ࡱ>  1  0 !"#$%&()*+,-./3456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry Y @ITEM000  FY Y1Table'%CompObjq՜.+,0 hp|  F '  ANEXĂ Title  FMicrosoft Office Word Document MSWordDocWord.Document.89q%F\Object F4rMicrosoft Office Word DocumentC:\Documents and Settings\danielacordea\Desktop\legis\O43_2016.RTF#3Rich Text FormatWordDocument7"SummaryInformation( DocumentSummaryInformation8Ole 5Oh+'0  4 @ L Xdlt| ANEXĂdanielacordea Normal.dotdanielacordea2Microsoft Office Word@@t~Y@`9Y@`9Yb'` j!bjbjLULU 7".?.?J (@ @ @ @ L ! ,d d d d d d d d  $M hp -d d d d d d d T T T d d d T d T T T d X Y@ T 0! T % .%T %T 4d d T d d d d d J d d d ! d d d d d@ @ $  ANEX (Anexa nr. 19 la norme) ANGAJATOR ................................... Nr. de nregistrare ............ data .............. ADEVERINb Prin prezenta se certific c domnul/doamna ..............................................................., CNP ................................................, act de identitate ............., seria ............. nr. .............., eliberat de ................................. la data de ............................., cu domiciliul n ........................................, str. ....................... nr. ...., bl. ...., ap. ...., sectorul/judecul ......................., are calitate de persoan asigurat pentru concedii _i indemnizacii de asigurri sociale de sntate n sistemul de asigurri sociale de sntate, potrivit Ordonancei de urgenc a Guvernului nr. 158/2005 privind concediile _i indemnizaciile de asigurri sociale de sntate, aprobat cu modificri _i completri prin Legea nr. 399/2006, cu modificrile _i completrile ulterioare. Prezenta adeverinc are o perioad de valabilitate de 30 de zile de la data emiterii. 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Numrul de zile de concediu medical de care persoana asigurat a beneficiat n ultimele 12 luni este de ........... zile, pn la data de .......... aferente fiecrei afecciuni n parte, dup cum urmeaz: ____________________________________________________________________ | Cod de indemnizacie | Numr zile concediu medical | | | n ultimele 12 luni | |______________________________________|_____________________________| | | | |______________________________________|_____________________________| | | | |______________________________________|_____________________________| | | | |______________________________________|_____________________________| Reprezentant legal angajator ...................................................................................... 50P:pbc/ =!"#$% @@@ NormalCJ_HaJmHsHtHDAD Default Paragraph FontRiR  Table Normal4 l4a (k(No List HH T Balloon TextCJOJQJ^JaJJ " zJ &'5]; #j?[I L $$$$$$$$$ $$$$$.j$.j$.j$.j$.j$.j$.j$.j$.j$.j$$$$ &'5]; #j?[I L 0@0@00@0@0@00@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00@0@0j! j! j!  %+4a;? -jL  %+49\a:? 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T@@N3@R@~LOH..............................................................., CNP ................................................, act de &NTA&&44!%;3 TNI3@R@.sLO4identitate ............., seria ............. nr. .............., eliberat de ................................. la !;3:! !3!4--.4'!4--;'--4!!:4'3!-;4--!4 T|L3@R@LO\data de ;4 4f;4gTLN3@R@_LO ............................., cu domiciliul n ........................................, str. &" WMFC 6vg4;g:;Y!4 ! ; g :gg.!' :Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w[= 0< dv%  TNU3@R@:pLO,....................... nr. ...., bl. ...., ap. ...., sectorul/judecul ......................., are calitate de %;'%%;!%%4;%%.44!;&; ! :;3!:!%%4'4%44!!!3!4$:3 % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w`= 0< dv%  TtY5 3@R@1LOpersoan asigurat pentru concedii _i indemnizaci;4&.;3;4(3-!:;'3!4':4; ';(3:;43; !(-!( ::5Y;!43!  % ( 6 Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wc= 0< dv%  T 6 YN3@R@6 #LOi de asigurri sociale de sntate !(:4(4- ;;&4&!(-;3!4 4(;4'.3;4 4!3 % (  GRp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wf= 0< dv%  T(Nb3@R@GOLOn sistemul de asigurri sociale de sntate, potrivit Ordonancei de urgenc a !;?-!-!4Y;!@;3@4- :;'4&!@-;3!3!4?;4?.3:4!3!4@::!' :!!@T&:;:4; 4!?;4?;&;3; 4@3 % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wj= 0< dv%  TLeN3@R@ULOGuvernului nr. 158/2005 privind concediile _i indemnizaciile de asigurri sociale de T;;4&:; :!;';:; :;:;;&!: ;:4:;34:! 4-!!:;4Y;!43! ! 4;34-!:;'3'!-;4 4 4:3 % (  S Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wn= 0< dv%  T n 3@R@S 9LOsntate, aprobat cu modificri _i completri prin Legea.4:4!3!4L3;&;:4!4K3;LY;;!' 44&!L-!L3:Y;!4!4'!K;&!;LG3;43 % ( T Nn 3@R@ S LOp nr. 399/2006, cu L;'L:;: ;::;L4:  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wr= 0< dv%  T<q  3@R@ (LOmodificrile _i completrile ulterioare.Y;;!'!44& !4-!3;Y;!4!4&! 4:!!3' ;4'4 % ( TTq 7 3@R@ LOP 4 _ Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w4v= 0< dv%  T, Nz 3@R@_ PLO Prezenta adeverinc are o perioad de valabilitate de 30 de zile de la data A'444; 4=3;3;4&!: 4=4'4<;<;4&!:4;3=;3=;3!3; ! !3!4<;4<;:<;4=3! 4<;4<!4<;4 3 % (  T~  3@R@ LO`emiterii.5Y!!4&&" WMFC v!!TT~  3@R@ LOP 4 l Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wt@ 0< dv%  T8 N 3@R@l RLO Sub sancciunile aplicate faptei de fals n acte publice, declar c datele din A;;=.4:4 !::! 4>3; !43!4>&4:!3!=;4>'3 .> ;>34!3>::; !44=:44!4&>44=;3!4 4=; : % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$wt@ 0< dv%  T$  3@R@ $LOadeverinc sunt corecte _i complete.4;3;4&!:!4.:;!4;&43!4-!3;Y;!4!4 % ( TT  3@R@ LOP 4 x Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w@ 0< dv%  T@ N 3@R@x SLO Numrul de zile de concediu medical de care persoana asigurat a beneficiat n T<Y4';!':4'3!!4&:4'4:;43:!;'Y4;!43!&:4'44'4&;4&-;4:4'3. :;'3!4'4&;3;4&!3!4 ' : % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w@ 0< dv%  T  3@R@ 6LOultimele 12 luni este de ........... zile, pn la dat; !!Y4!4=;;= ;:!>3- 4>;3>>4!!4>:4;4=!4=;3! % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w@ 0< dv%  T N 3@R@ "LOa de .......... aferente fiecrei 4=;4>>4'4'4:!4>&!434'3  % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL w0< ؏^Zw؏p$w@ 0< dv%  T,  3@R@ %LOafecciuni n parte, dup cum urmeaz:4'44 ;:! ;:4' 4::;43;Y;(Y4444! % ( TT  3@R@ LOP 5 Rp@1Courier New?5 z Courie Newv50Ln0dv% T 3@R@ ELO ____________________________________________________________________777777777777777777777777777777777777777777777777777777777777777777777TT 3@R@ LOP 7 VRp@1Courier New?5 @w/ !t"Courie Nep'/ ! @wl 3w0< ؏^Zw؏p$w@ 0< dv%  T  n3@R@VFLO| Cod de indemnizacie | Numr zile concediu medical |7777777777777777777777777777777777777777777777777777777777777777777777 % ( TT  @n3@R@ VLOP 7 TPt< 3@R@+LO| | n7777777777777777777777777777777777777777777T= t 3@R@= LO ultimele 12 luni |777777777777777777777777777TT t@3@R@ 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LOd___________|777777777777% TT ->3@R@ LOP 5 TT443@R@LOP 5 T73@R@4LO Reprezentant legal angajatoN4;'444:!3;!!4:4!3:;4 4 :TT73@R@LOPr'TT7D3@R@LOP 5 T @3@R@%oLO, ......................................................................................TT  @3@R@ %LOP 6 TTC43@R@LOP 5%   ."System-@Times New Roman- @Times New Roman-.2   ANEX.- 2 d -2 . @Times New Roman-.2 .(Anexa nr. 19 la norme)       - 2 .  2 G 2 a  ANGAJAT  2 a|OR 2 a F2 z' ................................... 2 z _2 8 Nr. de nregistrare ............ data ..............         2 ~  2  -/2  42  e 2  @Times New Roman- @Times New Roman-.2  ADEVERIN .-- 2   2  @Times New Roman-.I2 ) Prin prezenta se certific c domnul/  G   G G  G G  .-2 doamna  2 ~..............................................................., CNP ................................................, act de    2 -sidentitate ............., seria ............. nr. .............., eliberat de ................................. la              2 Gdata de   2 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)}}{\*\pnseclvl7 \pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar \qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid12542818 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1048\langfe1048\cgrid\langnp1048\langfenp1048 {\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \f37\fs28\insrsid12542818 ANEX\'c3 \par }{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 }{\rtlch\fcs1 \ai\af0\afs28 \ltrch\fcs0 \i\fs28\insrsid12542818 (Anexa nr. 19 la norme)}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 \par \par ANGAJAT}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid15079208 OR}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 \par ................................... \par Nr. de \'eenregistrare ............ data .............. \par \par }{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid15079208 }{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 }{\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0 \b\f37\fs28\insrsid12542818 ADEVERIN\'de\'c3 }{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 \par \par }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \f37\fs28\insrsid12542818 Prin prezenta se certific\'e3 c\'e3 domn}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 ul/doamna ..............................................................., CNP ................................................, act de identitate ............., seria ............. nr. .............., eliberat de ................................. la data }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \f37\fs28\insrsid12542818 de ............................., cu domiciliul \'een ........................................, str. ....................... nr. ...., bl. ...., ap. ...., sectorul/jude\'fe ul ......................., are calitate de persoan\'e3 asigurat\'e3 pentru concedii \'bai indemniza\'feii de asigur\'e3ri sociale de s\'e3n\'e3tate \'een sistemul de asigur\'e3ri sociale de s\'e3n\'e3tate, potrivit Ordonan\'feei de urgen\'fe\'e3 a Guvernului nr. 158/2005 privind concediile \'bai indemniza\'feiile de asigur\'e3ri sociale de s\'e3n\'e3tate, aprobat\'e3 cu modific\'e3ri \'bai complet\'e3ri prin Legea nr. 399/2006, cu modific\'e3rile \'bai complet\'e3rile ulterioare. \par Prezenta adeverin\'fe\'e3 are o perioad\'e3 de valabilitate de 30 de zile de la data emiterii. \par Sub sanc\'feiunile aplicate faptei de fals \'een acte publice, declar c\'e3 datele din adeverin\'fe\'e3 sunt corecte \'bai complete. \par Num\'e3rul de zile de concediu medical de care persoana asigurat\'e3 a beneficiat \'een ultimele 12 luni este de ........... zile, p\'e2n\'e3 la data de .......... aferente fiec\'e3rei afec\'feiuni \'een parte, dup\'e3 cum urmeaz\'e3: \par }{\rtlch\fcs1 \af2\afs22 \ltrch\fcs0 \f2\fs22\insrsid12542818 ____________________________________________________________________ \par }{\rtlch\fcs1 \af57\afs22 \ltrch\fcs0 \f57\fs22\insrsid12542818 | Cod de indemniza\'feie | Num\'e3r zile concediu medical | \par }{\rtlch\fcs1 \af2\afs22 \ltrch\fcs0 \f2\fs22\insrsid12542818 | | \'een ultimele 12 luni | \par |______________________________________|_____________________________| \par | | | \par |______________________________________|_____________________________| \par | | | \par |______________________________________|_____________________________| \par | | | \par |______________________________________|_____________________________|}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 \par \par Reprezentant legal angajato}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid15079208 r}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid12542818 \par ...................................................................................... \par }} TL=3@R@LOMtdata de ...........;4 @S BR&" WMFC5 VvlN@S EMFv; .'   O%  Rp@Times New RomanGz Times ew Roman?s?sD0Ln0dv%  jRp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w<= 0< dv%  T 3@R@j LO` ANEXRTTHTT % ( TT A3@R@ jLOP A6 % Tds 3@R@LOT Rp@Times New Roman5 0\06 0Gz Times ew Roman4 0P030Ln0dv% Tt 3@R@tLO|(Anexa nr. 19 la norme)'G;44;:.:; ;;:.T4'% TT  3@R@LOP 4 TT43@R@wLOP 5 T3@R@ LOd ANGAJATTTUT.TGTX13@R@LOPORTNTT0e3@R@0LOP 6 T8p3@R@'LO ...................................TTq3@R@qLOP 6 T$3@R@ 8LO Nr. de nregistrare ............ data ..............T';4!;'3; -!'4'4;4!4TT $3@R@ LOP 5 TT'43@R@LOP 5 % T33@R@LO| T33@R@LO TT33@R@LOP Rp@Times New Roman5 0\06 0Gz Times ew Roman4 0P030Ln0dv% Rp@Times New Roman5 0\0 0G @w/ !xw"Times ew op'/ ! @w& 8w80< ^Zwp$wK= 0< dv%  T13@R@ LO`ADEVERINbTTNTOU.TNT % ( % TT2 33@R@LOP 5 TT443@R@LOP 5 "Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wN= 0< dv%  T0a =3@R@"&LO Prin prezenta se certific c domnA'!;v;'343:!4v.4v34' !'!34v43v;;Y; % ( Tb N=3@R@b " LO`ul/doamna ; !:;4Z;3 T@@N3@R@~LOH..............................................................., CNP ................................................, act de &NTA&&44!%;3 TNI3@R@.sLO4identitate ............., seria ............. nr. .............., eliberat de ................................. la !;3:! !3!4--.4'!4--;'--4!!:4'3!-;4--!4 TlL(3@R@LOXdata ;4 4fT)LN3@R@)bLOde ............................., cu domiciliul n ........................................, str. ;4g&" WMFC 6vg4;g:;Y!4 ! ; g :gg.!' :Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w[= 0< dv%  TNU3@R@:pLO,....................... nr. ...., bl. ...., ap. ...., sectorul/judecul ......................., are calitate de %;'%%;!%%4;%%.44!;&; ! :;3!:!%%4'4%44!!!3!4$:3 % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w`= 0< dv%  T`Y3@R@.LOpersoan asigurat pentru concedii _i indemniz;4&.;3;4(3-!:;'3!4':4; ';(3:;43; !(-!( ::5Y;!4 % ( Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wc= 0< dv%  T0YN3@R@&LOacii de asigurri sociale de sntate 3! !(:4(4- ;;&4&!(-;3!4 4(;4'.3;4 4!3 % (  GRp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wf= 0< dv%  T(Nb3@R@GOLOn sistemul de asigurri sociale de sntate, potrivit Ordonancei de urgenc a !;?-!-!4Y;!@;3@4- :;'4&!@-;3!3!4?;4?.3:4!3!4@::!' :!!@T&:;:4; 4!?;4?;&;3; 4@3 % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wj= 0< dv%  TLeN3@R@ULOGuvernului nr. 158/2005 privind concediile _i indemnizaciile de asigurri sociale de T;;4&:; :!;';:; :;:;;&!: ;:4:;34:! 4-!!:;4Y;!43! ! 4;34-!:;'3'!-;4 4 4:3 % (  S Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wn= 0< dv%  T n 3@R@S 6LOsntate, aprobat cu modificri _i completri prin Le.4:4!3!4L3;&;:4!4K3;LY;;!' 44&!L-!L3:Y;!4!4'!K;&!;LG3 % ( T Nn 3@R@ S LOxgea nr. 399/2006, cu ;43L;'L:;: ;::;L4:  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wr= 0< dv%  T<q  3@R@ (LOmodificrile _i completrile ulterioare.Y;;!'!44& !4-!3;Y;!4!4&! 4:!!3' ;4'4 % ( TTq 7 3@R@ LOP 4 _ Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w,v= 0< dv%  T, Nz 3@R@_ PLO Prezenta adeverinc are o perioad de valabilitate de 30 de zile de la data A'444; 4=3;3;4&!: 4=4'4<;<;4&!:4;3=;3=;3!3; ! !3!4<;4<;:<;4=3! 4<;4<!4<;4 3 % (  T~  3@R@ LO`emiterii.5Y!!4&!!&" WMFC vTT~  3@R@ LOP 4 l Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wl@ 0< dv%  T8 N 3@R@l RLO Sub sancciunile aplicate faptei de fals n acte publice, declar c datele din A;;=.4:4 !::! 4>3; !43!4>&4:!3!=;4>'3 .> ;>34!3>::; !44=:44!4&>44=;3!4 4=; : % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$wl@ 0< dv%  T$  3@R@ $LOadeverinc sunt corecte _i complete.4;3;4&!:!4.:;!4;&43!4-!3;Y;!4!4 % ( TT  3@R@ LOP 4 x Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w@ 0< dv%  T@ N 3@R@x SLO Numrul de zile de concediu medical de care persoana asigurat a beneficiat n T<Y4';!':4'3!!4&:4'4:;43:!;'Y4;!43!&:4'44'4&;4&-;4:4'3. :;'3!4'4&;3;4&!3!4 ' : % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w@ 0< dv%  T  3@R@ 6LOultimele 12 luni este de ........... zile, pn la dat; !!Y4!4=;;= ;:!>3- 4>;3>>4!!4>:4;4=!4=;3! % (  Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w@ 0< dv%  T N 3@R@ "LOa de .......... aferente fiecrei 4=;4>>4'4'4:!4>&!434'3  % (   Rp@Times New RomanG @w/ !E> Times ew op'/ ! @wL 8w80< ^Zwp$w@ 0< dv%  T,  3@R@ %LOafecciuni n parte, dup cum urmeaz:4'44 ;:! ;:4' 4::;43;Y;(Y4444! % ( TT  3@R@ LOP 5 Rp@1Courier New?5 z Courie Newv50Ln0dv% T 3@R@ ELO ____________________________________________________________________777777777777777777777777777777777777777777777777777777777777777777777TT 3@R@ LOP 7 VRp@1Courier New?5 @w/ !t"Courie Nep'/ ! @wl 38w80< ^Zwp$w@ 0< dv%  T  n3@R@VFLO| Cod de indemnizacie | Numr zile concediu medical |7777777777777777777777777777777777777777777777777777777777777777777777 % ( TT  @n3@R@ VLOP 7 TPt< 3@R@+LO| | n7777777777777777777777777777777777777777777T= t 3@R@= LO ultimele 12 luni |777777777777777777777777777TT t@3@R@ LOP 7 T >3@R@&FLO|_______________| &WMFCv_______________________|_____________________________|7777777777777777777777777777777777777777777777777777777777777777777777TT @>3@R@ &LOP 7 TD 3@R@FLO| | |7777777777777777777777777777777777777777777777777777777777777777777777TT D@3@R@ LOP 7 T 3@R@FLO|______________________________________|_____________________________|7777777777777777777777777777777777777777777777777777777777777777777777TT @3@R@ LOP 7 T8v3@R@^LOl| 777777777777777T9 v3@R@9^7LO | |7777777777777777777777777777777777777777777777777777777TT @v3@R@ ^LOP 7 T{ 3@R@FLO|______________________________________|_____________________________|7777777777777777777777777777777777777777777777777777777777777777777777TT {@3@R@ LOP 7 T E3@R@-FLO| | |7777777777777777777777777777777777777777777777777777777777777777777777TT @E3@R@ -LOP 7 % TKu 3@R@:LO|______________________________________|__________________7777777777777777777777777777777777777777777777777777777777Tv K 3@R@v  LOd___________|777777777777% TT ->3@R@ LOP 5 TT443@R@LOP 5 T73@R@4LO Reprezentant legal angajatoN4;'444:!3;!!4:4!3:;4 4 :TT73@R@LOPr'TT7D3@R@LOP 5 T @3@R@%oLO, ......................................................................................TT  @3@R@ %LOP 6 TTC43@R@LOP 5%   ."System-@Times New Roman- @Times New Roman-.2   ANEX.- 2 d -2 . @Times New Roman-.2 .(Anexa nr. 19 la norme)       - 2 .  2 G 2 a  ANGAJAT  2 a|OR 2 a F2 z' ................................... 2 z _2 8 Nr. de nregistrare ............ data ..............         2 ~  2  -/2  42   2  @Times New Roman- @Times New Roman-.2  ADEVERIN .-- 2   2  @Times New Roman-.D2 & Prin prezenta se certific c domn  G   G G  G G  .-2  ul/doamna   2 ~..............................................................., CNP ................................................, act de    2 -sidentitate ............., seria ............. nr. .............., eliberat de ................................. la              2 Gdata #  2 G8bde ............................., cu domiciliul n ........................................, str.       `@Times New Roman-.2 `p....................... nr. ...., bl. ...., ap. ...., sectorul/judeul ......................., are calitate de               .-z@Times New Roman-.P2 z.persoan asigurat pentru concedii i indemniz             .-z@Times New Roman-.D2 z&aii de asigurri sociale de sntate            .-@Times New Roman-.2 On sistemul de asigurri sociale de sntate, potrivit Ordonanei de urgen a                     .-@Times New Roman-.2 UGuvernului nr. 158/2005 privind concediile i indemnizaiile de asigurri sociale de                         .-@Times New Roman-.\2 6sntate, aprobat cu modificri i completri prin Le                .-+2 gea nr. 399/2006, cu     @Times New Roman-.G2 (modificrile i completrile ulterioare.             .- 2 U @Times New Roman-.2 P Prezenta adeverin are o perioad de valabilitate de 30 de zile de la data              .-2  emiterii.   2 K ,@Times New Roman-.2 ,R Sub sanciunile aplicate faptei de fals n acte publice, declar c datele din                    .-F@Times New Roman-.A2 F$adeverin sunt corecte i complete.            .- 2 F= _@Times New Roman-.2 _S Numrul de zile de concediu medical de care persoana asigurat a beneficiat n e                         .-y@Times New Roman-.\2 y6ultimele 12 luni este de ........... zile, pn la dat          .-y@Times New Roman-.>2 y"a de .......... aferente fiecrei       .-@Times New Roman-.C2 %afeciuni n parte, dup cum urmeaz:r          .- 2 O @1Courier New-s2 E ____________________________________________________________________| 2  @1Courier New-.t2 F| Cod de indemnizaie | Numr zile concediu medical | .- 2  L2 +| | nn 42  ultimele 12 luni | 2  t2 F|______________________________________|_____________________________| 2  t2 F| | | 2  t2 F|______________________________________|_____________________________| 2  "2 | ^2 7 | |. 2  t2 1F|______________________________________|_____________________________| 2 1 t2 EF| | | 2 E -b2 Y:|______________________________________|__________________ 2 Y_ ___________| - 2 Y  2 r Y2 4 Reprezentant legal angajato       2 r 2  2 o ......................................................................................  2 g  2  -NANIfic\'e3ri \'bai complet\'e3ri prin Legea nr. 399/2006, cu modific\'e3rile \'bai complet\'e3rile ulterioare. \par Prezenta adeverin\'fe\'e3 are o perioad\'e3 de valabilitate de 30 de zile de la data emiterii. \par Sub sanc\'feiunile aplicate faptei de fals \'een acte publice, declar c\'e3 datele din adevrecte \'bai complete.}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \fs28\insrsid7285163 \par }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \f37\fs28\insrsid7285163 Num\'e3rul de zile de concediu medical de care persoana asigurat\'e3 a beneficiat \'een ultimele 12 luni este de ........... zile, p\'e2n\'e3 la data de .......... aferente fiec\'e3 rei afec\'feiuni \'een parte, dup\'e3 cum urmeaz\'e3: \par }{\rtlch\fcs1 \af2\afs22 \ltrch\fcs0 \f2\fs22\insrsid7285163 __________________________________