S.C. ___________________________________ S.R.L.

Loc______________________________ Jud ________________________

PROCES VERBAL DE PREDARE-PRIMIRE (AUTO)VEHICUL

Nr. nmatriculare (auto) vehicul______________________
Locul predrii__________________________________Data______________________
PREDTOR:
1. Nume-Prenume_____________________________ Domiciliat n______________________ ,
str____________________________, Nr._______, Jud.____________________, posesor al BI/CI_______,
nr.________________, cu funcia de_______________________
2. Nume-Prenume_____________________________ Domiciliat n______________________ ,
str____________________________, Nr._______, Jud.____________________, posesor al BI/CI_______,
nr.________________, cu funcia de_______________________
PRIMITOR:
1. Nume-Prenume_____________________________ Domiciliat n______________________ ,
str____________________________, Nr._______, Jud.____________________, posesor al BI/CI_______,
nr.________________, cu funcia de_______________________
2. Nume-Prenume_____________________________ Domiciliat n______________________ ,
str____________________________, Nr._______, Jud.____________________, posesor al BI/CI_______,
nr.________________, cu funcia de_______________________
(AUTO)VEHICUL: Nr. nmatriculare ______________, categoria___________________________,
marca_____________, tipul______________, caroserie tip____________________;
Nr. km la bord_____________; Motorina n rezervor 1. _____ litri, _____ cm; rezervor 2. _____ litri, ____ cm;
Stare de funcionare__________________;
DEFECIUNI CONSTATATE:_________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
mpreun cu (auto)vehiculul s-au predat/primit i urmtoarele documente i accesorii:
Documente:
Carte de identitate (auto) vehicul (copie)
Polia de asigurare CASCO (copie)
Certificat de nmatriculare (auto) vehicul

Certificat de inspecie tehnic ITP

Copie conform licena de tranport (original)

Certificat de poluare

Licena de transport a firmei (copie)

Certificat de zgomot

Copie legalizat a contractului de leasing /

nchiriere (dup caz)

Certificat internaional de inspecie tehnic ITPI

Polia de asigurare RCA

Dovada de verificare tahograf+limitator

Asigurare pentru marfa CMR

Taxa de drum (rovinieta)
Alte documente: _____________________________________________________________________
Formular descarcat gratuit de pe www.euload.com

APARATE PENTRU TAXELE DE DRUM:

GOBOX (AUSTRIA)
OBU (GERMANIA)
TELEPASS (ITALIA)
UTA MULTI BOX (SPANIA, FRANA)

PREMID (CEHIA)
VIA TOLL (POLONIA)
MYTO (SLOVACIA)

ACCESORII:
Becuri...........................................................buc

Mapa cu cartea tehnic.................................buc

Bocanci.........................................................per

Pan roi........................................................buc

Casca............................................................buc

Roat de rezerv...........................................buc

Cabluri electrice ajuttoare pt pornire..........buc

Set chei tubulare...........................................buc

Casetofon/CD...............................................buc

Set sigurane..................................................set

Crlig remorcare...........................................buc

Staie........................buc, antena...................buc

Chei roi+eava.............................................buc

Stingtor.......................................................buc

Cric...............................................................buc

Triunghi reflectorizant..................................buc

Cui remorcare...............................................buc

Trusa ADR....................................................buc

Disp de ancorare marf./ chingi...................buc

Trusa de scule...............................................buc

Furtun umflat roi.........................................buc

Trus medical..............................................buc

Lantern........................................................buc

Vesta reflectorizant.....................................buc

Lanuri antiderapante....................................buc
ALTE ACCESORII (frigider, tampil, etc):_____________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Primitorul a preluat (auto)vehiculul n dotare cu cele amintite mai sus, n urma unui inventar, fiind
rspunztor de lipsa oricruia dintre cele amintite, precum i de defeciunile cauzate de neutilizarea
(auto)vehiculului n mod corespunztor, conform specificaiilor cuprinse n fia postului.
OBSERVAII:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
AM PREDAT
1.Nume/prenume_____________________
Semntura_________________________
2. Nume/prenume_____________________
Semntura_________________________

AM PRELUAT
1.Nume/prenume_____________________
Semntura_________________________
2. Nume/prenume_____________________
Semntura_________________________

Prezentul formular a fot ncheiat ntr-un numr de _______ exemplare, din care_________ rmne la
predtor i ________ la primitor.
Formular descarcat gratuit de pe www.euload.com