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Preenchimento obrigatrio)#PUBLICO1.1 - Identificao do EmpregadorPARA USO DA CAIXARazo social/nomeCNPJ/CEI do empregadorTomador de Servios (CNPJ/CEI)Protocolo de Recepo e Assinatura, sob carimbo,  FORMTEXT       FORMTEXT       FORMTEXT       do responsvel pela conferncia.FPASSimplesBase da ContaEndereo eletrnico (e-m@il)DDD/telefone  FORMTEXT     FORMTEXT    FORMTEXT    FORMTEXT      ( FORMTEXT    )  FORMTEXT      1.2 - Identificao do TrabalhadorNome do trabalhadorN do PIS/PASEPData de admissoCategoriaData de Nascimento FORMTEXT       FORMTEXT       FORMTEXT    /  FORMTEXT    /  FORMTEXT      FORMTEXT    FORMTEXT    /  FORMTEXT    /  FORMTEXT     Data de Opo*CTPS (n/srie)Data de Movimentao/CdigoAviso PrvioDissdio/Acordo Data de Homologao FORMTEXT    /  FORMTEXT    /  FORMTEXT      FORMTEXT       /  FORMTEXT       FORMTEXT    /  FORMTEXT    /  FORMTEXT      FORMTEXT    FORMTEXT   1 - Trabalhado3 - Ausncia/ Dispensa FORMTEXT    /  FORMTEXT    /  FORMTEXT     *Obrigatrio para admisso anterior a 05/10/19882 - 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FORMTEXT    /  FORMTEXT    /  FORMTEXT      FORMTEXT    FORMTEXT   FORMTEXT    /  FORMTEXT    /  FORMTEXT     2.3 - Informao de remunerao/valor base para clculo do recolhimento rescisrioMs anterior rescisoMs de rescisoAviso prvio indenizadoValor base para fins rescisrios-Multa rescisriaValor total recolhido O valor lanado no campo VALOR TOTAL RECOLHIDO  FORMTEXT      , FORMTEXT    FORMTEXT      , FORMTEXT    FORMTEXT      , FORMTEXT    FORMTEXT      , FORMTEXT    FORMTEXT      , FORMTEXT   Estou ciente de que se verificada, a qualquer tempo, a falsidade das informaes constantes desse documento, sujeitar-se- o responsvel s penalidades previstas na legislao civil e penal, sem prejuzo das aes administrativas cabveis.  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