Formular tipizat

Aprobat prin Ordinul Ministerului

Finanelor al Republicii Moldova
nr.130 din 30 septembrie 2010


130 30 2010 .

ACT DE ACHIZIIE A MRFURILOR Seria _____Nr.

_____
din _________________ 20___

Primit n baza contractului

nr._____ din __________ 20___
______

___________________________________________________________________________________________
denumirea entitii, adresa ( , )

Cod fiscal / IDNO _____________________ Conductorul entitii / ______________________________

/ IDNO persoana mputernicit_____numele, prenumele (, )
/

Primit mrfuri ______________________________________________________________________________

___________________________numele, prenumele (, )

Predat mrfuri _____________________________________________________________________________

_____________________________numele, prenumele (, )

___________________________________________________________________________________________
cod personal / IDNP, datele buletinului de identitate, adresa
( / IDNP, , )

Cod fiscal / IDNO _____________________ Conductorul entitii / ______________________________

/ IDNO persoana mputernicit_____numele, prenumele (, )
/

Primit mrfuri ______________________________________________________________________________

___________________________numele, prenumele (, )

Predat mrfuri _____________________________________________________________________________

_____________________________numele, prenumele (, )

___________________________________________________________________________________________
cod personal / IDNP, datele buletinului de identitate, adresa
( / IDNP, , )
Denumirea mrfurilor Unit. de Cantitate Pre Valoare, lei
msur unitar, lei ,

,

1 2 3 4 5=34

Total / X X X

Valoarea total __________________________________________________________________________

__________________________n litere ()

Reineri:

la buget ____________________________________________________________________ ___________
________________________________ n litere () _______________________n cifre ()
avansuri achitate ____________________________________________________________ ___________
_______________________n litere () _______________________n cifre ()

Total de plat _______________________________________________________________ ___________

____________________n litere () _______________________n cifre ()

Predat mrfuri _________________________

semntura ()

Declaraia pe propria rspundere a persoanei fizice care a predat mrfurile.

, .
Declar c mrfurile predate snt obinute integral pe teritoriul Republicii Moldova:
, :
_______________________________
numele, prenumele (, )
_______________________________
semntura ()

Declaraiile i nscrisurile false, precum i nsuirea averii strine se pedepsete conform legislaiei n vigoare.
,
.

Primit mrfuri _________________________

semntura ()

Conductorul entitii/persoana mputernicit __________________________

/ semntura ()

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