Declaratie,
Denumirea furnizorului..................................................................................................................................................................................................................................................................................................Sediul social / Adresa fiscala........................................................................................................................................................................................................................................................................................DeclaratieSubsemnatul (a), .............................................................................legitimate (a) cu B.I./C.I. seria ............, nr. ..............., cunoscand ca falsul in declaratii se pedepseste conform legii, declar pe propria raspundere ca de la data ultimei evaluari nu au intervenit modificari ale conditiilor care au stat la baza evaluarii, drept pentru care semnez si raspund.Data Reprezentant legal..................... (semnatura si stampila)................................................... ................
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