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Ex.

_________
Nr. exemplarului Formular tipizat
. Anexa 1 la Ordinul Ministerului Finnanelor al
Republicii Moldova
nr.115 din 6 septembrie_2010

1
115 6 2010 .
FACTUR FISCAL Seria, Nr.
,

8. Foaia de parcurs seria: _________ numr:_____________ data _______________


Data eliberrii /data livrrii _______________ / _______________
/ 9. Transportator c.f./ nr.TVA
../
1. Furnizor: c.f./ nr.TVA
../
2. Cumprtor: c.f./ nr.TVA
../
3. Delegaie data _______________ delegatul 4. Documente anexate

5. Punct ncrcare 6. Punct descrcare 7. Redirijri

10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12
Denumirea mrfurilor, serviciilor i cod nomenclator al Unitate de Cantitatea Pre Valoarea total Cota Suma total Valoarea Alt informaie Tip ambalaj Numr Masa brut,
mrfii msur mrfurilor, unitar fr TVA, lei TVA,% a TVA, lei mrfurilor, locuri tone
, volumul fr TVA, serviciior, lei -
serviciilor lei , , % , ,
, ,
,
,

11. TOTAL (pe pagin) / ( ) x x x x


12. TOTAL (pe factura fiscal) / ( ) x x x x
13. Permis eliberarea:

:________________________________________________________________________________________________________________________________________
Funcia, numele, prenumele i semntura
, ,
14. Predat bunurile (serviciile):
()
_______________________________________________________________________________________________________________________
Funcia, numele, prenumele i semntura
L.. , ,
..
15. Primit bunurile intermediarul (transportatorul):

()________________________________________________________________________________________________________
Funcia, numele, prenumele i semntura
, ,
16. Predat bunurile intermediarul (transportatorul):

()__________________________________________________________________________________________________________
Funcia, numele, prenumele i semntura
, ,
17. Primit bunurile (serviciile) cumprtorul:
() __________________________________________________________________________________________________
L..
Funcia, numele, prenumele i semntura
..
, ,

18. Timpul de staionare a mijlocului de transport 19. Ruta i distana de transport, km


,
Operaia Ziua, luna, ora, minutele la Semntura _____________________________________
, , ,
Sosire Plecare Staionare
_____________________________________
_____________________________________
ncrcare _____________________________________

_____________________________________
Descrcare

20. Forma de plat



21. Meniuni

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
22. Calculul prestaiilor de transport

______________________________________________________________________________________
______________________________________________________________________________________