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V. ACTIVE FINAN ClARE

l.COntmi si depozite bancare, fonduri de investitii, forme echivalente de economisire si investire,daca valoarea insumata a tuturor acestora depaseste 5.000 EuroNota.. se vor declara inclusiv cele ajlate in banci sau institutiijinanciare din strainatate

*Categoriile indicate soot: (1) Cont curent sau echivalente ( inclusiv card); (2) Depozit bancar sauechivalente; (3) Fonduri de investitii sau echivalente, inclusiv fonduri private de pensii sau alte sisteme cuacumulare

2. Plasamente, investitii directe si imprumuturi acordate, daca valoarea de piata insumata a tuturoracestora depaseste 5.000 Euro-.-----

*Categoriile indicate sunt : (l) Hartii de valoare detinute ( titlun' de stat, certificate, obligatiuni) ; (2) Actiuni sauparti sociale in societati comerciale (3) Imprumuturi acordate in nume personal3. Alte active producatoare de venituri nete, care insumate depasesc echivalentul a 5.000 Euro pe an :Nota: se vor declara inclusiv cele aflate in strainatate.

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V. DATORII

Debite ( inclusiv taxe neachitate), ipoteci, garantii emise in beneficiul unui tel"t, bunuri achizitionate insistem leasing si alte asemenea bunuri, daca valoarea insumata a tututror acestora depaseste 5.000Euro.

,Nota: se vor dec!ara inclusiv pasivele financiare acumulate in strainatateHHHH HHUHHHHHHHH,H"UUUUU'U'HHHHHHHHHHHHHHHHH'HH,HH.,,~ ~VI. Cadoul"i, selvicii sau avantaje primite gratuit sau subventionate fata de valoarea de piata, dinpartea unor pel"soane, organizatii, societati comerciale, regii autonome, companii / societati nationalesau institutii publice romanesti sau straine, inclusiv burse, credite, garantii, decontari de cheltuieli saualte asemenea, a cal"or valoare individuala de aseste 300 Euro*CINEA REALIZAT SURSAVENITULUI: SEVICIULPRESTAT/

NUME, OBIECTULVENIT ANUAL INCASAT

*Se excepteaza de la declarare cadourile si tratatiile uzuale primite din partea rudelor de gradul I si ILVII. Venituri ale declarantului si ale membrilor sai de familie, realizate in ultimul an fiscal incheiat(ptrivit art.41 din Legea nr. 571/2003 - Codul fiscal, cu modificarile si completarile ultel"ioare)ota : se vor declara inclusiv veniturile provenite din strainatate

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copilul), iar in cazul bunurilor proprii in coproprietate, cota-parte si numele coproprietarilor.Prezenta declaratie constituie act public si raspund, potrivit legii penale, pentru inexactitatea sau caracter

incomplet al atelor mentionate.Data completarii :

,8. <)3. rw08sernnatu~ 3

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