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   Nr. …. din …..
 CERERE
 pentru acordarea licentei de import
   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 …………., posesorul buletinului de identitate seria ……. nr. ………, eliberat de ………….., avand functia de ……………., pe baza pieselor anexate la dosar, solicit eliberarea licentei de import pentru:
   1. ………………………
   2. ………………………
   3. ………………………
   Data …………
 Semnatura
 …………..
   Domnului director general al Directiei generale ……………..

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