Adres:

Str. Stoian Militaru, nr.

71,
sector 4, Bucuresti
cod potal: 040718

Tel.: 021.311.51.55E-mail:
021.440.13.51
secretariat@copsi.ro
021.440.13.52
Fax: 021.440.13.51directiajuridica@copsi.ro
litigii@copsi.ro

Dosar nr. _________/______/______________

(se completeaz de ctre Secretariatul Comitetului director
al Colegiului Psihologilor din Romnia)

Plngere
1.Petent:
___________________________________________________________________________
(numele i prenumele/denumirea petentului), cu domiciliul/sediul n
___________________
str. _____________________________________________, nr. _______, bl._____,
sc._____, etaj _______, ap._____________judeul/sectorul
__________________________________, CNP/Cod de nregistrare fiscal/Cod
unic de nregistrare: ____________________________,
e-mail:
_______________________________, tel/fax. _______________________________
reprezentat/ prin
___________________________________________________________,
formulez prezenta plngere mpotriva
2.
_________________________________________________________________________
(numele i prenumele/denumirea petentului), cu domiciliul/sediul n
___________________
str. _____________________________________________, nr. _______, bl._____,
sc._____, etaj _______, ap._____________judeul/sectorul
__________________________________, CNP/Cod de nregistrare fiscal/Cod
unic de nregistrare: ____________________________,
e-mail:
_______________________________, tel/fax. ______________________________.
i solicit analiza i luarea unor msuri corespunztoare referitoare la fapta
psihologului cu drept de liber practic reclamat, conform prevederilor
Legii nr. 213/2004 i H.G. 788/2005.
3. Obiectul plngerii (cu indicarea faptei i a dispoziiei legale nclcate,
astfel cum sunt acestea prevzute n Codul deontologic i n Abaterile
disciplinare anexate la Codul deontologic, din Hotrrea nr. 4 CN/2013)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. Sanciunea solicitat (se marcheaz o singur sanciune):
mustrare;
avertisment;
1

Adres:
Str. Stoian Militaru, nr.
71,
sector 4, Bucuresti
cod potal: 040718

Tel.: 021.311.51.55E-mail:
021.440.13.51
secretariat@copsi.ro
021.440.13.52
Fax: 021.440.13.51directiajuridica@copsi.ro
litigii@copsi.ro

suspendare temporar, pe un interval de 6-12 luni a avizului de

exercitare a profesiei;
retragerea definitiv a atestatului.
5. Motive (prezentarea pe scurt a faptei reclamate):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. n susinerea prezentei plngeri anexez urmtoarele documente:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
7. Pentru soluionarea prezentei plngeri optez pentru urmtoarea cale de
soluionare:
Mediere/Conciliere (Preedintele Colegiului Psihologilor din Romnia);
Analiza dosarului (potrivit procedurii rspunderii disciplinare prevzute
n Codul de procedur disciplinar, Anexa nr. 2 la Hotrrea nr. 4
CN/2013);
Potrivit dispoziiilor Legii nr. 677/2001, cu modificrile i completrile
ulterioare, mi exprim consimmntul, n mod expres i neechivoc, pentru
prelucrarea datelor mele cu caracter personal n vederea soluionrii
2

Adres:
Str. Stoian Militaru, nr.
71,
sector 4, Bucuresti
cod potal: 040718

Tel.: 021.311.51.55E-mail:
021.440.13.51
secretariat@copsi.ro
021.440.13.52
Fax: 021.440.13.51directiajuridica@copsi.ro
litigii@copsi.ro

prezentei plngeri, precum i pentru orice prelucrare ulterioar a acestora,

potrivit procedurilor Colegiului Psihologilor din Romnia, n condiiile legii.
Data,
original),

Semntur petent (n