sosit*____________________________
Plecat* __________________________
Cu / Fr cazare ___________________

Data ___________________________

Sosit*___________________________
Plecat* __________________________
Cu / Fr cazare __________________

tampila unitii
i semntura

Sosit*____________________________
Plecat* __________________________
Cu / Fr cazare ___________________

tampila unitii
i semntura

Sosit*___________________________
Plecat* _________________________
Cu / Fr cazare __________________

tampila unitii
i semntura

tampila unitii
i semntura

*) Se va completa ziua, luna, anul i ora

*) Se va completa ziua, luna, anul i ora

14-5-4 t2

14-5-4 t2

Sosit*____________________________
Plecat* __________________________
Cu / Fr cazare ___________________
tampila unitii
i semntura

Sosit*____________________________
Plecat* __________________________
Cu / Fr cazare ___________________
tampila unitii
i semntura

Ziua i ora plecrii: __________________

Avans spre decontare:

Ziua i ora plecrii: __________________

Avans spre decontare:

Ziua i ora sosirii: ___________________

Primit la plecare: __________________ Lei

Ziua i ora sosirii: ___________________

Primit la plecare: __________________ Lei

Data depunerii decontului: ____________

Primit n timpul deplasrii:

Data depunerii decontului: ____________

Primit n timpul deplasrii:

Penalizri calculate: __________________

________________________________ Lei

Penalizri calculate: __________________

________________________________ Lei

Total: ___________________________Lei

Cheltuieli efectuate conform documentelor anexate

Felul actului i emitentul

Nr. i data actului

Cheltuieli efectuate conform documentelor anexate

Suma

TOTAL CHELTUIELI:
Diferena de restituit s-a depus cu dispoziie de
Diferena de restituit / primit (Lei):
ncasare ctre casieria nr. ___________________
___________________________
din ____________________
Aprobat,
conductorul
unitii

Control financiar
preventiv

Verificat
decont

ef
compartiment

Total: ___________________________Lei

Titular avans

Felul actului i emitentul

Nr. i data actului

Suma

TOTAL CHELTUIELI:
Diferena de restituit s-a depus cu dispoziie de
Diferena de restituit / primit (Lei):
ncasare ctre casieria nr. ___________________
___________________________
din ____________________
Aprobat,
conductorul
unitii

Control financiar
preventiv

Verificat
decont

ef
compartiment

Titular avans