(logo)

S.C. ......................................... S.R.L.

Chamber of Commerce: J......./......./............
Fiscal identification code: ....................
VAT code: RO..................

Headquarter: Country: România, County: ......, City/Village: ......, Street: .........., Number: ..........., Postcode: .............
Office & warehouse: Country: România, County: .........., City/Village: ............., Street: ..........., Number: ........., Postcode: .............
....................@..........................ro

Document number: …………….. / Date: ………………

Written statement concerning transport of goods from another member country

Acquirer/buyer of goods:
S.C. ......................................... S.R.L.
Chamber of Commerce: J......./......./............
Fiscal identification code: ....................
VAT code: RO..................
Headquarter: Country: România, County: ......, City/Village: ......, Street: .........., Number: ...........,
Postcode: .............
Office & warehouse: Country: România, County: .........., City/Village: ............., Street: ...........,
Number: ........., Postcode: .............

Supplier of goods: .......................................................

the goods have been dispatched or transported

 by the acquirer:
 by a third party on behalf of the acquirer:
common carrier: ..........................
truck identification number: ...................
international waybill (CMR): ........................

Member State of destination of the goods/place of destination: Country: România, County: ..........,
City/Village: ............., Street: ..........., Number: .........

date of issue / number and date of Invoice for delivered goods: .................... / ......................

quantity and nature of the goods: ..........................

date and place of the arrival of the goods: .......................

Underigned buyer, ......................... S.R.L., we declare that we are prepared to intercede any information
concering place of destination stated in this document, to (suppliers country name) tax authority.

Business Manager & Administrator

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