SC ____________________ SRL Nr.

____/______________
CIF: RO ____________________
Romania

ÎMPUTERNICIRE / DELEGARE

SC __________________________, identificată prin CIF __________________________, cu sediul în

Sat __________________________, Strada __________________________, nr.__, Județul _____________,
Romania, reprezentată prin administrator __________________________, împuternicim prin prezenta pe
__________________________, Domiciliat în Județul _________, Localitatea _______________, (Comuna
__________________________), Nr. ___, Ap.____, posesor al C.I. seria ____, nr.
__________________________, Eliberat de SPCLEP __________________________ la data de
__________________________, CNP __________________________, , sa folosească autoturismul pe
teritoriul Uniunii Europene, marca __________________________, Combo-Van, nr de identificare
W__________________________, conform certificat de înmatriculare nr. __________________________,
Nr.Înmatriculare __________________________.

Semnătura : Semnătura :
Administrator : Angajat :
SC __________________________SRL Nr.___ /___________
CIF: RO_____________________________
Locality ___________, Street _______, No.___ ,______
Country Romania

EMPOWERMENT / DELEGATION

SC __________________________SRL, identified by CIF RO __________________________,

based in Locality ________________________, Street __________________________, No.___ ,__________
Country Romania, represented by the administrator ________________________, hereby empowerment
by __________________________, identified by Identity Card with Series ___, No. _______________,
Issued by SPCLEP __________________________, tu use the vehicles on territory of the European Union
, trademark Opel, Combo-Van, according to the registration certificate no.
__________________________, identification no. __________________________.

Signature : Signature :
Administrator Employee :