Doamna Presedinte,

Subsemnata/ul_______________________________, domiciliat/a in Galati,

str.___________________________, nr.____, bl._____, sc.____, et._____, ap._____
identificat cu cnp:_________________________, CI., seria____nr.________,
angajat/a in functia de__________________________________in cadrul
_____________________________________________________, solicit retragerea
din Sindicatul “Solidaritatea Sanitara” incepand cu data de _____________________.

Data Semnatura
_________________ ________________