ANNEX

ATTESTATION OF ACTIVITIES1 (REGULATION (EC) 561/2006 OR THE AETR2) To be filled in by typing and signed before a journey. To be kept with the original control device records wherever they are required to be kept FALSE ATTESTATIONS CONSTITUTE AN INFRINGEMENT Part to be filled in by the undertaking

(1) (2) (3)

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Name of the undertaking:SC

D-L GEO AUTOEUROLINE SRL

Street address, postal code, city, country: SUSLANESTI, 117486, MIOARELE, ROMANIA Telephone number (including international prefix): 0040744769595 Fax number (including international prefix): E-mail address:spinu_geo@yahoo.com

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(14) (15) (16) (17) (18) (19)

I, the undersigned: Name and first name SPINU

MARIAN GEORGE

Position in the undertaking:ADMINISTRATOR

declare that the driver: Name and first name:SPINU

MARIAN GEORGE 631983

Date of birth (day/month/year): 17/03/1985 Driving licence or identity card or passport number: AS

who has started to work at the undertaking on (day/month/year): 18/02/2013

for the period: from (hour/day/month/year): 12 to (hour/day/month/year):22 was on sick leave*** was on annual leave*** was on leave or rest*** drove a vehicle exempted from the scope of Regulation (EC) 561/2006 or the AETR *** performed other work than driving*** was available*** Place:SUSLANESTI Date:02

30/01/02/3013

40/02/O3/2013

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(21)

03 2013

Signature: 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. Place:SUSLANESTI Date: 02

(22)

03 2013

Signature of the driver:

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This form is available in electronic and printable versions at the following address: http://ec.europa.eu European Agreement concerning the Work of Crews of Vehicles engaged in International Road Transport. *** Choose only one box

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