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Anexa nr.

1
la Ordinul ARFC
nr. 20 din 3 februarie 2014
Numrul de nregistrare a procesului-verbal

Codul agentului constatator

Seria

PROCES VERBAL CU PRIVIRE LA CONTRAVENIE


_____ _________________ 20 ___


data /

luna /

anul /

________________________________________

ora ________

locul ncheierii /

1. Funcia, numele i prenumele agentului constatator___________________________________________________________


,

_______________________________________________________________________________________________________
denumirea autoritii pe care o reprezint __________________________________________________________

2. Numele, prenumele, contravenientului______________________________________________________________________


, , ( se va indica persoana fizic sau cu funcie de rspundere / )

data naterii __________________; codul personal ___________________________; seria i nr. buletinului________________


domiciliul ______________________________________________________________________________________________

viza de reedin _________________________________________________________________________________________

locul de munc i funcia___________________________________________________________________________________


alte documente ce identific persoana ________________________________________________________________________


3. Persoana juridic: ________________________________________________________;cod fiscal _____________________


:

denumirea /

adresa juridic ______________________________________; sediul ______________________________________________


Persoana fizic cu drept de reprezentare ______________________________________________________________________


numele prenumele / ,

funcia_________________________________________; document confirmativ_____________________________________

4. Esena contraveniei_____________________________________________________________________________________

_______________________________________________________________________________________________________
circumstanele cauzei care au importan pentru stabilirea faptelor i consecinelor lor juridice

_______________________________________________________________________________________________________
,

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
nclcnd prevederile prevzute de ___________________________________________________________________________

numrul articolelor i denumirea actelor normative nclcate /

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
rspunderea pentru contravenie / contravenii fiind prevzut de art._______________ Codului contravenional al RM (CC RM)
/

(K )

5. Drepturile i obligaiile prevzute de art. 378, 384 ale CC al RM au fost aduse la cunotin.
a , 378, 384 , .

Agent constatator _____________________________

ontravenientul __________________________

semntura /

semntura /

6. Obieciile i probele pe care contravenientul le aduce n aprarea sa:______________________________________________


, :

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________

__________________
semntura /

7. Numele prenumele interpretului/ traductorului _____________________________________; data naterii______________


,

locul de munc i funcia __________________________________________________________________________________


aducerea la cunotin a prevederilor art. 312 din Codul penal privind rspunderea interpretului__________________________
. 312.

semntura interpretului /

8. Procesul verbal a fost ncheiat __________________________________________________________________________


se va consemna n lipsa sau n prezena contravenientului /

9. Martorii la ncheierea procesului verbal cu privire la contravenie:


:

1) __________________________________________________________________________________________________
numele, prenumele / ,
se va indica martor ocular sau asistent /
________________________________________________________________________________________________________________
domiciliul /

______________________
semntura /

numrul telefonului de contact /

2) __________________________________________________________________________________________________
numele, prenumele / ,
se va indica martor ocular sau asistent /
_________________________________________________________________________________________________________________
domiciliul /

_____________________
semntura /

numrul telefonului de contact /

10. La procesul-verbal se anexeaz__________________________________________________________________________


______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
DECIZIA AGENTULUI CONSTATATOR

11. Aplicarea sanciunii contravenionale:


a) Sanciunea principal:_____________________________________________________________________________
b) Sanciunea complementar:______________________________________________________________________
Remiterea pentru examinare conform competenei n temeiul articolului 4161 al Codului Contravenional al RM:
. 4161

a) Instana de judecat_______________________________________________________________________________

adresa _________________________________________________________________________________________

b) Cu recomandare _________________________________________________________________________________

_______________________________________________________________________________________________
Alte meniuni ______________________________________________________________________________________

Agent constatator ____________________________


semntura /

ontravenientul __________________________

semntura /

NOT:
Procesul-verbal cu privire la contravenie poate fi contestat n termen de 15 zile n ordinea prevzute de art.448
Cod Contravenional al Republicii Moldova.
15 , .448 .

Un exemplar al procesului-verbal am primit pentru ce semnez ____________________________________________________


,

(numele, prenumele contravenientului, semntura / , , )