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ATTESTATION OF ACTIVITIES* / FORMULAIRE DATTESTATION DACTIVITS*
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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 and first name: .......................................................................................................................
7. /Position in the undertaking: ..........................................................................................
, /declare that the driver :
8. /Name and first name: ........................................................................................................................
9. : (//)/ Date of birth (day/month/year): ..........................................................................
10. /Driving licence or identity card or
passport number

11. (//)/ who has started to work at the undertaking on (day/month/year)
/for the period:
12. (///)/ from (day/month/year):

13. (///)/ to (day/month/year): .........................................................................................................

***
14. / was on sick leave
15. ***/ was on annual leave)
16. ***/was on leave or rest
17. , () 561/2006
***/drove a vehicle exempted from the scope of the Regulation(EC) 561/2006 or the AETR
18. , ,***/was performing any work other
than driving of a vehicle
19. ***/was available
20. /Place:.... /date: ...
/signature
21. , , , ,
, 561/2006 () .
(I, the driver, confirm that I have not been driving a vehicle falling under the scope of the (EC) Regulation 561/2006 or AETR
during the period mentioned above).
22. /Place:.... /date:
/signature of the driver

*
/ This form is available in electronic
and printable versions at the following address: http://www.unece.org/trans/main/sc1/aetr.html
**
C, ,
/European Agreement concerning the Work of Crews of Vehicles engaged in International Road Transport.
***
/Choose only one box.
 60

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