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_______________in loc.__________________
judetul_________________si domiciliul actual in str._________________________
nr.___ap._____localitatea__________________________jud__________________
studii ___________________angajat la societatea _______________________ avind
marca_______________calificarea_________________________in functia de
_____________________________declar pe proprie raspundere ca deplasarea de la
domiciliul actual la locul de munca o efectuez pe urmatorul traseu:
___________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________________________
folosind urmatoarele 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 mijloace de transport__________________________________
___________________________________________________________________
timpul total al deplasarii fiind in medie de _____ore si _____minute.
data:

semnatura
_____________________