DECLARATIE

pe proprie raspundere privind traseul de deplasare la/de la serviciu

Subsemnatul___________________________, angajat la ___________________, posesor al C.I.

Seria____, Nr._________, in functia ___________________________

declar urmatoarele:

1. Domiciliul meu actual este:

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2. Deplasarea de la domiciliu la locul de munca si retur se face pe traseul:

(Enumerati 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):
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3. Deplasarea se face cu :

Mijloace de transport in comun, vehicul proprietate individuala, vehicul societate, ca pieton, cu

bicicleta, cu motocicleta/scuter.

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4. Durata deplasarii este circa _________ minute;

Mentionez ca datele sunt corecte si complete

Aceasta este declaratia pe care o dau pe proprie raspundere si o semnez, cunoscand sanctiunile
aplicabile faptei de fals

Semnatura angajatului, Data,

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