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                                    CERERE,
   Agentul economic …………………, cu sediul in …………………., str. …………………….., nr. ……, inregistrat in registrul comertului la nr. …………, codul/fiscal ……………… telefon ………, fax ……., telex ……….., reprezentat prin ……………………, domiciliat in ……………., str. …………………… nr. ……, bl. ……, sc. ….., et. …., ap. …., sectorul ……., judetul …………, posesorul buletinului/cartii de identitate seria ………., nr. ………… eliberata de ………., avand functia de ………………………, pe baza pieselor anexate la dosar, solicit eliberarea/autorizatiei de comercializare pentru:
   1. ………………………………………………..
   2. ………………………………………………..
   3. ………………………………………………..
   Data ………………………
 ………….
 (semnatura)
   Domnului/Doamnei director general al Directiei generale ………………..

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