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mun.Chișinău, str.

Korolenko,2

CERERE DE AUDIENȚĂ

Nume ___________________________________________

Prenume_________________________________________

Adresa de contact:
Localitatea (oraș/raion)________________________________________
Strada______________________________________________________
Nr.__________ bl._______scara________apartament________________
Telefon ____________________________________________________
e-mail______________________________________________________

Subiectul audienței (tema)___________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

La cerere atașez următoarele acte : DA NU


1.___________________________________________________________

2.___________________________________________________________

Data Semnătura persoanei ce solicită audiența