Universitatea Al. I.

Cuza IASI
(Societatea)

Depus decontul
(numarul si data)
____________________

ORDIN DE DEPLASARE (DELEGATIE ) NR._________

Dl(d-na)______________________________________________________
Avand functia de _______________________________________________
Este delegat pentru____________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
la ___________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Durata deplasarii de la ___________________la______________________________
Se legitimeaza cu_______________________________________________________
Stampila societatii si semnatura, RECTOR
Data__________________
Sosit*__________________________
Plecat*_________________________
Cu (fara) cazare__________________
Stampila societatii
si semnatura,

Sosit*__________________________
Plecat*_________________________
Cu (fara) cazare__________________
Stampila societatii
si semnatura,

Sosit*__________________________
Plecat*_________________________
Cu (fara) cazare__________________
Stampila societatii
si semnatura,

Sosit*__________________________
Plecat*_________________________
Cu (fara) cazare__________________
Stampila societatii
si semnatura,

Se va completa ziua, luna, anul si ora.

Ziua si ora plecarii__________________ Avans spre decontare:

Ziua si ora sosirii___________________ Primit la plecare_________________lei
Ziua depunerii
Primit in timpul
decontului_____________
deplasarii_______________lei
Penalizari
TOTAL
_______________lei
calculate__________________
Cheltuieli efectuate conform documentelor anexate
Felul documentului si emitentul
Nr si data actului
Suma

TOTAL CHELTUIELI
Diferenta de restituit s-a depus cu
Diferenta de primit/restituit__________lei
chitanta nr_________din_____________
Semnatura
Se aproba,
Control
Verificat
Sef
Titular
conducatorul
Fin
decont
Compartiment
avans
unitatii
preventiv