Formularz EU EN.doc

ATTESTATION OF ACTIVITIES UNDER
REGULATION (EC) NO 561/2006
OR
THE EUROPEAN AGREEMENT CONCERNING THE WORK OF CREWS OF VEHICLES ENGAGED IN INTERNATIONAL ROAD TRANSPORT (AETR) (*)

To be filled in by typing and signed before a journey
To be kept with the original tachograph records wherever they are required to be kept
False attestations constitute an infringement

1. Name of the undertaking:

2. Street address, Postal code, City, Country: , , ,

3. Telephone number (including international prefix):

4. Fax number (including international prefix):

5. E-mail address:

I, the undersigned
6. Name:
7. Position in the undertaking:

declare that the driver

8. Name:
9. Date of birth:
10. Driving licence number or Identity card number or Passport number:

for the period

11. from (time-day-month-year) ---
12. to (time-day-month-year) -

13.               was on sick leave (**)

14.               was on annual leave (**)

15.               drove a vehicle exempted from the scope of Regulation (EC) No 561/2006 or AETR (**)

16. For the undertaking, place date signature _______________

17. I, the driver, confirm that I have not been driving a vehicle falling under the scope of Regulation (EC) No. 561/2006 or AETR during the period mentioned above.

18. Place date Signature of the driver _______________

(*) This form is available in an electronic and printable version on the Internet at ec.europa.eu.

(**) Only one of the boxes 13, 14 or 15 may be chosen.