Number:                                                                                                                    …/…./…….

Subject:

PROVINCIAL DIRECTORATE OF LABOUR AND EMPLOYMENT AGENCY

                                                                                                          ……………………….

……………… (which is being processed in the file numbered ……………… in your Directorate / at ……………. address, ……………….. with the title ………………..) ………………… (although we are not obliged we employ ……….. disabled – ………. ex-convict- …………. Victim of terrorism/on quota …………. Disabled-, …………. Ex-convicts-, ………….. victims of terrorism / ……… disabled with a disability rate of more than 80%), we request that the necessary action be taken to benefit from the relevant social insurance premium incentive.

Mailing Address and Phone                                                      Authorized Signatures

Annexes (evidencing the given information)