Subsemnata _______________________domiciliat n ________________identificat
cu CI _seria __ nr________________ CNP________________ declar c am primit de la________________________ suma de ________________., reprezentnd________________ .
Subsemnata _______________________domiciliat n ________________identificat
cu CI _seria __ nr________________ CNP________________ declar c am primit de la________________________ suma de ________________., reprezentnd________________ .