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CERTIFICAT DE DESFSURARE A ACTIVIT..IIREGULAMENTUL (CE) NR. 561/2006 SAU ACORDUL A.E.T.R. (*)(Highlight comment Ionut9/28/13 9:29:19 PMblank)ATTESTATION OF ACTIVITIES UNDER REGULATION (EC) NO 561/2006ORTHE EUROPEAN AGREEMENT CONCERNING THE WORK OF CREWS OF VEHICLES ENGAGED IN INTERNATIONAL ROADTRANSPORT (AETR) (*)A se completa prin dactilografiere .i a se semna nainte de cltorie.A se p.stra mpreun. cu nregistrarea original a aparaturii de control, n cazul n caeste necesar pstrarea nregistrriiFalsificarea certificatelor constituie infractiune.To be filled in by typing and signed before a journey.To be kept with the original tachograph records wherever they are required to be keptFalse attestations constitute an infringement(combobox)1. Numele ntreprinderii:(combobox)(Name of the undertaking)(Highlight comment Ionut9/28/13 9:29:53 PMblank)2. Strada, codul po.tal, ora.ul, .ara:(Street address, Postal code, City, Country)(text)(text)3. Num.rul de telefon (inclusiv prefixul interna.ional):(Telephone number (including international prefix)4. Num.rul de fax (inclusiv prefixul interna.ional):(Fax number (including international prefix)(text)5. Adresa de e-mail:(E-mail address)Subsemnatul,(subsemnata) (I, the undersigned),6. Numele .i prenumele:(combobox)(text)( Name)7. Func.ia ocupata n ntreprindere:( Position in the undertaking)declar c. conduc.torul auto (declare that the driver)8. Numele .i prenumele:(combobox) 0( Name)(text) -(text) -9. Data na.terii:( Date of birth)10. Num.rul permisului de conducere, sau a c.r.ii de identitate sau a pa.aportului:( Driving licence number or Identity card number or Passport number)11. care lucreaza n cadrul ntreprinderii de la(ziua/luna/anul) from (time-day-month-year)(text) -pentru perioada ,(for the period )12. de la (ora, ziua, luna, anul) from (time-day-month-year):(text)(text)(: Yes) Unchecked13. la (ora, ziua, luna, anul) to (time-day-month-year):14. . s-a aflat n concediu medical (was on sick leave) (*)(checkbox) Unchecked15. . s-a aflat n concediu de odihn. (as on annual leave) (*)(checkbox) Unchecked16.se afla n concediu sau n repaus (was on leave or rest) (*)(checkbox) Unchecked17. . a condus un vehicul exceptat de la aplicarea Regulamentului (CE) nr.561/2006 sau AE.T.R. (*)(checkbox) Uncheckeddrove a vehicle exempted from the scope of Regulation (EC) No 561/2006 or AETR (*)18.desfsura o alt activitate, dect condusul (performed other work than driving)(checkbox) Unchecked19.(checkbox) Uncheckedera disponibil (was available)(text)(listbox)20. Pentru ntreprindere, localitateadata(: Yes) UncheckedFor the undertaking, placeSemn.tura ______________________signature21. Subsemnatul, conduc.tor auto, confirm c. nu am condus un vehicul care intrn domeniul de aplicare al prevederilorRegulamentului (CE) nr. 561/2006 sau AETR . (I, the driver, confirm that I havenot been driving a vehicle falling under the scope ofRegulation (EC) No. 561/2006 or AETR during the period mentioned above.)(text)(listbox)22. LocalitateadataPlaceSemn.tura conduc.torului auto ______________________Signature of the driver(1)Acest formular poate fi ob.inut n versiune electronic. .i imprimabil. pe site-ulhttp://arr.ro/verticala/Formular%20atestare.doc(1)This form is available in an electronic and printable version on the Internet atec.europa.eu.(*) Se alege doar una dintre c.su.ele(*) Only one of the boxes..

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