OFICIUL TERITORIAL CHIINU

al Consiliului Naional pentru Asistena

Juridic Garantat de Stat

CERERE
de acordare a asistenei juridice de urgen garantat de stat
Data solicitrii:___________________________ ora solicitrii: ____________________________
Solicitantul: ______________________________________________________________________
(numele, prenumele, funcia)

Datele de contact:__________________________________________________________________
(sediul, telefon de contact)

________________________________________________________________________________
Beneficiarul asistenei juridice: _______________________________________________________
(numele, prenumele, patronimicul)

Data naterii a beneficiarului asistenei juridice:__________________________________________

(data, luna i anul naterii)

Datele de contact:__________________________________________________________________
(domiciliul sau reedina, telefon de contact)

________________________________________________________________________________
Motivul reinerii___________________________________________________________________
data reinerii__________________, ora reinerii_________, timpul, locul i aciunea procesual
preconizat: _____________________________________________________________________
________________________________________________________________________________.

Semntura solicitantului:____________________________________________________________