ODOBRITEV IZPLAČILA - IZPOLNI JSKD
								Znesek: 				

Datum: 								Podpis: 					

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ZAHTEVEK ZA IZPLAČILO – za leto 2011 

1. Št. pogodbe:												

2. Vlagatelj zahtevka (= investitor): 

Davčna številka vlagatelja:					__________________________________

Številka transakcijskega računa									 _____  , 

odprt pri 												

3. Kontaktna oseba vlagatelja zahtevka: 				___ , tel.: 			 	 ,

    elektronski naslov: ______________________________@_______________________________________

4. Obračun stroškov

Delež sredstev JSKD											

SKUPAJ (= vsota predloženih računov)								

5. Priloge
- fotokopije računov
s pripisom: 1. »KOPIJA JE ENAKA IZVIRNIKU«, 2. »DELA SO IZVRŠENA« 
(seznam)
	Izdajatelj računa								znesek

1. 													

2.													

3.													

4.													

5.													

6.													

7.													

								SKUPAJ				

Vse priložene fotokopije računov so izvirno žigosane in podpisane.

Datum in kraj:					žig					Podpis

6. Vsebinsko poročilo – lahko tudi kot samostojna priloga:

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Datum in kraj:					žig					Podpis
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