FIRMA ___________________________LOCALITATEA ____________________________JUDET ____________________________

DECONT CHELTUIELI NR _________________CURSA NR. ____________/ __________Conform ordin de plata _______________________

-Tara si localitatea-Numele si Prenumele-Data plecarii si sosirii-Numar foaie de parcurs-Numar inmatriculare auto-Total km parcursi extern-Temei legal HG.137/05.03.1990_____________________________________________________________________________________

CAPITOLUL I (cheltuieli)1 – Diurna2 – Stationare3 – Cheltuieli cu carburanti4 – Cheltuieli cu lubrifianti5 – Alte cheltuieli(taxe.,asig.,autoriz..)6 – Cheltuieli materiale(piese de schimb)7 – Cheltuieli reparatiiTotal Cheltuieli (1,2,3,4,5,6,7)

CAPITOLUL II1 – Avans spre decontare

CAPITOLUL III1 – Suma de plata : -de acordat (cap.I-cap.II) -de restituit (cap.II-cap.I)

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DIRECTOR CONTABIL

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