Attestation of activities

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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. 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:

  1. Name and first name      

  2. Position in the undertaking:     

declare that the driver:

  1. Name and first name:     

  2. Date of birth (day/month/year):      /     /     

  3. Driving licence or identity card or passport number:      

  4. who has started to work at the undertaking on (day/month/year):      /     /     

for the period:

  1. from (hour/day/month/year):      /     /     /     

  2. to (hour/day/month/year):     /     /     /     

  3.  was on sick leave***

  4.  was on annual leave***

  5.  was on leave or rest***

  6.  drove a vehicle exempted from the scope of Regulation (EC) 561/2006 or the AETR***

  7.  performed other work than driving***

  8.  was available***

  9. Place:      Date:     


  1. 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.

  2. Place:      Date:      

Signature of the driver:

1This form is available in electronic and printable versions at the following address:

2European Agreement concerning the Work of Crews of Vehicles engaged in International Road Transport.

*** Choose only one box


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