S.C. __________________________________ S.R.L.

Str. ____________, nr. ___, bl. ___, sc. ___, ap. ___
Localitate _____________, Judet _______________
CUI - ___ ___________________
Nr. ______/__________________

CATRE,
ADMINISTRATIA FINANTELOR PUBLICE _________

SUBIECT - Cerere de amnare la plat a obligatiilor fiscale

S.C. _________________ S.R.L., cu sediul in ____________, str. ____________, nr.
___, bl. ___, sc. ___, ap. ___, Judetul ________, CUI - ___________, telefon ___________,
fax _______________, e-mail ____________________ :
- reprezentata prin Dl./Dna. ______________________________, in calitate de
administrator.
- reprezentata prin Dl./Dna. ______________________________, in calitate de
__________________, conform imputernicirii nr. ___/_____________ .
Solicitam,
-

amnarea la plat a obligatiilor fiscale pentru o perioada de

________ luni;

Suma total pentru care se solicit amnarea la plat, defalcat pe tipuri de

impozite, taxe, contribuii i alte sume datorate bugetului general consolidat,
este :
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
iar majorrile de ntrziere aferente acestora, sunt :
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
- _____________________________________
Pentru sediul secundar, cu adresa in ____________, str. ____________, nr. ___, bl.
___, sc. ___, ap. ___, Judetul ________, CUI - ___________, telefon ___________, fax
_______________, e-mail ____________________, situatia este urmatoarea:
- _____________________________________
- _____________________________________
- _____________________________________
iar majorrile de ntrziere aferente acestora, sunt :
- _____________________________________
- _____________________________________
- _____________________________________

Data : _______________

Semnatura si stampila,
_____________________________