DECLARATIE DE TRASEU

privind deplasarea de la domiciliu la locul de munca si invers

Subsemnatul(a) _________________________________, angajat la SC LIFE

GUARD CONSULTING SRL, domiciliat in _________________________________,
str. _______________________, nr. ___, ap. _____, localitatea ____________________________,
jud. __________________, declar pe proprie raspundere ca incepand cu ____________________,

deplasarea de la domiciliul actual la locul de munca si retur o efectuez pe unul din urmatoarele
trasee * :

1. __________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_______________________________________. Timp de deplasare (minute): _____

2. __________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_______________________________________. Timp de deplasare (minute): _____

3. __________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_______________________________________. Timp de deplasare (minute): _____

Prin prezenta declaratie, ma angajez ca in momentul schimbarii domiciliului

(temporar sau permanent) sau a schimbarii traseelor de deplasare catre /de la locul de
munca, sa notific imediat SC LIFE GUARD CONSULTING SRL si sa schimb prezenta
declaratie de traseu.
Pag. 1/1

__________________
(semnatura angajat)

Nota: * Se vor mentiona, mijloacele de deplasare (mijloace propriii (mers pe jos,

auto, motociclete, scutere, biciclete…etc), mijloace de transport in comun) si cel putin
2 puncte intermediare (strazi, intersectii) de pe fiecare traseu (in afara punctelor de
plecare si sosire).