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

1. Numele ntreprinderii: (Name of the undertaking) 2. Strada, codul potal, oraul, ara: Mihai Eminescu 24, 920093, (Street address, Postal code, City, Country) 3. Numrul de telefon (inclusiv prefixul internaional): 0729353802 (Telephone number (including international prefix) 4. Numrul de fax (inclusiv prefixul internaional): (Fax number (including international prefix) 5. Adresa de e-mail: scviomel@gmail.com (E-mail address)

Sc Viomel Srl

Slobozia, Romania

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

Enache Melania Stefania 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: Enache Dumitru ( Name) 9. Data naterii: 17.09.1963 ( Date of birth) 10. Numrul permisului de conducere, sau a crii de identitate sau a paaportului: ( Driving licence number or Identity card number or Passport number)

I00047538L
15.03.2010
Dtum

11. care lucreaza n cadrul ntreprinderii de la(ziua/luna/anul) from (time-day-month-year) 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. 17. 18. 19.

09:30 25-Apr-2012

s-a aflat n concediu medical (was on sick leave) (*) s-a aflat n concediu de odihn (as on annual leave) (*)
se afla n concediu sau n repaus (was on leave or rest) (*)

09:30 07-May-2012

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 (*) desfsura o alt activitate, dect condusul (performed other work than driving) era disponibil (was available)

20. Pentru ntreprindere, localitatea Sc Viomel For the undertaking, place Semntura ______________________ signature

Srl Slobozia

data

07-May-2012

Dtum

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 Sc Viomel Srl Slobozia Place Semntura conductorului auto ______________________ Signature of the driver data

07-May-2012

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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.