Travel Order no.

Mr. / Ms.

holding the position of

is delegated for

Travel period from la

Identification document

Organization signature and stamp Approval signature and stamp

Data

Travel confirmations

Sosit^*)

Plecat^*)

With (without) accommodation

Organization signature
and stamp

Sosit^*)

Plecat^*)

With (without) accommodation

Organization signature
and stamp

Sosit^*)

Plecat^*)

With (without) accommodation

Organization signature
and stamp

Sosit^*)

Plecat^*)

With (without) accommodation

Organization signature
and stamp

Departure date and time

Arrival date and time

Expense report submission date

Calculated penalties

Advance for expenses

Received at departure

Received during travel

TOTALlei

Expenses incurred conform documentelor anexate
Felul actului	Document no. and date	Suma (lei)

TOTAL EXPENSES lei

Refundable difference was deposited

with receipt no. dated

Difference of

received refunded

lei

Signature

Approved,
head of
unit

Preventive
financial
control

Expense report
checked

Department
head

Advance
holder