INTERNATIONAL POLICE ASSOCIATION

NGO in cosultative status (Roster) with the Economic and Social Council of the United Nations and in Consultative Status with the Council of Europe

Servo per Amikeco Servicii prin Prietenie

Asociaia Internaional a Poliitilor Secia

Republica Moldova

BIROUL TERITORIAL__________________________________
Adresa _________________________________________________ Aici se lipete
fotografia color
Telefon ________________________________________________ tip paaport (4/5)
Fax ___________________________________________________ Poza trebuie s
Cont e-mail _____________________________________________ fie pe hrtie
fotografic
normal

CERERE DE NSCRIERE (MD)

PENTRU OBTINEREA CALITATII DE MEMBRU DE DREPT

Subsemnatul(a)_________________________________________________________nscut()
la ______________________, domiciliat() n localitatea ______________________________ ,
str.___________________nr._____, bl.____, ap.____, telefon (domiciliu,mobil,serviciu,e-mail)
_____________________________________________________________, ndeplinind funcia
de ______________________n cadrul _____________________________, solicit aderarea n
Asociaia Internaional a Poliitilor (I.P.A.) - Secia Republica Moldova.
M oblig s respect prevederile Statutului I.P.A. Secia Republica Moldova, Regulamentului de
organizare i funcionare al acesteia, Statutul Internaional I.P.A. i Declaraia Universal a Drepturilor
Omului, adoptat de ONU la 10 decembrie 1948.
M declar de acord cu achitarea taxei de aderare i cotizaiei anuale de membru I.P.A.- Secia Republica
Moldova.
La prezenta cerere anexez copii de pe: buletinul de identitate i legitimaia de serviciu (pentru rezerviti
i copia de pe carnetul de pensionar).

Cunosc c legitimaia de membru I.P.A. este netransmisibil.

Data: ________________ Semntura _____________

Membrii de drept ce recomand candidatul :

1._________________________________________________________domiciliat __________________
___________________________________________________________(nr.leg. ___________________)
semntura_______________
2._________________________________________________________domiciliat__________________
___________________________________________________________(nr.leg. ___________________)
semntura_______________
Informaii suplimentare:
Locul naterii (satul, comuna, oraul, municipiul, raionul, judeul, regiunea)
_________________________
____________________________________________________________________________________
_
Naionalitatea_________________________________________________________________________
_
Cetenia _____________________________________________________________________________
Starea civil___________________________________________________________________________
Studiile, denumirea instituiei de nvmnt, anul absolvirii, specialitatea dup absolvire________________
____________________________________________________________________________________
_
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Cursuri de
perfecionare__________________________________________________________________
Gradul tiinific, titlu tiinific
_____________________________________________________________
Experiena profesional (activitatea de munc)
________________________________________________
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Aptitudini i competene personale _________________________________________________________
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Posedarea de limbi strine_______________________________________________________________

Cererea aprobat n edina Comitetului Executiv al Biroului Teritorial _____________________________

________________________________________________ din data ____________anul______________
Preedintele Comitetului Executiv al Biroului Teritorial ___________________________________
_____________________________________________________________________________
(semntura i tampila)

Cererea aprobat n edina Comitetului Executiv al I.P.A. - Secia Republica Moldova din data
______________ anul ______________

Preedintele I.P.A. - Secia Republica Moldova

_________________________________________________
______________________________________________________________________________
(semntura i tampila)
_________________________________________________________________________________________

Am primit legitimaia de membru I.P.A.

Data: ________________ Semntura ______________