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İDARİ PARA CEZASINA İTİRAZ DİLEKÇESİ
T.C. Sosyal Güvenlik Kurumu
SGK provincial directorate / centre Müdürlüğüne
İtiraz eden: Employer name
İşyeri sicil no: Workplace registration number
Vergi kimlik no: Tax ID number
Adres: Address
İtiraz edilen ceza: Date and number of the penalty notice tarih ve sayılı yazı ile uygulanan Penalty amount (TRY) TL idari para cezası
Tebliğ tarihi: Notification date
Açıklamalar
Grounds for objection (facts and basis)
Sonuç ve istem
Yukarıda açıklanan nedenlerle, 5510 sayılı Kanun'un 102. maddesi uyarınca süresi içinde yaptığım itirazımın kabulü ile idari para cezasının iptalini talep ederim.
Ekler
List of attachments
Tarih: Date
Yetkili: Employer signatory
İmza / kaşe:
OBJECTION TO AN ADMINISTRATIVE FINE
Social Security Institution
To the SGK provincial directorate / centre
Objecting party: Employer name
Workplace registration no: Workplace registration number
Tax ID: Tax ID number
Address: Address
Fine objected to: administrative fine of TRY Penalty amount (TRY) imposed by letter dated and numbered Date and number of the penalty notice
Notification date: Notification date
Explanation
Grounds for objection (facts and basis)
Conclusion and request
For the reasons above, I request that my objection, made in time under article 102 of Law No. 5510, be accepted and the administrative fine cancelled.
Annexes
List of attachments
Date: Date
Authorised person: Employer signatory
Signature / stamp: