Biroul migraie i azil al Ministerului Afacerilor Interne

Agenia Naional pentru Ocuparea Forei de Munc

Nr. dosar.
data........../............../20...
Certific identitatea persoanei i corectitudinea datelor
nscrise n cerere ____________________________
(Semntura persoanei responsabile)

Foto
3X4

CERERE

pentru acordarea dreptului de edere provizorie investitorului strain

Nume (Family/ last name) Gkountis
Prenume (Given/first name (s)) Dimitrios
Numele prinilor: Tata (Father`s name) Stergios Mama (Mother`s name)

Kasiani

Cetenie (Citizenship) Greciadata/luna/anul naterii (Date of birth) 23/11/

1974 , Sex (Gender) M

Locul naterii (Place of birth): ara (Country) Grecia Localitatea (Town/city) Larisa
Adresa n ara de origine (Address in origin country)

Androutsou 2, Larisa

Paaport (Passport) seria (series) AI (no.) 1796519 Eliberat de (Issued by) Comisariatul de poliie or.Larisa
la data (on) 14/01/2012 valabil pn la (date of expiry)

13/01/2017

Tipul vizei (Type of visa)_____________seria (series) ______ nr. (no.) ________ Eliberat de (Issued by)________________
la data (on)_______/______/______valabil pn la (date of expiry)_____/______/_______Scopul (Purpose)______________
Data ultimei intrri n Republica Moldova (Last entry in Republic of Moldova) 25.08.2014
Punctul de trecere a frontierei (Border check point) AEROPORT INTERNAIONAL CHIINU

Solicit s mi se acorde dreptul de edere pentru investitori strini pe un termen de (I request

for the right residence right for the foreign investors for a period of) 2 ani (years )
Alte date (Additional data):
Starea civil (Marital status)
Profesie (Profession)

Necstorit Apartenena etnic (Ethnic affiliation) Grec Studiile (Studies) Economie

Economist limbi vorbite

(Spoken languages)

Englez, Spaniol, Greac, Italian,

Francez, Romn Grupa sangvin (Blood group) II + nlimea (height) 185 cm, culoarea ochilor (eyes colour)
albatri
Locul de munc (Work place): ntreprinderea/Organizaia (Company/Organisation)

S.R.L Tasty Fruits

IDNO/nr. de nregistrare (personal code) 1013600007925 Suma investiiilor (amount of the investments)

4 087 300 lei

Funcia (Position) Administrator Vechimea n munc (Work experience) 2 ani (years)
Adresa juridic a angajatorului (Employer`s address):

Republica Moldova

os. Balcani, 2/1 ap.(of.) 21, mun. Chiinu,

Numele, prenumele conductorului ( Family/ last name, Given/first name of the Unit Head) Gkountis

Dimitrios

Domiciliul n Republica Moldova (Residence in Republic of Moldova): raion /ora:

Localitatea Chiinu str. Bogdan

Voievod nr.10 , tel: 060202082

Anterior am avut reedina n Republica Moldova (Previous residence in Republic of Moldova): Da/Nu (se indic
perioada) (Yes/No, period of stay/residence)

Chiinu, str. Aleco Russo 3/2 ap.12

Lista membrilor de familie care m nsoesc (so, soie, copii, prini)

(List of accompanied family members (spouse, children, parents))

Nume

Prenume

Data
naterii

Gradul de
rudenie

Solicit acordarea
dreptului de
edere n
Republica
Moldova: Da/Nu

Domiciliul

Declar, n deplin cunotin de cauz, c toate informaiile furnizate de mine sunt corecte i complete. Am fost
informat c orice declaraie fals din partea mea va atrage refuzul cererii de acordare a dreptului la munc i
dreptului de edere sau anularea/revocarea acestuia.
(I certify that the information on this application is complete, true and accurate. I was informed that any false
information offered can cause denial of my application for residence)
mi asum deplina responsabilitate ce-mi revine pentru nerespectarea legislaiei privind regimul strinilor n
Republica Moldova.
(I assume all my responsibility in case of not complying with the legislation for foreigners in Republic of Moldova)
Sunt de acord cu prelucrarea datelor prezentate n conformitate cu Legea nr. 133 din 08.07.2011 privind protecia
datelor cu caracter personal
(I agree with processing of data presented in accoding with Law no. 133/08.07.2011 on protection of personal data)

Data (date)____________________
Semntura (signature)