ANEXO III
INSTRUÇÃO NORMATIVA Nº 77 /PRES/INSS, DE 21 DE JANEIRO DE 2015
FICHA DE CADASTRAMENTO
1. Identificação: _____________________________________________________________________________
Nome da Instituição/Grupo: __________________________________________________________________________________________________________________________________________________________
Endereço: __________________________________________________________________________________________________________________________________________________________
Bairro: _____________________________________________________________________________
Cidade: _______________________________________________________ Estado: _________
CEP: __________________________________ Telefone: ______________________________
Ônibus: _____________________________________________________________________________
Órgão Mantenedor: _____________________________________________________________________________
2. Finalidade da instituição/grupo: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Serviços prestados/atividades: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. Usuário: ____________________________________________________________________
Faixa etária: ___________________________________________________________________
Forma de pagamento: ____________________________________________________________
Horário de atendimento ao usuário: _________________________________________________
Área de abrangência: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Documentação exigida: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5. Outros dados complementares: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. Representante legal da instituição/grupo:
Nome: ________________________________________________________________________
Cargo: ________________________________________________________________________
7. Responsável pelas informações:
Nome: ________________________________________________________________________
Cargo: ________________________________________________________________________
Data: _____________________________
A nossa missão é lutar por essa causa lado a lado do advogado em busca de honrar os valores da advocacia, garantir os direitos fundamentais da sociedade e resgatar o verdadeiro status quo do operador do direito.
A nossa missão é lutar por essa causa lado a lado do advogado em busca de honrar os valores da advocacia, garantir os direitos fundamentais da sociedade e resgatar o verdadeiro status quo do operador do direito.
