Formular tipizat

$QH[DOD2UGLQXO0LQLVWHUXOXL)LQQDQĠHORUDO5HSXEOLFLL0ROGRYD
nr.118 din 28 august 2017
Ɍɢɩɨɜɚɹɮɨɪɦɚ
ɉɪɢɥɨɠɟɧɢɟɤɩɪɢɤɚɡɭɆɢɧɢɫɬɟɪɫɬɜɚɎɢɧɚɧɫɨɜɊɟɫɩɭɛɥɢɤɢɆɨɥɞɨɜɚ
ʋɨɬɚɜɝɭɫɬɚɝ

)$&785Ă),6&$/Ă Seria, Nr.

ɇȺɅɈȽɈȼȺəɇȺɄɅȺȾɇȺə ɋɟɪɢɹʋ EAA004794579

8. Foaia de parcurs seria: QXPăU data:

'DWDHOLEHUăULLGDWDOLYUăULL15.03.2021 / 15.03.2021 ɉɭɬɟɜɨɣɥɢɫɬɫɟɪɢɹ ɧɨɦɟɪ ɞɚɬɚ
Ⱦɚɬɚɜɵɩɢɫɤɢɞɚɬɚɩɨɫɬɚɜɤɢ 9. Transportator c.f./ nr.TVA /
ɉɟɪɟɜɨɡɱɢɤ ɮɤɤɨɞɇȾɋ
1. Furnizor: AGENTIA NATIONALA PENTRU SANATATE PUBLICA, str. Gheorge Asachi Cont c.f./ nr.TVA 1018601000021 /
ɉɨɫɬɚɜɳɢɤ MD19TRPAAA142310A15826AA, MF -TR Chisinau Bugetul de Stat, TREZMD2X ɮɤɤɨɞɇȾɋ

&XPSăUăWRUEHQHILFLDU COMUNITARA ORHEI, OR.ORHEI Vasile Mahu nr.160 c.f./ nr.TVA 1013620006539 /
ɉɨɤɭɩɚɬɟɥɶɩɨɥɭɱɚɬɟɥɶ ɮɤɤɨɞɇȾɋ

'HOHJDĠLHseria QXPăU data delegatul 4. Documente anexate

Ⱦɨɜɟɪɟɧɧɨɫɬɶ ɫɟɪɢɹ ɧɨɦɟɪ ɞɚɬɚ ɞɟɥɟɝɢɪɨɜɚɧɧɵɣ ɉɪɢɥɚɝɚɟɦɵɟɞɨɤɭɦɟɧɬɵ

3XQFWvQFăUFDUH 3XQFWGHVFăUFDUH 5HGLULMăUL

ɉɭɧɤɬɩɨɝɪɭɡɤɢ ɉɭɧɤɬɪɚɡɝɪɭɡɤɢ ɉɟɪɟɚɞɪɟɫɨɜɤɢ

10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12
'HQXPLUHDPăUIXULORUDFWLYHORUVHUYLFLLORUúLFRGXOSR]LĠLHL Unitate Cantitatea 3UHĠXQLWDU 9DORDUHDWRWDOă Cota 6XPDWRWDOăD Valoarea $OWă Tip ambalaj 1XPăU Masa
WDULIDUHDOPăUILLDFWLYXOXL de PăUIXULORUDF IăUă79$OHL IăUă79$OHL TVA,% TVA, lei PăUIXULORUDFWLYHORU LQIRUPDĠLH Ɍɢɩɭɩɚɤɨɜɤɢ locuri EUXWăWRQH
ɇɚɢɦɟɧɨɜɚɧɢɟɬɨɜɚɪɨɜɚɤɬɢɜɨɜɭɫɥɭɝɢɤɨɞɬɨɜɚɪɧɨɣ PăVXUă tivelor, ɐɟɧɚ Ɉɛɳɚɹɫɭɦɦɚ ɋɬɚɜɤɚ Ɉɛɳɚɹɫɭɦɦɚ , serviciilor, lei Ⱦɪɭɝɚɹ Ʉɨɥɢ Ɇɚɫɫɚ
ɩɨɡɢɰɢɢɬɨɜɚɪɚɚɫɬɢɜɚ ȿɞɢɧɢɰ volumul ɟɞɢɧɢɰɵɛɟɡ ɛɟɡɇȾɋɥɟɟɜ ɇȾɋ ɇȾɋɥɟɟɜ ɋɬɨɢɦɨɫɬɶ ɢɧɮɨɪɦɚɰɢɹ ɱɟɫɬɜɨ ɛɪɭɬɬɨ
ɚ serviciilor ɇȾɋɥɟɟɜ ɬɨɜɚɪɨɜɚɤɬɢɜɨɜ ɦɟɫɬ ɬɨɧɧ
ɢɡɦɟɪɟ Ʉɨɥɢɱɟɫɬɜɨ ɭɫɥɭɝɥɟɟɜ
ɧɢɹ ɬɨɜɚɪɨɜɚɤɬɢ
ɜɨɜɨɛɴɟɦ
ɭɫɥɭɝ
Servicii Medico Sanitare unit 1 4514 4514 - 0 4514 0
727$/SHIDFWXUDILVFDOăȼɫɟɝɨɩɨɧɚɥɨɝɨɜɨɣɧɚɤɥɚɞɧɨɣ 4514 X 0 4514 X X X 0,00

13. Permis eliberarea: contabil Natalia Ungurean $SOLFDWăVHPQăWXUDGLJLWDOăGHFăWUH)XUQL]RU?ɉɪɢɦɟɧɟɧɚ

Ɉɬɩɭɫɤ ɰɢɮɪɨɜɚɹɩɨɞɩɢɫɶɉɨɫɬɚɜɳɢɤɚ
ɪɚɡɪɟɲɢɥ
)XQFĠLDQXPHOHSUHQXPHOHVHPQăWXUD \ Ⱦɨɥɠɧɨɫɬɶɮɚɦɢɥɢɹɢɦɹɩɨɞɩɢɫɶ

143UHGDWPăUIXULOHDFWLYHOHVHUYLFLLOH contabil Natalia Ungurean $SOLFDWăVHPQăWXUDGLJLWDOăGHFăWUH)XUQL]RU?ɉɪɢɦɟɧɟɧɚ

ɋɞɚɥɬɨɜɚɪɵɚɤɬɢɜɵɭɫɥɭɝɢ ɰɢɮɪɨɜɚɹɩɨɞɩɢɫɶɉɨɫɬɚɜɳɢɤɚ

)XQFĠLDQXPHOHSUHQXPHOHVHPQăWXUD \ Ⱦɨɥɠɧɨɫɬɶɮɚɦɢɥɢɹɢɦɹɩɨɞɩɢɫɶ
/ù

Ɇɉ
153ULPLWPăUIXULOHDFWLYHOHLQWHUPHGLDUXOWUDQVSRUWDWRUXO

ɉɪɢɧɹɥɬɨɜɚɪɵɚɤɬɢɜɵɩɨɫɪɟɞɧɢɤɩɟɪɟɜɨɡɱɢɤ

)XQFĠLDQXPHOHSUHQXPHOHVHPQăWXUD\ Ⱦɨɥɠɧɨɫɬɶɮɚɦɢɥɢɹɢɦɹɩɨɞɩɢɫɶ
163UHGDWPăUIXULOHDFWLYHOHLQWHUPHGLDUXO
(transportatorul)::
ɋɞɚɥɬɨɜɚɪɵɚɤɬɢɜɵɩɨɫɪɟɞɧɢɤɩɟɪɟɜɨɡɱɢɤ

)XQFĠLDQXPHOHSUHQXPHOHVHPQăWXUD \ Ⱦɨɥɠɧɨɫɬɶɮɚɦɢɥɢɹɢɦɹɩɨɞɩɢɫɶ
3ULPLWPăUIXULOHDFWLYHOHVHUYLFLLOH 9DOLGăQXPDLFXVHPQăWXULOHRORJUDIHDOH&XPSăUăWRUXOXL
FXPSăUăWRUXOEHQHILFLDUXO \Ⱦɟɣɫɬɜɢɬɟɥɶɧɚɬɨɥɶɤɨɩɪɢɧɚɥɢɱɢɢɝɨɥɨɝɪɚɮɢɱɟɫɤɢɯɩɨɞɩɢɫɟɣ
ɉɪɢɧɹɥɬɨɜɚɪɵɚɤɬɢɜɵɭɫɥɭɝɢ ɉɨɤɭɩɚɬɟɥɹ
ɩɨɤɭɩɚɬɟɥɶɩɨɥɭɱɚɬɟɥɶ
)XQFĠLDQXPHOHSUHQXPHOHVHPQăWXUD\ Ⱦɨɥɠɧɨɫɬɶɮɚɦɢɥɢɹɢɦɹɩɨɞɩɢɫɶ

Pagina 1 din 2
)$&785Ă),6&$/Ă Seria, Nr.
ɇȺɅɈȽɈȼȺəɇȺɄɅȺȾɇȺə ɋɟɪɢɹʋ EAA004794579

187LPSXOGHVWDĠLRQDUHDPLMORFXOXLGHWUDQVSRUW 195XWDúLGLVWDQĠDGHWUDQVSRUWNP
ȼɪɟɦɹɩɪɨɫɬɨɹɬɪɚɧɫɩɨɪɬɧɨɝɨɫɪɟɞɫɬɜɚ Ɇɚɪɲɪɭɬɞɜɢɠɟɧɢɹɢɪɚɫɫɬɨɹɧɢɟɩɟɪɟɜɨɡɤɢɤɦ

2SHUDĠLD Ziua, luna, ora, minutele la 6HPQăWXUD

Ɉɩɟɪɚɰɢɹ Ⱦɟɧɶɦɟɫɹɰɱɚɫɦɢɧɭɬɵ ɉɨɞɩɢɫɶ

Sosire Plecare 6WDĠLRQDUH

ɉɪɢɛɵɬɢɹ ɍɛɵɬɢɹ ɉɪɨɫɬɨɹ
ÌQFăUFDUH
ɉɨɝɪɭɡɤɚ
'HVFăUFDUH
Ɋɚɡɝɪɭɡɤɚ
)RUPDGHSODWă
ȼɢɞɨɩɥɚɬɵ
0HQĠLXQL

Ɉɬɦɟɬɤɢ

&DOFXOXOSUHVWDĠLLORUGHWUDQVSRUW
Ɋɚɫɱɟɬɬɪɚɧɫɩɨɪɬɧɵɯɭɫɥɭɝ

Pagina 2 din 2