CERTIFICAT DE DESFSURARE A ACTIVITII

REGULAMENTUL (CE) NR. 561/2006 SAU ACORDUL A.E.T.R. (*)

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 kept with the original tachograph records wherever they are required to be kept
False attestations constitute an infringement

SRL Nimerion
1. Numele ntreprinderii:
(Name of the undertaking)
2. Strada, codul potal, oraul, ara: 4228, R. Moldova, r-l Stefan-Voda,
(Street address, Postal code, City, Country)
3. Numrul de telefon (inclusiv prefixul internaional): + 373 0242 34248
(Telephone number (including international prefix)
4. Numrul de fax (inclusiv prefixul internaional):
+373 0242 34888
(Fax number (including international prefix)
5. Adresa de e-mail:
nimerenco60@mail.ru
(E-mail address)

s. Popeasaca, str. Ion Creanga, 37

Subsemnatul,(subsemnata) (I, the undersigned),

Nimerenco Ion
6. Numele i prenumele:
( Name)
7. Funcia ocupata n ntreprindere: Administrator
( Position in the undertaking)

declar c conductorul auto (declare that the driver)

8. Numele i prenumele: Bodiu Petru
( Name)
9. Data naterii:
27.01.1960
( Date of birth)
10. Numrul permisului de conducere, sau a crii de identitate sau a paaportului: 065300130
( Driving licence number or Identity card number or Passport number)
11. care lucreaza n cadrul ntreprinderii de la(ziua/luna/anul) from (time-day-month-year) 03.02.2004
pentru perioada ,(for the period )
12. de la (ora, ziua, luna, anul) from (time-day-month-year):
13. la (ora, ziua, luna, anul) to (time-day-month-year):
14.
15.
16.

s-a aflat n concediu medical (was on sick leave) (*)

s-a aflat n concediu de odihn (as on annual leave) (*)

18:00 - 05 Dec - 2015

13:00 - 14 Dec - 2015

se afla n concediu sau n repaus (was on leave or rest) (*)

a condus un vehicul exceptat de la aplicarea Regulamentului (CE) nr.561/2006 sau AE.T.R. (*)
drove a vehicle exempted from the scope of Regulation (EC) No 561/2006 or AETR (*)
18. desfsura o alt activitate, dect condusul (performed other work than driving)
19.
era disponibil (was available)
17.

20. Pentru ntreprindere, localitatea SRL

For the undertaking, place
Semntura ______________________
signature

Nimerion, s. Popeasca

data

14 dec 2015

21. Subsemnatul, conductor auto, confirm c nu am condus un vehicul care intr n domeniul de aplicare al prevederilor
Regulamentului (CE) nr. 561/2006 sau AETR . (I, the driver, confirm that I have not been driving a vehicle falling under the scope of
Regulation (EC) No. 561/2006 or AETR during the period mentioned above.)
22. Localitatea
SRL Nimerion, s. Popeasca
Place
Semntura conductorului auto ______________________
Signature of the driver

(1)

(*)

data

14 dec 2015

Acest formular poate fi obinut n versiune electronic i imprimabil pe site-ul http://arr.ro/verticala/Formular%20atestare.doc

(1)
This form is available in an electronic and printable version on the Internet at ec.europa.eu.
Se alege doar una dintre csuele
(*) Only one of the boxes.