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Dlui Serghei RAILEAN

Director general
al S CRIS Registru

CERERE DE ACORDARE/MODIFICARE A ACCESULUI


LA RESURSELE INFORMAIONALE

nr.______ din _______________20__

Organizaia/instituia ______________________________________________________
(denumirea i forma organizatorico-juridic)

Persoan juridic de drept public


Persoan juridic de drept privat
Alta

Conductor_______________________________acioneaz n baza___________________
__________________________________________________________________________

Adresa juridic ____________________________________________________________

Rechizite bancare___________________________________________________________

IDNO_________________________________Cod TVA____________________________

Modalitatea de accesare ______________________________________________________

Informaia solicitat (indicai categoriile de date)


__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Date cu caracter personal din categoria datelor speciale solicitate (conf. art. 7 al Legii nr. 17-XVI
din 15.02.2007 cu privire la protecia datelor cu caracter personal)
__________________________________________________________________________
__________________________________________________________________________
Scopul solicitrii informaiei___________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Baza normativ-juridic (motivaia legal pentru solicitarea informaiei) ________________


__________________________________________________________________________
__________________________________________________________________________
Modul n care persoanele, datele crora sunt procesate, sunt informate asupra drepturilor lor
cu privire la protecia confidenialitii datelor cu caracter personal
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Garanii privind asigurarea securitiii datelor cu caracter personal


Consimmntul persoanei
Acte normative i legislative*
Altele (indicai)
_________________________________________________________________________
*
Specificai denumirea, numrul i data documentului

Msurile de securitate i confidenialitate asigurate n vederea protejrii datelor cu caracter


personal (documentele de asigurare a securitii informaionale)______________________
__________________________________________________________________________
__________________________________________________________________________
Canalulul de legtur securizat_________________________________________________
__________________________________________________________________________
Nr. de utilizatori care urmeaz a fi conectai______________________________________
__________________________________________________________________________
Administratorul (numele, prenumele, funcia, tel., fax, e-mail)________________________
__________________________________________________________________________
__________________________________________________________________________

Numele, prenumele
Conductorului_________________________ semntura L..

Anexe: 1.----
2.----

Not: n scopul examinrii cererii de acordare a accesului la resursele informaionale de stat datele
prezentate vor fi verificate.