Cccccccccc document de identitate seria ccc nr. cccccc emis de la data domiciliat in localitatea Str. , nr. , bl. , sc , ap. judetul avand calitatea de : c Pensionar cu nr. dosar cccccc c DL 118/1990 c Veteran de razboi si pensionari IOVR c Persoane care lucreaza in mediu c Asigurat in sist. asig. sociale in una din formele prevazute la Art. 5.

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  1. Press the ‘Get Form’ button to access the form and open it for editing.
  2. Begin by filling in your personal details. In the first section, write your full name and personal identification number within the designated fields. Ensure that this information is accurate as it will be used for verification.
  3. Next, provide details from your identity document including the series and number of the document, as well as the issuing authority and date of issuance.
  4. Indicate your residency information. Fill in your address details including street name, number, block, staircase, and apartment number, along with the county.
  5. Select your status from the provided options. This includes categories such as pensioner, war veteran, or insured individual in the social insurance system. Make sure to tick the appropriate box.
  6. State your request for the treatment ticket by naming the desired health resort and the type of treatment you are applying for. Include the period in which you would like to receive treatment.
  7. Declare whether you have already benefited from a treatment ticket during the current year. This could be done with a simple check box.
  8. Once you have completed all sections, review the information to ensure its accuracy. This step is crucial to avoid any processing delays.
  9. Finalize your submission by saving your changes. You will have the option to download, print, or share the completed form as needed.

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