DATA DA ENTREVISTA _______/_______/_______ RESPONSVEL ____________________________ I - QUALIFICAO DO RECLAMANTE Nome____________________________________________________________________ Nacionalidade ____________________ Estado civil _____________________________ Profisso __________________________ Data de nascimento ______/_______/______ RG n_______________________ CTPS n ________________ - srie ______________ CPF n ________________________________ PIS n ____________________________ Telefone ____________________________________ Celular _____________________ Telefone p/ contato __________________________________ Residente na ______________________________________________________________ ______________________________________________, CEP. ______________________ Filiao Me _____________________________________________________________ Pai ______________________________________________________________ Cnjuge Nome ___________________________________________________________ RG n ________________________ CPF n ___________________________ Data de nascimento _____/_____/______ Regime de Casamento _________________________________________ II - QUALIFICAO DA RECLAMADA Razo social ______________________________________________________________ __________________________________________________________________________ na pessoa do scio _________________________________________________________ CNPJ /CPF n _____________________________________________________________ Endereo___________________________________________________________________________________________________- Cep______________Tel_________________ III - TOMADOR DE SERVIO responsabilidade subsidiria Havia empreiteira ou tomador de servio _____________________________________ Se houver, qual a razo social _______________________________________________ Endereo _________________________________________________________________