Příloha č. 4
VÝKAZ PRO INTRASTAT JEDNORÁZOVÉ PŘIJETÍ
+----------------------------------------------------------------------------------------------------------------------------------+
| +--+--+--+--+--+--+ +--+--+ |
| Období (rrrrmm) | | | | | | | Počet řádků | | | |
| +--+--+--+--+--+--+ +--+--+ |
+---------------------------------------------------------------------+------------------------------------------------------------+
| Zpravodajská jednotka DIČ +-------------------------------+ | Třetí strana |
| Obchodní jméno nebo název | | | Obchodní jméno nebo název anebo |
| anebo příjmení, jméno a adresa +-------------------------------+ | příjmení, jméno a adresa |
| | |
| Kontaktní osoba | Kontaktní osoba |
| +------------------------+ +--------------------------+ | +------------------------+ +------------------+ |
| Tel. | | Fax | | | Tel. | | Fax | | |
| +------------------------+ +--------------------------+ | +------------------------+ +------------------+ |
| +--------------------------------------------------------+ | +------------------------------------------------+ |
| E-mail | | | E-mail | | |
| +--------------------------------------------------------+ | +------------------------------------------------+ |
+---------------------------------------------------------------------+------------------------------------------------------------+
Zvl. Trans- Stát Skup. Stát Druh Stat. Vlastní hmotnost Množství Fakturovaná
pohyb akce odesl. dod.p. původ dopr. Kód zboží znak v kg v doplňkové MJ hodnota v Kč
+------+-----+-----+-----+-------+-----+-----+-----------------------+-----+------------------+------------------+-----------------+
| čís. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| řád. | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 01 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 02 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 03 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 04 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 05 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 06 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 07 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 08 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 09 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 10 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 11 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 12 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 13 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 14 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
| 15 | | | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+--+--+-----+--+--+--+--+--+--+--+--+--+--+------------------+------------------+-----------------+
+--+--+--+--+--+--+--+--+
Příjmení a jméno: Datum (rrrrmmdd): | | | | | | | | | Podpis:
+--+--+--+--+--+--+--+--+
VÝKAZ PRO INTRASTAT JEDNORÁZOVÉ ODESLÁNÍ
+----------------------------------------------------------------------------------------------------------------------------------+
| +--+--+--+--+--+--+ +--+--+ |
| Období (rrrrmm) | | | | | | | Počet řádků | | | |
| +--+--+--+--+--+--+ +--+--+ |
+---------------------------------------------------------------------+------------------------------------------------------------+
| Zpravodajská jednotka DIČ +-------------------------------+ | Třetí strana |
| Obchodní jméno nebo název | | | Obchodní jméno nebo název anebo |
| anebo příjmení, jméno a adresa +-------------------------------+ | příjmení, jméno a adresa |
| | |
| Kontaktní osoba | Kontaktní osoba |
| +------------------------+ +--------------------------+ | +------------------------+ +------------------+ |
| Tel. | | Fax | | | Tel. | | Fax | | |
| +------------------------+ +--------------------------+ | +------------------------+ +------------------+ |
| +--------------------------------------------------------+ | +------------------------------------------------+ |
| E-mail | | | E-mail | | |
| +--------------------------------------------------------+ | +------------------------------------------------+ |
+---------------------------------------------------------------------+------------------------------------------------------------+
Zvl. Trans- Stát Skup. Druh Stat. Vlastní hmotnost Množství Fakturovaná
pohyb akce určení dod.p. dopr. Kód zboží znak v kg v doplňkové MJ hodnota v Kč
+------+-----+-----+-----+-------+-----+-----------------------+-----+--------------------+--------------------+-------------------+
| čís. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| řád. | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 01 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 02 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 03 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 04 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 05 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 06 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 07 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 08 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 09 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 10 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 11 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 12 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 13 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 14 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
| 15 | | | | | | | | | | | | | | | | | | | | | |
+------+--+--+--+--+--+--+-------+-----+--+--+--+--+--+--+--+--+--+--+--------------------+--------------------+-------------------+
+--+--+--+--+--+--+--+--+
Příjmení a jméno: Datum (rrrrmmdd): | | | | | | | | | Podpis:
+--+--+--+--+--+--+--+--+
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