Expeditor (denumire, adresa, tara) SCRISOARE DE TRANSPORT

1
Sender (name, address, country) INTERNATIONAL CONSIGNEMENT NOTE

Destinatar (denumire, adresa, tara) Operator de transport (denumire, adresa, tara)

2 ###
Consignee (name, address, country) Carrier (name, address, country)

AUTO NR.

Locul incarcarii (locul, tara, data) Operatori de transport succesivi (denumire, adresa, tara)
3 ###
Place and date of taking over the goods (place, country, date) Succesive carriers (name, address, country)

Locul descarcarii (locul, tara) Observele si rezervatiile operatorului de transport

*In case of dangerous goods mention, besides the possible certifi

4 ###
Place of delivery of the goods (place, country) Carrier's reservations and observations

Documente anexate
5
Documents attached
The spaces framed with h

Marca si numarul Numar de colete Modul de ambal Natura marfurilor Numar statistic Masa bruta (kg Volumul (m3)
6 7 8 9 10 11 12
Marks and Nos Number of pakages Method of packi Nature of the goo Statistical num Gross weight in Volume in m3

Clas Numarul Litera (ADR*)

Clas Number Letter
Instructiunile expeditorului Acorduri speciale
13 ###
Sender's instructions Special agreements

Plata prin Expeditor Moneda Destinatar

###
To be paid by Sender Curency Consignee
Pretul transportulu
Carriage charges
Deduceri
Deductions
Sold
Balance
Instructiuni de plata Taxe suplimentare
14
Instruction as to payement carriage Supplem. charges
Alte taxe
Plata la expediere / Carriage
Other charges
TOTAL
Plata la destinatie / Carrage forward
Total to be paid
Stabilit in data
21 ###Suma de plata / Cash on delivery
Established in on

Bunuri primite
22 ### 24
Goods received

Loc Data
Place on
Semnatura si stampila expeditorului Semnatura si stampila operatorului de transport Semnatura si stampila destinatarului
Signeture and stamp of the sender Signature and stamp of the carrier Signature and stamp of the consignee