ANEXO I

ORIENTAO INTERNA N 151 INSS/DIRBEN, DE 16 DE NOVEMBRO DE 2006

FORMULRIO PARA INTERPOSIO DE RECURSO JUNTA DE RECURSO DA

PREVIDNCIA SOCIAL

RECURSO JUNTA DE RECURSO DA PREVIDNCIA SOCIAL DO CONSELHO DE

RECURSOS DA PREVIDNCIA SOCIAL

SEGURADO: ____________________________________________________________________
(NOME)
RECORRENTE: __________________________________________________________________
(NOME)
RECORRIDO INSS: _____________________________________________________________
(LOCALIDADE)
ENDEREO PARA CORRESPONDNCIA:
_________________________________________________________________________________
_________________________________________________________________________________
______________________________________________________________________________
(RUA, N, BAIRRO, CIDADE, MUNICPIO, ESTADO, CEP)

MOTIVO DO RECURSO:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________________________________________________________

INDEFERIMENTO DO BENEFCIO N: ______________________________________________

CESSAO DO BENEFCIO N: ____________________________________________________

DECISO PROFERIDA NO PROCESSO N: __________________________________________

RAZES DO RECURSO:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________________

__________________________________________________________
LOCAL e DATA

__________________________________________________________
ASSINATURA (do prprio ou do representante legal)