Dejanmilosevic

ATTESTATION OF ACTIVITIES*/FORMULAIRE D’ATTESTATION D’ACTIVITÉS (REGULATION (EC) 561/2006 OR THE AETR) /(RÈGLEMENT (CE) 561/2006 OU L’AETR)

POTVRDA O ODSUSTVOVANJU VOZAČA

To be filled in by typing in Latin characters and signed before a journey / Popunjava se u štampanom obliku i potpisuje pre početka putovanja To be kept with the original control device records wherever they are required to be kept / Čuva se uz originalni tahografski listić ili ispis iz digitalnog

tahografa False attestations constitute an infringement / Unos netačnih podataka u potvrdu predstavlja prekršaj

Part to be filled in by the undertaking / Popunjava prevoznik

1. Name of the undertaking / Naziv preduzeća /preduzetnika ……………………………………………………………………………

2. Street address, postal code, city / Ulica, poštanski broj, grad ………………………………………………………………………......

...........…………………………………………………………………………………………………………………………………… Country / Država: Republic of Serbia / Republika Srbija

3. Telephone number (including international prefix) / Broj telefona +381 …………………………......

4. Fax number (including international prefix / Broj faksa +381 …………………………….

5. Adresse courrier électronique / adresa elektronske pošte):……………………………………………………………………………….

I, the undersigned / Ja, dole potpisani:

6. Name and first name / Ime i prezime: ……………………………………………………………………………………………………

7. Position in the undertaking / na radnom mestu u preduzeću ……………………………………………………………………………..

declare that the driver / izjavljujem da je vozač:

8. Name and first name / Ime i prezime vozača…………………………..:………………………………………………………………...

9. Date of birth (day/month/year) /Datum rođenja: (dan/mesec/godina): …………………………………………………………………..

10. Driving licence or identity card or passport number / Broj vozačke dozvole lične karte ili pasoša

…………………………………………………………………………………………………………………………………………………….

11. who has started to work at the undertaking on (day/month/year) / koji je otpočeo sa radom u preduzeću (dan/mesec/godina) …………………………………………………………………………………………………………………

au cours de la période / za period:

12. from (hour/day/month/year) / od(čas/dan/mesec/godina):………………………………………………………………………………

13. to (hour/day/month/year) / do (čas/dan/mesec/godina):…………………………………………………………………………………

14. □ was on sick leave* / bio na bolovanju*

15. □ was on annual leave* / koristio godišnji odmor*

16. □ was on leave or rest* / odsustvovao sa posla ili koristio slobodne dane*

17. □ drove a vehicle exempted from the scope of Regulation (EC) 561/2006 or the AETR* / upravljao vozilom koje nije iz oblasti AETR-a*

18. □ performed other work than driving* / obavljao druge poslove osim upravljanja vozilom*

19. □ was available* / bio raspoloživ *

20. Place / Mesto:……………………………………………………….... Date / Datum:…………………………………………………

Signature / Potpis:…………………………………………………………………….

21. I, the driver, confirm that I have not been driving a vehicle falling under the scope of Regulation (EC) 561/2006 or the AETR during the period mentioned above / Ja, vozač, potvrđujem da nisam upravljao vozilom iz oblasti AETR-a tokom gorepomenutog perioda.

22. Place / Mesto:………………………………………………………. Date / datum…………………………………….........................

Signature of the driver / Potpis vozača: ...................................................................................................

* Choose only one box/ Izabrati jednu od ponuđenih opcija.