Model Declaratie de Traseu

DECLARATIE DE TRASEU

Privind deplasarea de la domiciliu la locul de munca si invers Subsemnatul(a) __________________ ____________________________ _______________ _____ care ma legitimez cu____  seria ______nr.________________________CNP___________________________  grupa sanguina_______data nasterii_________ n asterii_______________in ______in loc.__________________  loc.__________________   judetul____  judetul________ ________ ________ _____si _si domicili domiciliul ul actual in in str._____ str._________ ________ ________ _______ _______ _____  _  nr.___ap._____localitatea___________________ nr.___ap._____localitatea________ __________________jud_____ _______jud______________ _____________  ____  studii ___________________angajat ___________________angajat la societatea ___________________ _______________________ ____ avind marca_______________calificarea__________ marca_______________calificarea_____________________ _______________in ____in functia de  ________  ____________ ________ ________ ________ ________ _____declar _declar pe pe proprie proprie raspundere raspundere ca deplasarea deplasarea de la domiciliul actual la locul de munca o efectuez pe urmatorul traseu:  ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _______  ___   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ______  __   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ______  __   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _____  _  folosind urmatoarele u rmatoarele mijloace de transport :___________________ :_____________________________ ______________  ____   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _______  ___  timpul total al deplasarii fiind in medie de ______ore si _______ minute. Deasemenea la deplasarea de la locul de munca la domiciliu folosesc urmatorul traseu:______________________________________________________________   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ______  __   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ______  __   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _____  _  folosind urmatoarele u rmatoarele mijloace de transport_________________________ transport__________________________________  _________   ________  ____________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _______  ___  timpul total al deplasarii fiind in medie de _____ore si _____minute. data:

semnatura  ________  ____________ ________ ________ _____  _