Banca______________________________

Sucursala/Filiala______________________

FOAIE DE VARSAMANT

Nr._____ din _________

Subsemnatul___________________________depun pentru_________________________________in
contul nr.___________________deschis la Banca _________________sucursala/filiala______________.

S.C.____________________S.R.L.

Ce reprezinta Simbol plan casa Lei Monetar

depunerea Buc. Cup. Lei

Adica______________________________________________

____________________________________________ lei. Total lei

Spatiu rezervat pentru Banca ___________________________________________________

Semnatura casieriei: Semnatura contabilitatii:

__________________________ __________________________

Data:_____________________