Decont

Subsemnatul – nume/prenume; The undersigned:(Required)

CNP; Personal identification NR(Required)

CI Serie/NR; ID Serial/NR(Required)

Domiciliul complet; Address(Required)

Inceputul deplasării; Beginning of travel(Required)

Finalul deplasării; End of travel(Required)

Ruta; Route(Required)

Eveniment; Event(Required)

Deplasare cu; Travel with:(Required)

Nr Bon 1 / Receipt 1 ID(Required)

Data bon 1 / Receipt 1 date(Required)

Valoare bon 1 / Receipt 1 val(Required)

Please enter a number from 0 to 600.

Nr. km călătorie pt autoturism (bon 1); Trip nr. of km for car trip (receipt 1)

Please enter a number from 0 to 1000.

Preț/litru (bon 1); Price/liter (receipt 1)

Please enter a number from 0 to 10.

Nr Bon 2 / Receipt 2 ID

Data bon 2 / Receipt 2 date

Valoare bon 2 / Receipt 2 val

Please enter a number from 0 to 600.

Nr. km călătorie pt autoturism (bon 2); Trip nr. of km for car trip 2 (receipt 2)

Please enter a number from 0 to 1000.

Preț/litru (bon 2); Price/liter (receipt 2)

Please enter a number from 0 to 1000.

Combustibil consumat la 7.5% (automat) / Used fuel at 7.5% (automatic)(Required)

Valoare decontabila (automat) / Refundable value (automatic)(Required)

Societate cazare / Accomodation company(Required)

Serie nr, data fact. / Invoice number and date(Required)

Nr. nopti / nights(Required)

Please enter a number from 0 to 10.

Valoare factura cazare / accomodation invoice value(Required)

Please enter a number from 0 to 2000.

Valoare totală solicitată pentru decont / Refund request total value(Required)

IBAN(Required)

Documente călătorie, facturi / travel documents, invoices

Drop files here or

Max. file size: 128 MB.

Data decont; request date

Signature

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