Documente Academic
Documente Profesional
Documente Cultură
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la certificatul de nregistrare a formei de exercitare a profesiei, cu denumirea
______________________________________________________________________________________
,
cod de nregistrare: _________________, avnd ca obiect:
1. Denumirea: __________________________________________________________________________
______________________________________________________________________________________
_
2. Sediul profesional situat n
_____________________________, str. _____________________________________________________,
nr. ____, bl. ____, sc. ____, et. ____, ap. ____, sector/jude __________________________ si
3. Punct/e de lucru situate n
3.1. __________________________, str. ____________________________________________________,
nr. ____, bl. ____, sc. ____, et. ____, ap. ____, sector/jude __________________________
3.2. __________________________, str. ____________________________________________________,
nr. ____, bl. ____, sc. ____, et. ____, ap. ____, sector/jude __________________________
4. Patrimoniul iniial al cabinetului este constituit din aportul titularului, n procent de 100%, potrivit
documentelor anexate (acte de proprietate, facturi, chitane, bonuri fiscale, etc.), n valoare total de
__________________ lei(RON).i cer nregistrarea acestuia n Registrul unic al psihologilor cu drept de
liber practic din Romnia partea a II-a, cu specialitile:
psihologie clinic;
consiliere psihologic;
psihologia transporturilor;
vocaional;
psihoterapie;
psihologie special;
psihologie
Data
________________
Solicitant (titular),
(semntur i paraf)