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.