______________________________________________________________________________| || EWC ROMANIA SRL Depus decontul (numărul şi data) || (Unitatea) ..................................... || || ORDIN DE DEPLASARE (DELEGAŢIE) || Nr. ___ || || Domnul (a) ................................................................. || având funcţia de ........................................................... || este delegat pentru ........................................................ || ............................................................................ || ............................................................................ || ............................................................................ || la ......................................................................... || ............................................................................ || ............................................................................ || Durata deplasării de la ................... la .......................... || Se legitimează cu ....................................................... || Ştampila unităţii şi semnătura || || || Data ................. ||______________________________________________________________________________|| Sosit *) ........................... | Sosit *) ............................ || Plecat *) .......................... | Plecat *) ........................... || Cu (fără) cazare | Cu (fără) cazare || Ştampila unităţii | Ştampila unităţii || şi semnătura | şi semnătura ||______________________________________|_______________________________________|| Sosit *) ........................... | Sosit *) ............................ || Plecat *) .......................... | Plecat *) ........................... || Cu (fără) cazare | Cu (fără) cazare || Ştampila unităţii | Ştampila unităţii || şi semnătura | şi semnătura ||______________________________________|_______________________________________| *) Se va completa ziua, luna, anul şi ora. 14-5-4 A5 t2

(verso) ______________________________________________________________________________| Ziua şi ora plecării ............... | Avans spre decontare: || Ziua şi ora sosirii ................ | - Primit la plecare ............. lei || Data depunerii decontului .......... | - Primit în timpul || Penalizări calculate ............... | deplasării .................... lei || | TOTAL ........................... lei ||______________________________________|_______________________________________|| CHELTUIELI EFECTUATE CONFORM DOCUMENTELOR ANEXATE ||______________________________________________________________________________|| Felul actului şi emitentul | Nr. şi data actului | Suma ||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________|

|______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________||______________________________________|___________________________|___________|| TOTAL CHELTUIELI | ||__________________________________________________________________|___________|| Diferenţa de restituit s-a depus cu | primit || chitanţa nr. ....... din .......... | Diferenţa de ----------- lei ........ || | restituit ||______________________________________|_______________________________________|| Semnătura | Aprobat, | Control | Verificat | Şef | Titular || | conducătorul |financiar- | decont | compartiment | avans || | unităţii |preventiv | | | || |______________|___________|___________|______________|____________||___________|______________|___________|___________|______________|____________|