PROCES-VERBAL CU PRIVIRE LA CONTRAVENIE

Seria MF Nr.______________
Locul ncheierii________________________

______ _________________20_______ora__________

Agent constatator______________________________________________________________________________
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(calitatea, numele i prenumele agentului constatator)

Denumirea autoritii pe care o reprezint:_______________________adresa juridic________________________

1. Datele persoanei n a crei privin a fost pornit procesul contravenional:
1.1 Numele:____________________________Prenumele:__________________Patronimicul:__________________________
1.2. Locul naterii________________________________________ data naterii_____________________________________
1.3.Cetenia________________________________________ sexul_______________________________________________
1.4. Identificat prin (tipul actului)____________________________seria___________________________________________
numrul___________________eliberat de____________________la________________IDNO _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.5. Viza de reedin: ara______________localitatea__________________strada_______________________bloc____ap___
1.6.Domiciliul:ara_________________localitatea_____________________strada________________________bloc____ap___
1.7. Locul de munc ______________________________ ocupaia__________________________ tel:___________________
1.8. Timpul comiterii: data_______luna _____anul ________ ora comiterii______locul comiterii________________________
(localitatea)

Persoana juridic:
1.9. Denumirea ntreprinderii_______________________________________________________________________________
1.10. Sediul (adresa juridic)_______________________________________________________________________________
1.11. Ocupaia (genul principal de activitate)__________________________________________________________________
1.12. Codul fiscal al persoanei juridice _______________________________________________________________________
1.13. Date despre persoana care o reprezint __________________________________________________________________

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_________________________________________________tel._________________________________________
Timpul comiterii: data____luna ________ anul ________ ora comiterii ______locul comiterii___________________________
(localitatea )

Fapta contravenional:__________________________________________________________________________________
(indiciile calificative ale elementelor constitutive ale contraveniei, circumstanele cauzei care au importan pentru
stabilirea faptelor i consecinelor lor juridice, evaluarea eventualelor pagube cauzate de contravenie)

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Prin ce a comis o contravenie, prevzut de art.______________________________________________________
___________________________________________________________din Codul contravenional al R. Moldova.
2. Explicaiile contravenientului n privina cruia s-a ntocmit proces-verbal:_______________________________
Obieciile, probele i completrile pe care le aduce n aprarea sa contravenientul

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Semntura: Agentului constatator________________________________________________________________________
Contravenientului_________________________________ Victimei________________________________________

3. Drepturile i obligaiile prevzute de art. 34, 384, 387 Cod contravenional al Republicii Moldova au fost
explicate, pentru ce semnez:_________________________________________________
(semntura contravenientului)
Pentru a participa la examinarea cazului contravenional v prezentai pe adresa:
____________________________________________________
la data de _____ __________20___ la ora ________________
4. Interpret/traductor___________________________________________________________________________
numele, prenumele, patronimicul, data naterii, funcia

5. Au fost ridicate corpuri delicte______________________________________________________________

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Am luat cunotin de contravenia imputat, de drepturile i obligaiile prevzute de art. 384 Cod contravenional, iar copia
procesului-verbal ntocmit conform art.443 C.C. am primit, pentru ce semnez:_______________________________________
Contravenient

6.Meniunea privind refuzul contravenientului de a semna procesul-verbal, motivele refuzului__________________

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7. Martori (martori asisteni):
1____________________________________________________________________________________________
numele, prenumele, patronimicul, viza de domiciliu, telefonul, semntura

2____________________________________________________________________________________________
numele, prenumele, patronimicul, viza de domiciliu, telefonul, semntura

Semnturile: Agent constatator___________________________________________________________________________

Contravenient _____________________________________________________________________________
Martorii __________________________________________________________________________________
__________________________________________________________________________________

8.
DECIZIA AGENTULUI CONSTATATOR
8.1. aplicarea sanciunii contravenionale:___________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8.2. de ncetare a procesului_______________________________________
8.3. de remitere pentru examinare conform competenei n temeiul articolului_______________________________
8.3.1. organul competent_________________________________________________________________________
adresa________________________________________________________________________________________
8.3.2.cu recomandare____________________________________________________________________________
8.3.3.sanciunea contravenional aplicat de agentul constatator_________________________________________
_____________________________________________________________________________________________
Agentul constatator al autoritii_________________________________________________________________
(numele, prenumele funcia agentului constatator care a examinat cauza contravenional)

Data _______________________ora_______
Contravenient:

___________________________

(semntura)
Amenda contravenional urmeaz a fi achitat la contul bancar al bugetului de stat _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,
cu indicarea contului trezorerial de ncasri _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .

NOT:
Conform alin. (3) art.34 i alin. (11) art. 443 Cod contravenional al Republicii Modova contravenientul
este n drept s achite jumtate din amend dac o pltete n cel mult 72 de ore din momentul stabilirii ei.
Procesul-verbal cu privire la contravenie poate fi contestat n termen de 15 zile n ordinea prevzut de art.
448 Cod contravenional al Republicii Moldova.
Drepturile i obligaiile mi sunt aduse la cunotin
i un exemplar al procesului-verbal am primit pentru ce semnez ___________________________________________
(numele, prenumele contravenientului, semntura)