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UNIVERSITATEATRANSILVANIADINBRAOV

Numrcredite _______

FACULTATEADESIGNDEPRODUSIMEDIU

Numrpunctevalorice _______

Restane_______
(secompleteazdesecretara)

Subsemnatul(a)_________________________________________________________________student la

programul de studiu ________________anul_____grupa_________v rog smi acordai pe semestrul____al


anuluiuniversitar______________BURSASOCIALAAJUTORSOCIAL(sebifeazcuX)
ORFAN(secompleteazdoardestudeniiorfaniprinX)
Nr.CONTcuataareaextrasuluidecont______________________________________________________

DECLARAIEDEVENITURI
(declartoateveniturileobinutedefamilie)

1.Salariinetetotale

mama_________________lei/lun

tata___________________lei/lun

2.Pensii

mama_________________lei/lun

tata___________________lei/lun

3.Alteajutoareprimitedelastat

mama_________________lei/lun

(pensiideurma,ajutoromaj,ordonan)tata___________________lei/lun

4.Alocaiipentrucopii+alocaiilesuplimentare______________________lei/lun

5.Venituridinagricultur

mama_________________lei/lun

tata___________________lei/lun

6.Venituridinalteasocieri/dividende

mama_________________lei/lun

tata___________________lei/lun

______________________lei/lun

______________________lei/lun

7.Altevenituri

TOTALVENITURI

Numrultotalalpersoanelordinfamilie____________dincare:
Numrprecolari___________Numrelevi___________Numrstudeni___________

Venitnetpemembrudefamilie___________________lei/lun

Pentrujustificareacelordeclarate,anexezurmtoareleacte:________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Declarpeproprierspunderecdatelenscrisemaisussuntreale,cunoscndcnedeclarareaveniturilor

sau declararea fals a acestora atrage dup sine suportarea consecinelor legale. n cazul oricrei modificri a
veniturilorcarestaulabazaacordriiacestorsume,voiaducelacunotinasecretareifacultiiacestlucru,ncaz
contrarsumavafideclaratnecuvenitipotfiurmrit()penal,nvederearecuperriiacesteia.
Data________________

Semntura_______________________