Codul Fiscal......................…………………………………. Nr De Inmatriculare De La Registrul Comertului/Anul………....................…………………….. Sediul (Localitate, Str, Nr)................………………….. Chitanta Nr……………............................ ………………………………………………............................ Data…………….................………………… Judetul………………………………………….....................
Am Primit De La …………...………………………………………....................................… Adresa ……………………………………………............................................……………… Suma De................………………………….Adica……........................……………...…… ……………………………..........…………....................................……………………………… Reprezentand ………………………….................................…………………….........…… …………………………………….........................................……………………………......…
