Consulatul General al

Operator de date cu caracter personal

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notificat cu nr. 5285 / 5286 / 5287
%ăOĠL

1UvQUHJLVWUDUH Data:
10.05.2018

Cod de cerere SIMISC: PE1749468

CERERE
de prestare a unui serviciu consular

1. DATELE DE IDENTITATE ALE SOLICITANTULUI

1.1. Numele de Numele de familie actual: Numele de familie la QD‫܈‬WHUH: Alte nume de familie anterioare:
familie:
%Ì/,&,
1.2. Prenumele: Prenumele actual: 3UHQXPHOHODQD‫܈‬WHUH: Alte prenume anterioare:

ALINA
&HWă‫܊‬HQLD 1.4. Codul numeric personal:
R. MOLDOVA
1.5. Sexul: FEMININ Localitatea: =Ă,&$1,

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Ziua Luna Anul ‫܉‬DUD R. MOLDOVA

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identitate provizorie
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identitate IDENTITATE
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‫܉‬DUD Localitatea: -XGH‫܊‬XO6HFWRUXO5HJLXQHD
1.9.Domiciliul legal:
R. MOLDOVA =Ă,&$1, 5Ìù&$1,
(conform Strada: Nr.: Bloc: Apartament: &RGSR‫܈‬WDO
documentelor de
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adresa de domiciliu)

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telefon: 068066205 raduen911@gmail.com

2. SERVICIUL CONSULAR SOLICITAT

2.1. Obiectul
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cererii:

2.2. Date despre

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&HWă‫܊‬HQLLOHDFWXDOH R. MOLDOVA FUHGLQ‫܊‬ăUHSXQHUHDvQ
termen: Nu

2.5. Data Ordinului

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ANC de
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UHGREkQGLUHD 26.04.2018 399/P/2018
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sprijinul cererii:
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Ziua Luna Anul

4./RFXOFRPSOHWăULLFHUHULL 0LVLXQHDGLSORPDWLFă2ILFLXO Localitatea: ‫܉‬DUD

consular:

CONSULATUL GENERAL AL %Ă/ğ, R. MOLDOVA

520Æ1,(,/$
4.6HPQăWXUDVROLFLWDQWXOXL

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