7/24/2019 Declaratia 4BASS1 Tab 1si 2

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Primit ________ Anexa nr.1 la Ordinul CNAS nr. 102-A

(data) 1 10

FORMA 4

tampila CTAS

Declaraie

privind calcularea i utilizarea contribu iilor de asigurri sociale de stat obligatorii

pentru perioada

_____________________________________________________________________________________(denumirea complet a pltitorului)

( )

_______________________________________________________________________________________________________________________

(adresa juridic)

( )

Codul fiscal________________________________________________________________________________________

!Nr. nregistrrii la CNAS_____________________________________________________________________________"# $ %

Codul statistic al localitii confor! C"A#$_______________________________________________________________

& ! $ " 'A()

%ru&a acti'itii &rinci&ale confor! CA($________________________________________________________________

* %" %! !+ " ,

!abelul nr" #" $alcularea contribuiilor de asigurri sociale de stat obligatorii

/# 1. & %% +" "!%" #" %+

1 2 3 4 5 6 !

1#1 112 01 $

1#2 112 01 $

$ $ $ $ $

1#2% 112 #1 $ $ & $

1#2' 112 #1 $ $ & $

1#3 112 01 $

1#4 112 01 & $

1# 112 02 & &

1#6 112 02 $ $ &

1# $ $

#i&ul declaraiei )*ifai+/ !# iniial ,%&+ corectat, 45+

Codrnd

Tariful contribuiilor

Numrul persoanelorasigurate conform

categoriilor de pltitori(!"#$)

% &

'

()

Baza de calcul acontribuiilor

corespunztortarifelor

* + &

,,,

Suma calculat- ,

de angajator(./0$1 "$2324234236 7

89":;< ./0$= "$23= > 89":; )

? +

($1$23242342367 89":;