………………………………………………………………………………………………………………………………………………………

(full name of the unit)

U.R.C. ……………………………………………………………………………………………………………………………………………… Registration no. ............................
No. of order in the Trade Register J ……………… /……………………… /……………………………………………………
No. of registration in other evidences (Unique register of medical offices / Bar / Court of Appeal) ……… Date of issue ………………………
Unit type: State capital Private equity Mixed capital
No. of employees: ………………………
Phone ………………………………………………………………… Fax ………………………………………………………………………
Contact: ………………………………………… Position of the contact person: ………………………………….

INCOME STATEMENT

The Subscribed ........................................................................... (hereinafter referred to as the Company), with its registered office in .....................,
str.............................................................., nr. .........., bl. .........., sc. ........, et. ......., ap. ......, county/sector ...................................., legally represented
by Mr / Ms .............................................................................................., as .................................................., we hereby confirm that Mr. / Mrs.
.............................................................................................., PNC .................................................. is the employee of our unit for a period:
undetermined starting with the date of ................................,
determined from the date of .......................... until the .......................... .
Other information about the employee:
Current position (according to the COR): .......................................... .
Last graduated school: general school high school (incl. vocational school/10 classes) high school / university college
faculty master.
V Continuous length of service at the previous work place (according to the records in the Work Book) is: ....... years and ...... months.
Period of interruption (according to the records in the Work Book) between the current and the previous workplace is: ......calendar days and
...... months and ...... years. Total work seniority so far (according to the records in the Work Book) is: ...... years and ...... months.
Information on the salary income made during the last three months before issuing the certificate:
* For example: seniority raise, management incentives, fidelity incentives, stress incentives, etc.
We declare that these are the last net monthly wages of our employee, without including occasional bonuses and / or premiums or other
amounts
Month Employment salary Permanent bonuses, including meal Net salary
(gross basic salary without bonuses vouchers * (the net salary related to the
according to the Labor Book / Individual (the percentage and type of increase applied to the employment salary and the
Employment Contract / General Register employment salary) permanent bonuses)
of Employees Record)
1.

2.

3.

Additional, that do not have a permanent character.

Salary charged by monthly retainers: YES NO
The monthly amount of the withholdings is ............ RON, the reason for the withholdings is: …... (MAF, alimony, installments, attachments, other legal withholdings).
Salary payment is made: monthly, on the ........ of the month
bi-monthly, on the date of ....... of the month advance and on the date of ........ of the month liquidation.
We agree and oblige that in case of non-payment of the debts related to the loan, without other formalities, at the request of LIBRA INTERNET BANK SA, to withhold from
the income of our employee the debts related to the credit granted by LIBRA INTERNET BANK SA, starting with the first salary after the request made by the bank.

We also oblige you to inform Libra Internet Bank SA in case of any change in the employment contract of our employee.

We take full responsibility for the data mentioned in this document and confirm that the signatory persons of this certificate undertake our responsibility regarding the
reality of the information contained herein.

We mention that:
Company is / is not in the procedure provided by Law no. 85/2014 regarding the insolvency prevention and insolvency procedures or by the previous
similar law.

POSITION ** ………………………………….......... POSITION ** …………………………………................

……………………………………………….............. ………………………………………………....................
(last name, first name, signature ) (last name, first name, signature )
(stamp of the company)
**Function in clear, clear name and signature. Persons authorized for the first signature: Administrator / General Manager. Persons authorized for the second signature: Financial Director / Economic Director /
Accountant / Human Resources Officer. In the case of signing with the bar for another person, the name in clear and the function of the person who signed will be mentioned.
Exceptions from the previous signing rules are: educational institutions, public health institutions, banks, autonomous authorities, local public institutions, military and police units, in which case the income certificates
can be signed by persons who perform specific functions according to the activity. the respective institution (rector, dean, commander, etc.); the supermarket chains (Metro, Carrefour, Praktiker, Selgros, XXL,
Bricostore, etc.) and the territorial units (branches, work points, secondary offices, etc.) of the employers, in which case the income certificates can be signed by persons who perform functions of management in
the respective unit; the individual medical offices, the law offices, the public notary offices, where the first signature will be necessarily that of the titular doctor / the titular lawyer / the notary holder
Note: The certificate is valid for 30 calendar days from the date of issue.
ATTENTION! If the issuing unit does not wish to commit itself, it will bar or deny the paragraphs regarding the obligation to set up a confession and / or to announce the creditor in certain situations, it will also
sign and stamp, without making another note.
If, on the income statement, additions / deletions / modifications / cuts / thickens / corrective paste appear, these must be accompanied by the signature and stamp of the issuing unit. No additions
/ deletions / modifications / cuts / cuts / thickening / corrective paste will be accepted.