model sesizare ITM
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SESIZARE
Subsemnatul(a)________________________________________ identificat(ă) cu B.I./ C.I. seria ____ nr.__________, CNP [_]_]_]_]_]_]_]_]_]_]_]_]_], vârsta _____ ani, domiciliat(ă) în jud. ________________, loc. ________________________, str. _________________________ nr. ____, bl. __, sc. __, et. __, ap. __, angajat(ă)/fost(ă) angajat(ă) în perioada _____________________ la __________________________________ cu sediul în loc. ________________________ str. ________________________ nr. ___, bl. ___ reprezentată prin __________________________________; la firmă nr. de telefon ________________.
Punct de lucru: _____________________________________________________________
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Puncte de reper ale situării în spaţiu a sediului de firmă sau a punctului de lucru _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Număr de telefon la care pot fi contactat(ă) pentru infomaţii suplimentare ________________.
Prin prezenta vă relatez următorele:
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Data:______________ Semnătura_____________________