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DECLARATIE DE TRASEU

Privind deplasarea de la domiciliu la locul de munca si invers Subsemnatul(a)


_________________________________ care ma legitimez cu____ seria
______nr.________________________CNP___________________________ grupa
sanguina_______data nasterii_______________in
loc.__________________ judetul_________________sidomiciliul actual in
str._________________________ nr.___ap._____localitatea__________________________jud___
_______________ studii ___________________angajat la societatea
_______________________
avindmarca_______________calificarea_________________________in functia
de _____________________________declar pe proprie raspundere ca deplasarea de la
domiciliul actual la locul de munca o efectuez pe urmatorul
traseu: ___________________________________________________________________ _________
_____________________________________________________________ ______________________
________________________________________________ ___________________________________
__________________________ folosind urmatoarelemijloace de transport
:_________________________________ __________________________________________________
_________________ timpul total al deplasariifiind in medie de ______ore si _______
minute.Deasemenea la deplasarea de la locul de munca la domiciliufolosesc
urmatorultraseu:______________________________________________________________ ____
__________________________________________________________________ _________________
_____________________________________________________ ______________________________
_______________________________ folosind urmatoarelemijloace de
transport__________________________________ ________________________________________
___________________________ timpul total al deplasariifiind in medie de _____ore si
_____minute.data: semnatura _____________________