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   Nr. ……… din ……..
 CERERE
 pentru acordarea licentei de fabricatie
   Agentul economic …………….., cu sediul in …………………….. ……………., str. ……………… nr. ……, inregistrat la Registrul comertului sub nr. ………….., cod fiscal ………………………….. telefon …….., fax……., telex ………, reprezentat prin ………….. domiciliat in …………, str. ………… nr. …., bl. ….., sc. ……, et. …, ap. …, sectorul ….., judetul …….., posesor al buletinului de identitate seria ……….. nr. ….., eliberat de ……….., avand functia de …………, pe baza pieselor anexate la dosar solicit eliberarea licentei de fabricatie pentru unitatea de productie cu sediul in …………….., str. ………… nr. ……., sectorul/judetul ……………, in vederea fabricarii urmatoarelor produse alimentare/prestari de servicii, in domeniul:
   1. ………………………………………………………………
   2. ………………………………………………………………
   3. ………………………………………………………………
   4. ……………………………………………………………… ……………………………………………………………………
   Data …………..
 Semnatura
 ……………
   Domnului director general al Directiei generale pentru agricultura si alimentatie a ……………………….

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