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| |
| ................... Depus decontul (numărul şi data) |
| (Unitatea) ..................................... |
| |
| ORDIN DE DEPLASARE (DELEGAŢIE) |
| Nr. ................... |
| |
| Domnul (a) ................................................................. |
| având funcţia de ........................................................... |
| este delegat pentru ........................................................ |
| ............................................................................ |
| ............................................................................ |
| ............................................................................ |
| la ......................................................................... |
| ............................................................................ |
| ............................................................................ |
| Durata deplasării de la ................... la .......................... |
| Se legitimează cu ....................................................... |
| Ştampila unităţii şi semnătura |
| |
| |
| Data ................. |
|______________________________________________________________________________|
| Sosit *) ........................... | Sosit *) ............................ |
| Plecat *) .......................... | Plecat *) ........................... |
| Cu (fără) cazare | Cu (fără) cazare |
| Ştampila unităţii | Ştampila unităţii |
| şi semnătura | şi semnătura |
|______________________________________|_______________________________________|
| Sosit *) ........................... | Sosit *) ............................ |
| Plecat *) .......................... | Plecat *) ........................... |
| Cu (fără) cazare | Cu (fără) cazare |
| Ştampila unităţii | Ştampila unităţii |
| şi semnătura | şi semnătura |
|______________________________________|_______________________________________|
*) Se va completa ziua, luna, anul şi ora. 14-5-4 A5 t2
(verso)
______________________________________________________________________________
| Ziua şi ora plecării ............... | Avans spre decontare: |
| Ziua şi ora sosirii ................ | - Primit la plecare ............. lei |
| Data depunerii decontului .......... | - Primit în timpul |
| Penalizări calculate ............... | deplasării .................... lei |
| | TOTAL ........................... lei |
|______________________________________|_______________________________________|
| CHELTUIELI EFECTUATE CONFORM DOCUMENTELOR ANEXATE |
|______________________________________________________________________________|
| Felul actului şi emitentul | Nr. şi data actului | Suma |
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
|______________________________________|___________________________|___________|
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|______________________________________|___________________________|___________|
| TOTAL CHELTUIELI | |
|__________________________________________________________________|___________|
| Diferenţa de restituit s-a depus cu | primit |
| chitanţa nr. ....... din .......... | Diferenţa de ----------- lei ........ |
| | restituit |
|______________________________________|_______________________________________|
| Semnătura | Aprobat, | Control | Verificat | Şef | Titular |
| | conducătorul |financiar- | decont | compartiment | avans |
| | unităţii |preventiv | | | |
| |______________|___________|___________|______________|____________|
|___________|______________|___________|___________|______________|____________|