POTVRDAO AKTIVNOSTIMA - FORMULAIRED'ATTESTATIOND'ACTIVITES- ATTESTATION
OT-ACTIVITIES
l. Naziv tvftke / Nontde I'entrepri.se
I Numeof lhe undertoking
- MIKAN-PROM d.o.o.
2 Ulica' poStanski
I Rue,coclepo.stal,t,illelstreet aclre.ss,
broj. rn-iesto
postalcocle,cilv- Bijeljina,76300 Modran
Drlava I Pu.t,.s
I Country- Bosnai Hercegovina
3. TelefonI Telephone
I Phone- 0038765983256
4. Faksi Tele/ax
I Fsx- 00J875555050
5. Adresaelektronsl<e
- mikan.prom@gmail.com
poste/ Adre.sse
courrier electroniqueI Entctilacldres.s
Ja, nii.e potpisani I Le soussigtrdI I, the undersigned
6 l r n ei p r e z i m et N o n te t p r c n o m , ' F i r s tc t n dl c r . ynlc t m e- M i h a n p a r a d e n o v i d
7. Funkci.ja
u tvrtciI Foncliontlun.sI'enlrepri,se,t
Positionin the undertukinp- Direktor
fzjavljujem da vozat I ddclureque le conducleur I declarelhut the tlriver
8. IrneiprezimeI Nontet prenontI Fir.s!and la.stnutne- Radomir Stojanovi(
9. DaturnrodeniaI Date de naissance (lour/moi.s/annde)
I Date o/'birth (da.y/nonth/vear)-02.08. 1965.
l0 Br vozadkeclozvoleili osobneisk. ili putovniceI Numdrodu permisde concluireou clela c'ertecl'iclentite
ott clupa5.sepsr/
I
Driving
)rivtng licencc
licenccor identitl
identitl card
pa.ssportnunlbqr- Osobna iskaznica- l0GBM6058
card rtr pa.ssport
I l. Zaposlenu tvrlki od (daninr.jeseclgodina)
, QulLr c:t
tntnt ut7c tj tl
c:ontrnutTc?
de
e !!rut,ctiller
r uy o i | | er tl
tlans
u ns l'l'entr
en I reytri,se I c (j o ut.,,nto i s urtnee) i IL'ho hu.s sturlecl
Io tyotk ut the undertukiugon (clut,,ttronthtt'eur1- Q9. 02.2011.
Za razdoblje I uu conrs de la pdriode l.for the
iotl
l2 Od / du (heureijour/ntoi.s/annte)
I from (hour/, rv/ntonth/vearl - I 4 :30:00 t9. 12.2012.
- 07:30:00 29. 12.2012.
I 3 Do / an (heure/jour/ntois/anndeI to (hour/, 'ntonth/ttear)
14.Bio na bolovanjuI dtait en congdde moladieI a s o n . s i c kl e a y e - N E
1 5 .B i o n a g o d i S n j e rord m o r uI i t a i t e n ( ' o n g e(
I v,o.son annual/eave - NE
l6. Ostali izostanciI etuit en L'on!:eoLttcpos I trus tn leuyc rtr t'esl - DA
l 7 U p r a v l l a ov o z i l o n ti z u z e t i r ni z p l i r nj e n eU r e
(EC)561/2006 AETR i condui.saitttn vihicule esclu thr c'hunp t\'upplicution thr
riglenrent(('E) 56l,l()06 ou tla | '4 ETR,' tlt.cn,e
u
icle cxentptcd
of Regulution(EC) 561,'2006or the.46fR - NE
fi'ontthe sc'r,tpe
1 8 .O b a v l j a od r u g ep o s l o v eo s i mu p r a v l . j a n vj ao z i m I e/fec'tuaitautre Iravctilcluela c'onduiteI pejbrmed other vt,ork!han driving NE
lable - NE
ate - 29. 12.2012.
21. Ja.voza( Radomir Stoj'irnn,ui#pofvrdLrjent
dalrrisarn
upravl-iao
vozilonrobuhvaceuinr
primjenornuredbe(EC),56
l/2006 AETR
tijekorlgor.n.|egrazdobIjaiLe.sotts'signe't'ont|ut'|eut
rdglentent(CE) 561/2006ou clel'AETR qu coltr.tde la piriode.su.vmentionnee
i I, the clriver,confirn that I hcrvenor heendriving u
vehicle/ttlling underthe scopeo/-Regulation(EC) 561/2006or the AETR cluringthe perioclmentioneclabcn,e)
2 0 M j e s t oI l i e u I p l a c e - M o d r a n D a t u mI d a t eI d a t e - 2 9 . l Z . 2 0 l Z .
PotpisvozadaI signaturedu conducteurLsignatureof the drit;er
I S P U N I T IU D I G I T A L N O JF O R M I ( I S P I SN A P I S A E U )
c h a r a c t e r sa n d s i g n e d b e f b r ea 1 o u r n e r
d e r i c e r e c o r d sr r h e r r ' r c rt h e r a r c r c r l u r r e dt o L r ck c p t
K R l v l N A V o D I P R I - . D S l A V t . r A l tl ' t < t K l < i n . t L t r s l ^ t s s t r s A r - l E S T A f t o N S C o N S l i u E N r u N E T N F I I A C I - l o N
I N l r l ( l N ( i t r M F - NI l
/FAtsF.ATff-srAiIoNSCoNS-tlfut-t:,AN

potvrda o aktivnostima - formulaire d`attestation d`activites