Documente Academic
Documente Profesional
Documente Cultură
Locul predarii_______________________Data___/___/______
Predatator
Nume/Prenume________________________domiciliat in ________________________
str._________________ nr.______ Jud._______________ posesor al BI/CI cu Seria________
nr.______________ cu functia de _________________
PRIMITOR:
Nume/Prenume________________________domiciliat in ________________________
str._________________ nr.______ Jud._______________ posesor al BI/CI cu Seria________
nr.______________ cu functia de _________________
Stare de functionare___________________;
Pag. 1 din 5
Defectiuni constatate :
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Documente:
Nr.crt Denumire document Observatii
1. Certificat de inmatriculare autovehicul
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Pag. 2 din 5
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Accesorii:
Nr.Crt Denumire Numar Unitate masura(buc, set,etc.)
1. Stingator
2. Trusa medicala
3. Triunghi reflectorizant
4. Roata de rezerva
5. Cric
6. Cheie roti+teava
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Pag. 3 din 5
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Primitorul a preluat autovehiculul in dotare cu cele amintite mai sus, in urma unui inventar,
fiind raspunzator de lipsa oricaruia dintre cele amintite, precum si de defectiunile cauzate de
Observatii:
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Pag. 4 din 5
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AM PREDAT AM PRELUAT
Nume/Prenume Nume/Prenume
____________________________ ________________________________
Semnatura Semnatura
______________________________ ______________________________
Prezentul formular a fost incheiat intr-un nr. de____________exemplare, din care ____________
ramane la predator si_____________ la primitor
Pag. 5 din 5