______________________________________________________________________________

| |
| .................. |
| (Unitatea) |
| |
| ORDIN DE DEPLASARE (DELEGAIE) N STRINTATE |
| (transporturi internaionale) |
| NR. ................. |
| |
| Titularii de avans (Numele, prenumele i funcia) ....................... |
| ............................................................................ |
| se deplaseaz n ........................................................... |
| .................................... cu autovehiculul nr. .................. |
| marca ..................... pentru ......................................... |
| .................... conform comenzii nr. ........... emis de ............. |
| .................... locul de ncrcare .................................... |
| locul de descrcare ............................... pleac la .............. |
| anul ....... se napoiaz la terminarea cursei sau marrutei ............... |
|______________________________________________________________________________|
| Nr. km parcuri | Relaia | Relaia | Relaia |
|________________________|________________|_________________|__________________|
| Km. dus-ntors conform | | | |
| marrutei | | | |
|________________________|________________|_________________|__________________|
| Km. pentru redirijare | | | |
|________________________|________________|_________________|__________________|
| Total km. | | | |
|________________________|________________|_________________|__________________|
| Avans n valut se | Valut | Lei | Valut | Lei | Valut | Lei |
| acord pentru | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 1. Total 2 oferi | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 2. Diurna de deplasare | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| - conform marrutei | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| - pentru descrcare | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| - pentru ncrcare | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 3. Taxe drum | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 4. Combustibil | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 5. Autorizaii | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| 6. Alte cheltuieli | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| Total | | | | | | |
|________________________|________|_______|_________|_______|_________|________|
| Director, ef sector Viza control Am primit |
| exploatare, financiar sumele n valuta |
| preventiv, menionat mai sus, |
| ofer, |
| ................... |
| paaport nr. |
| |
| Achitat |
| Data ............................ |
| Casier .......................... |
|______________________________________________________________________________|
14-5-4/a A5 t2

(verso)
______________________________________________________________________________
| |
| Viza vmii la ieirea din Romnia |
| |
| DECLARAIE. La napoierea din curs la data de ............................. |
| am adus n ar urmtoarea valut neconsumat. |
|______________________________________________________________________________|
| Felul valutei | SUMA |
| |_______________________________________________|
| | n cifre | n litere |
|______________________________|___________________|___________________________|
|______________________________|___________________|___________________________|
|______________________________|___________________|___________________________|
|______________________________|___________________|___________________________|
|______________________________|___________________|___________________________|
|______________________________|___________________|___________________________|
| |
| Semnturile titularilor de avans |
| ................................ |
| ................................ |
| |
| |
| |
| Viza vmii la intrarea n Romnia |
| |
| |
| |
|______________________________________________________________________________|