Unitatea ..........

...................
...................
...................

NOTĂ DE RECEPŢIE ŞI CONSTATARE DE DIFERENŢE

______________________________________________________________________________
| Număr | Data | Cod | Cod | Contract | Factură | Cont |
|document|______________|furnizor|primitor|Nr. -------- |Nr. -------- |creditor|
| |Ziua|Luna|Anul| | | Comandă | Aviz de | |
| | | | | | | | însoţire | |
| | | | | | | | a mărfii | |
|________|____|____|____|________|________|_____________|_____________|________|
| | | | | | | | | |
|________|____|____|____|________|________|_____________|_____________|________|

Subsemnaţii, membrii comisiei de recepţie, am procedat la recepţionarea

valorilor materiale furnizate de ...........................................
din .................... cu vagonul/auto nr. ................. documente
însoţitoare ......................... delegat ........................
constatându-se
următoarele: ................................................................... .
............................................................................ .
______________________________________________________________________________
|Nr. | Denumirea | Cont | Cod | U/M |Cantitatea| Recepţionat |
|crt.| bunurilor |debitor| | | conform |_____________________________|
| |recepţionate| | | |documente |Cantitate|Preţ unitar|Valoare|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
|____|____________|_______|_____|_____|__________|_________|___________|_______|
| Comisia de recepţie Primit în gestiune |
|______________________________________________________________________________|
|Numele şi prenumele|Semnătura|Numele şi prenumele|Semnătura| Data | Semnătura |
|___________________|_________|___________________|_________| | |
|___________________|_________|___________________|_________| | |
|___________________|_________|___________________|_________|______|___________|
14-3-1A A4 t2
 (verso)
______________________________________________________________________________
|Determinarea cantităţii |Pe cântarul nr.|Determinarea calităţii s-a făcut prin|
|s-a făcut prin: | |proba .............................. |
| ...................... | ............. | .............. nr. ................ |
|________________________|_______________|_____________________________________|
|Expeditor ................ Cărăuş ...................... Însoţitor .......... |
|Staţia de expediţie .............. Staţia de destinaţie ..................... |
|Data eliberării ............ Data expedierii .......... Data sosirii ........ |
|Delegaţii furnizorului (cărăuş neutru) care au participat la recepţie: |
|_____________________________________________________________ |
| Din partea | Numele şi | Calitatea | Buletin de | Semnătura | Alte menţiuni |
| cui | prenumele | | identitate | | |
|____________|___________|___________|____________|___________| |
|____________|___________|___________|____________|___________| |
|____________|___________|___________|____________|___________| |
|____________|___________|___________|____________|___________| |
|____________|___________|___________|____________|___________| |
|____________|___________|___________|____________|___________| |
| * | Denumirea | Cod | U/M | Diferenţe(+/-) | |
| | bunurilor | | |______________________________| |
| |recepţionate| | |Cantitate |Preţ unitar|Valoare| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|_____|____________|_____|_____|__________|___________|_______| |
|Concluziile comisiei de recepţie ............................................ |
|............................................................................. |
|............................................................................. |
|Punctul de vedere al delegatului furnizorului/cărăuşului (delegatul neutru) |
|............................................................................. |
|______________________________________________________________________________|
*) Tip document (operaţie)