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.