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FI DE CONSILIERE I INFORMARE

I. Date de identificare a beneficiarului

Nume i prenume:____________________________________________________________
Locul i data naterii:__________________________________________________________
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ B.I./C.I._______________________________
Domiciliul legal:______________________________________________________________
Domiciliul n fapt:_____________________________________________________________
Telefon:__________________________

II. Observaii
_______________________________________________________________________
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