UNITATEADISPOZITIE DE*________________________________________________catre caserienr____________________data________________________________________________Numele si prenumele________________________________________________________Functia (calitatea)___________________________________________________________Suma_______________lei____________________________________________________

(in litere)Scopul incasarii-platii________________________________________________________

Semnatura Conducatorul Viza de control Compartimentunitatii fin.preventiv financiar contabil

*se va inscrie "INCASARE" sau "PLATA"dupa caz 14-4-4 A6 12

DATE SUPLIMENTAREPRIVIND BENEFICIARUL SUMEI

Se completeaza Actul de identitate seria_______nr.__________________________________________numai Am primit suma de ____________________________________________________leipentru Data_____________ (in cifre)plati Semnatura_______________________________________________________________

CASIERPlatit-Incasat suma de _________________________________________________leiData________________Semnatura___________________________________