Subsemnatul___________________________________________________nascut in data___________
angajat in functia________________________________cu domiciliul in
__________________________
strada______________________________nr. 101, bl. 8, ap. 9, judetul
(sectorul)___________________,
parcurg urmatorul traseu:
1. De la domiciliu la locul de munca
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. De la locul de munca la domiciliu ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________