DECLARATIE PE PROPRIA RASPUNDERE

privind traseul de deplasare la / de la serviciu

Nume: _____________________________________________________________________
Prenume:___________________________________________________________________
CNP:______________________________________________________________________
Act de identitate:_______ seria ________ numar___________________________________
Adresa: ____________________________________________________________________
___________________________________________________________________________
Resedinta: __________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Traseu de deplasare la/de la serviciu:

Mijloace de transport utilizate (enumerati toate mijloacele utilizate specificand
categoria: tramvai, autobuz, metrou, maxi-taxi, pietonal, cu bicicleta, cu auto firma, cu auto
personal, etc.):
___________________________________________________________________________
Perioada de timp alocata (in ore/minute) deplasarii de acasa la locul de munca / de la
locul
de
munca
spre
casa:
_______________________________________________________
Enumerati punctele de reper ce se gasesc pe traseul de deplasare de acasa la locul de
munca / de la locul de munca spre casa (adresa domiciliu reper 1 reper 2 - ... adresa loc
de munca):__________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Data:
lucratorului

Semnatura

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