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CERTIFICAT DE DESFSURARE A ACTIVITII REGULAMENTUL (CE) NR. 561/2006 SAU ACORDUL A.E.T.R.

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ATTESTATION OF ACTIVITIES UNDER REGULATION (EC) NO 561/2006 OR THE EUROPEAN AGREEMENT CONCERNING THE WORK OF CREWS OF VEHICLES ENGAGED IN INTERNATIONAL ROAD TRANSPORT (AETR) (*) A se completa prin dactilografiere i a se semna nainte de cltorie. A se pstra mpreun cu nregistrarea original a aparaturii de control, n cazul n care este necesar pstrarea nregistrrii Falsificarea certificatelor constituie infractiune. To be filled in by typing and signed before a journey.To be ept !ith the original tachograph records !herever they are re"uired to be ept #alse attestations constitute an infringement

SC BIN FURNI PROD SRL 1. Numele & '$e($# )e$##* (Name of the undertaking) 2. S'$%)%, -.)!/ (.0'%/, .$%0!/, 1%$%* ROMANIA JUD BRAILA ORAS (Street address, Postal code, City, Country) 4. N!"6$!/ )e 'e/e7. (# -/!8#9 ($e7#:!/ # 'e$ %1#. %/)* 0239620231 (Telephone number (including international prefix) <. N!"6$!/ )e 7%: (# -/!8#9 ($e7#:!/ # 'e$ %1#. %/)* 0239620231 ( ax number (including international prefix) 5. A)$e8% )e e+"%#/* $%&mail address'

BRAILA STR ORSOVA NR 9

S!>8e" %'!/,(subsemnata) (!, the undersigned),


BROASCA GABRIEL 6. N!"e/e 0# ($e !"e/e* ( Name) @. F! -1#% ocupata & & '$e($# )e$e* MANAGER TRANSPORT ( Position in the undertaking)

)e-/%$ -6 -. )!-6'.$!/ %!'. (declare that the dri"er)


A. N!"e/e 0# ($e !"e/e* PARLOAGA VASILE ( Name) B. D%'% %0'e$##* 01.01.1965 ( #ate of birth) 10. N!"6$!/ (e$"#8!/!# )e -. )!-e$e, 8%! % -6$1## )e #)e '#'%'e 8%! % (%0%(.$'!/!#* XR 152392 ( #ri"ing licence number or !dentity card number or Passport number) 11. care lucreaza n cadrul ntreprinderii de la(ziua/luna/anul) from (time-day-month-year) 01.03.2008 (e '$! (e$#.%)% ,(for the period ) 12. )e /% (.$%, C#!%, /! %, % !/) from (time-day-month-year): 13. /% (.$%, C#!%, /! %, % !/) to (time-day-month-year)* 14. 15. 16. 17.

07:00 30-Sep-2013

Dtum

D s-% aflat & D s-% aflat & D

15:30 07-Oct-2013

-. -e)#! "e)#-%/ (was on sick leave) (*) -. -e)#! )e .)#F 6 (as on annual leave) (*) se afla n concediu sau n repaus (was on leave or rest) (*)

% -. )!8 ! 9eF#-!/ e:-e('%' )e /% %(/#-%$e% ReG!/%"e '!/!# (CE) $.561/2006 8%! AE.T.R. (E) dro"e a "ehicle exempted from the scope of &egulation ('C) No ()*+,--) or .'T& (*) 18.  desfsura o alt activitate, dect condusul (performed other work than driving) 19. era disponibil (was available) 20. Pe '$! & '$e($# )e$e, /.-%/#'%'e% BRAILA or the undertaking, place Se" 6'!$% HHHHHHHHHHHHHHHHHHHHHH signature )%'a

08-Oct-2013

Dtum

21. S!>8e" %'!/, -. )!-6'.$ %!'., -. 7#$" -6 ! %" condus ! 9eF#-!/ care intr n domeniul de aplicare al ($e9e)e$#/.$ ReG!/%"e '!/!# (CE) $. 561/2006 8%! AETR . (!, the dri"er, confirm that ! ha"e not been dri"ing a "ehicle falling under the scope of &egulation ('C) No/ ()*+,--) or .'T& during the period mentioned abo"e/) 22. L.-%/#'%'e% BRAILA Place Se" 6'!$% -. )!-6'.$!/!# %!'. HHHHHHHHHHHHHHHHHHHHHH Signature of the dri"er )%'%

08-Oct-2013

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A-e8' 7.$"!/%$ (.%'e 7# .>1# !' & 9e$8#! e e/e-'$. #-6 0# #"($#"%>#/6 (e 8#'e+!/ http://arr.ro/verticala/Formular%20atestare.doc (1) This form is available in an electronic and printable version on the (nternet at ec.europa.eu. Se alege ).%$ ! % )# '$e -68!1e/e (*) 0nly one of the boxes/