PROCES - VERBAL DE CONSTATARE A CONTRAVENIEI

I DE APLICARE A SANCIUNII
____/________/______________
Avnd n vedere prevederile art.10 din Ordonana de urgen a Guvernului nr. 22/2009 privind nfiinarea Autoritii
Naionale pentru Administrare i Reglementare n Comunicaii,

1. ncheiat astzi____________n localitatea____________________, jude/sector ____________________

2. Subsemnaii:
Nume_prenume_______________________________, funcia ___________________ i legitimaia de
control nr. _________ din data de ____________ ;
Nume_prenume_______________________________, funcia ___________________ i legitimaia de
control nr. _________ din data de ____________;
Nume_prenume_______________________________, funcia ___________________ i legitimaia de
control nr. _________ din data de ____________,
avnd calitatea de ageni constatatori ai Autoritii Naionale pentru Administrare i Reglementare n Comunicaii
(ANCOM).

3. Persoana controlat este:

A.__________________________________________ cu sediul n localitatea __________________________,
str.__________________________________________,nr.____,bl.____, sc.___,et.__,ap.____,judeul/sectorul
___________, nregistrat la Oficiul Registrului Comerului cu nr. J____/________/_______, cod
fiscal/codul
unic
de
nregistrare
___________________________,
reprezentat
de
______________________________, n calitate de _____________________________, domiciliat() n
localitatea _________________________, str.__________________________________, nr.___, bl.___, sc.___,
ap.___, judeul/sectorul ____________, posesor al B.I./C.I. seria____, nr.___________, eliberat()
de________________ la data de ________________, CNP ______________________________
B._________________________________________, cu domiciliul n localitatea _____________________,
str.________________________________,
nr.___,
bl.____,
sc.____,
ap.____,
judeul/sectorul
___________________________, posesor al B.I./C.I. seria____, nr.________, eliberat() de
________________ la data de _________________, CNP ______________________________
4.
Aciunea
de
control
s-a
efectuat
la
data/n
perioada
_____________________________________
locul/locurile___________________________________________________________________________________
______________________________________________________________________________
5. Descrierea faptei/faptelor cu indicarea datei i orei/perioadei i a locului svririi:
5.1.______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
care constituie contravenia prevzut la art. ______ alin. ______ lit./pct. ______ i sancionat la
art. ______ alin. ______ lit./pct. ______ din ________________________________________________________
ANCOM
contravenient/Martor
Nume, prenume_____________________semntura______________

Reprezentant
Nume, prenume________________________

Nume, prenume_____________________semntura______________

Semntura____________________________

Nume, prenume_____________________semntura______________

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5.2 ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________
care constituie contravenia prevzut la art. ______ alin. ______ lit./pct. ______ i sancionat la
art. ______ alin. ______ lit./pct. ______ din _______________________________________________
5.3. _____________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________
care constituie contravenia prevzut la art. ______ alin. ______ lit./pct. ______ i sancionat la
art. ______ alin. ______ lit./pct. ______ din __________________________________________________
6. Au fost ataate urmtoarele anexe, care fac parte din prezentul proces verbal:
(Fia de msurtori/verificri; alte documente ridicate n timpul controlului)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________
7. Alte meniuni:
A._______________________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________
_________________________________________________________________________________________
B. Contravenientul nu a formulat / a formulat meniuni (obieciuni):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________

ANCOM

Reprezentant

contravenient/Martor
Nume, prenume_____________________semntura______________

Nume, prenume________________________

Nume, prenume_____________________semntura______________

Semntura____________________________

Nume, prenume_____________________semntura______________

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Contravenientul nu este de fa / refuz a / nu poate semna procesul-verbal, fapt atestat de

martorul ________________________, domiciliat() n ____________________, str. ___________________,
nr. ___, bl. ___, sc. ___, ap. ____, jude/sector _________________, identificat() cu actul de identitate
___ seria ___, nr. ____, CNP _________________ eliberat de __________________ la data de
______________.
Prezentul proces-verbal de constatare a contraveniei i de aplicare a sanciunii nu a fost
semnat
de
niciun
martor
ntruct
____________________________________________________________________________
________________________________________________________________________________________.
Procesul-verbal de constatare a contraveniei i de aplicare a sanciunii s-a ntocmit n 3
exemplare, conine____ pagini (inclusiv anexele), din care un exemplar se nmneaz /se
comunic contravenientului.
mpotriva prezentului proces-verbal de constatare a contraveniei i aplicare a sanciunii se
poate face plngere n termen de 15 zile de la data nmnrii sau comunicrii, la judectoria n a
crei circumscripie a fost svrit contravenia.
ANCOM

Reprezentant

contravenient/Martor
Nume, prenume_____________________semntura______________

Nume, prenume_________________________

Nume, prenume_____________________semntura______________

Semntura_____________________________

Nume, prenume_____________________semntura______________

REZOLUIE DE APLICARE A SANCIUNII

Ca urmare a contraveniei(ilor) constatat(e) prin prezentul proces-verbal, n temeiul
prevederilor
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
se dispune, astzi _________________, sancionarea contravenientului cu AVERTISMENT /
AMEND n sum de:
_______________________________________________ lei pentru fapta prevzut la pct.5.1,
_______________________________________________ lei pentru fapta prevzut la pct.5.2,
_______________________________________________ lei pentru fapta prevzut la pct.5.3,
n cuantum total de _____________________(__________________________________) lei.
PREEDINTE
(L.S.)
Ca urmare a contraveniei(ilor) constatat(e) prin prezentul proces-verbal, n temeiul
prevederilor art.59 alin.(3) din Ordonana de Urgen a Guvernului nr. 79/2002, se dispun
urmtoarele msuri:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
PREEDINTE
(L.S.)

Am primit un exemplar al procesului-verbal de constatare a contraveniei i

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aplicare a sanciunii i al ntiinrii de plat

______________________________
(nume, prenume reprezentant persoan juridic/persoan fizic, semntur)

Data: __________________

NTIINARE DE PLAT
Amenda contravenional n cuantum de _______________ (________________________________)
lei, aplicat prin procesul verbal de constatare a contraveniei i aplicare a sanciunii nr.:
_________________/______________ se poate achita la unitile Trezoreriei Statului, prin intermediul
instrumentelor de plat electronic n cadrul Ghieului virtual de pli, precum i la ghieul unic
din punctele de trecere a frontierei de stat a Romniei, n termen de 15 zile de la data
nmnrii/comunicrii prezentei ntiinri de plat.
O copie a chitanei sau ordinului de plat i o copie a procesului-verbal vor fi depuse la
Autoritatea Naional pentru Administrare i Reglementare n Comunicaii Direcia Regional
_________________, la adresa ____________________________________________________ sau vor fi
transmise printr-un serviciu potal.
n caz de neplat a obligaiilor se va proceda la executarea silit conform prevederilor legale.

PREEDINTE
Marius Ctlin MARINESCU

Am primit un exemplar al procesului-verbal de constatare a contraveniei i

aplicare a sanciunii i al ntiinrii de plat

______________________________
(nume, prenume reprezentant persoan juridic/persoan fizic, semntur)

Data: __________________

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