______________________________________________________________________________ | | | .................. | | (Unitatea) | | | | ORDIN DE DEPLASARE (DELEGAIE) N STRINTATE | | (transporturi internaionale) | | NR. ................. | | | | Titularii de avans (Numele, prenumele i funcia) ....................... | | ............................................................................ | | se deplaseaz n ........................................................... | | .................................... cu autovehiculul nr. .................. | | marca ..................... pentru ......................................... | | .................... conform comenzii nr. ........... emis de ............. | | .................... locul de ncrcare .................................... | | locul de descrcare ............................... pleac la .............. | | anul ....... se napoiaz la terminarea cursei sau marrutei ............... | |______________________________________________________________________________| | Nr. km parcuri | Relaia | Relaia | Relaia | |________________________|________________|_________________|__________________| | Km. dus-ntors conform | | | | | marrutei | | | | |________________________|________________|_________________|__________________| | Km. pentru redirijare | | | | |________________________|________________|_________________|__________________| | Total km. | | | | |________________________|________________|_________________|__________________| | Avans n valut se | Valut | Lei | Valut | Lei | Valut | Lei | | acord pentru | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 1. Total 2 oferi | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 2. Diurna de deplasare | | | | | | | |________________________|________|_______|_________|_______|_________|________| | - conform marrutei | | | | | | | |________________________|________|_______|_________|_______|_________|________| | - pentru descrcare | | | | | | | |________________________|________|_______|_________|_______|_________|________| | - pentru ncrcare | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 3. Taxe drum | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 4. Combustibil | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 5. Autorizaii | | | | | | | |________________________|________|_______|_________|_______|_________|________| | 6. Alte cheltuieli | | | | | | | |________________________|________|_______|_________|_______|_________|________| | Total | | | | | | | |________________________|________|_______|_________|_______|_________|________| | Director, ef sector Viza control Am primit | | exploatare, financiar sumele n valuta | | preventiv, menionat mai sus, | | ofer, | | ................... | | paaport nr. |

| | | Achitat | | Data ............................ | | Casier .......................... | |______________________________________________________________________________| 14-5-4/a A5 t2 (verso) ______________________________________________________________________________

| | | Viza vmii la ieirea din Romnia | | | | DECLARAIE. La napoierea din curs la data de ............................. | | am adus n ar urmtoarea valut neconsumat. | |______________________________________________________________________________| | Felul valutei | SUMA | | |_______________________________________________| | | n cifre | n litere | |______________________________|___________________|___________________________| |______________________________|___________________|___________________________| |______________________________|___________________|___________________________| |______________________________|___________________|___________________________| |______________________________|___________________|___________________________| |______________________________|___________________|___________________________| | | | Semnturile titularilor de avans | | ................................ | | ................................ | | | | | | | | Viza vmii la intrarea n Romnia | | | | | | | |______________________________________________________________________________|