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                              DOMNULE PRESEDINTE,
   Subsemnatul ……………… (numele si prenumele partii care cere amanarea judecatii) reclamant (sau dupa caz – parat, recurent, intimat, contestator etc.) in cauza ce formeaza obiectul dosarului nr. ………….., va rog sa dispuneti, la termenul de ……………, amanarea judecarii acelei cauze, intrucat sunt internat in spital, dupa cum rezulta din certificatul anexat iar aparator nu am.
 Semnatura petititorului,
 ……………………
   DOMNULUI PRESEDINTE AL ………………………..

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