S.C.

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DECLARAIE

Subsemnatul__________________________________, lucrtor n cadrul

S.C.____________________________________, declar pe propria-mi rspundere c:
1. pentru a m deplasa de acas la serviciu utilizez urmtorul traseu:
____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________,
deplasarea efectund-o cu: mijloc de transport n comun (auto, C.F., metrou, tramvai,
naval, aerian), mijloc de transport proprietate personal, mijloc de transport proprietate a
firmei, pieton, __________________________ etc., timpul necesar pentru deplasare fiind
de:____ zile, ____ ore, ____minute;
2. pentru a m deplasa de la serviciu acas utilizez urmtorul traseu:
____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________,
deplasarea efectund-o cu: mijloc de transport n comun (auto, C.F., metrou, tramvai,
naval, aerian), mijloc de transport proprietate personal, mijloc de transport proprietate a
firmei, pieton, __________________________ etc., timpul necesar pentru deplasare fiind
de:____ zile, ____ ore, ____minute;
3. m angajez s anun angajatorul firmei, dendat, asupra oricrei
modificri survenite asupra celor declarate la punctele 1.i 2.din prezenta declaraie.

Data_______________

Semntura_____________________