Header with company data

No. output / date

________/_______
POWER OF ATTORNEY

The undersigned, SC _______________________________ SRL, with registered office in

____________________________ str._______________ no.___ bl.____ ap.___, registered at the Trade
Register under no. ___________________________, CUI _________________, represented by Mr./Ms.
____________________, as __________________________,

hereby authorizes on

Mr./Ms. __________________________________________ domiciled in

____________________________ str._______________ no.___ bl.____ ap.___, holder of Passport no.
_______________, CNP __________________ , to drive the car owned by the above-mentioned
company, make / type ________________ , chassis series _________________________ , registration
number ___________. , outside the borders of Romania, in the European Union and Turkey, in the
period ___/___/______ - ___/___/______

Representative,

Company stamp and

Authorized signature