Приказ МПС РФ от 27 мая 1999 г. N 10ЦЗ"Об утверждении Правил перевозок на железнодорожном транспорте группами вагонов по одной накладной" стр. 6

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Пров. ХХХХХХХХХ
Охр. ХХХХХХХХХХ
Сбор за объяв.цен. ХХХХ
Взыскано на станции отправления: ХХХХХХХХХХ руб.
Место расчета ХХХХХХХХХХХ(ХХ) Форма платежа: ХХХХХХХХХХХХХХХХХХХХХХХХХХХХ
Товарный кассир ______
При выдаче по окончательному расчету уплатил: __________________ руб.
Недобор ________ руб. Перебор ______ руб.
Платежи взысканы на станции назначения по квитанции разных сборов N _____
Товарный кассир ______
Календарные штемпеля о времени
Приема груза к перевозке Выгрузки груза ж.д. Оформления выдачи
или подачи под груза
выгрузку средствами
получателя
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Особые заявления и отметки отправителя
ХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХ
ХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХ
ХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХХ
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Отметки в пути следования
+-----------------------+------------------------+----------------------+
|Вагон N _____________ |Вагон N _____________ |Вагон N _____________ |
|Отцеплен на ст._______ |Отцеплен на ст.________ |Отцеплен на ст._______|
|________________ж.д. |________________ж.д. |________________ж.д. |
|По причине___________ |По причине___________ |По причине___________ |
|____________________ |____________________ |____________________ |
|____________________ |____________________ |____________________ |
|Составлен акт общей |Составлен акт общей |Составлен акт общей |
|формы N ____________ |формы N ____________ |формы N ____________ |
|от ____________19__ г. |от ____________19__ г. |от ____________19__ г.|
|Выписана досылочная |Выписана досылочная |Выписана досылочная |
|дорожная ведомость |дорожная ведомость |дорожная ведомость |
|N _________________ |N _________________ |N _________________ |
|от ____________19__ г. |от ____________19__ г. |от ____________19__ г.|
|Ответственный работник |Ответственный работник |Ответственный работник|
|станции |станции |станции |
|____________________ |____________________ |____________________ |
| (подпись) | (подпись) | (подпись) |
|Штемпель станции |Штемпель станции |Штемпель станции |
|отцепки вагона |отцепки вагона |отцепки вагона |
+-----------------------+------------------------+----------------------+
Отметки железной дороги
-------------------------------------------------------------------------
Отметки о выдаче груза
------------------------------
* печатается ЭВМ: "маршрут" - при перевозке груза маршрутной отправкой; "группу вагонов" - при перевозке груза групповой отправкой
Приложение 4
к Правилам перевозок грузов
на железнодорожном транспорте группами
вагонов по одной накладной

Дополнительный лист к накладной N _______ (сведения о ЗПУ)

+---+----+--------------------------------------------------------------+
|N | N | Сведения о запорно-пломбировочных устройствах |
|п/п|ва- +------+---+----+------+---+----+-----+---+----+------+---+----+
| |гона|Сокр. |Тип|Зна-|Сокр. |Тип|Зна-|Сокр.|Тип|Зна-|Сокр. |Тип|Зна-|
| | |наим | |ки |наим | |ки |наим.| |ки |наим | |ки |
| | |дороги| | |дороги| | |доро-| | |дороги| | |
| | | | | | | | |ги | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|1 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|2 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|3 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|4 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|5 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|6 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|7 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|8 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|9 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|10 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|11 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|12 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|13 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|14 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|15 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|16 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|17 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|18 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|19 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|20 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|21 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|22 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|23 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|24 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|25 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|26 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|27 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|28 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|29 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|30 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
Отправитель ________________________________
(должность и подпись разборчиво)

Дополнительный лист к накладной N _______(оборот) (сведения о ЗПУ)

+---+----+--------------------------------------------------------------+
|N | N | Сведения о запорно-пломбировочных устройствах |
|п/п|ва- +------+---+----+------+---+----+-----+---+----+------+---+----+
| |гона|Сокр. |Тип|Зна-|Сокр. |Тип|Зна-|Сокр.|Тип|Зна-|Сокр. |Тип|Зна-|
| | |наим | |ки |наим | |ки |наим.| |ки |наим | |ки |
| | |дороги| | |дороги| | |доро-| | |дороги| | |
| | | | | | | | |ги | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|31 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|32 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|33 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|34 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|35 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|36 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|37 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|38 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|39 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|40 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|41 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|42 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|43 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|44 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|45 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|46 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|47 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|48 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|49 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|50 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|51 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|52 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|53 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|54 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|55 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|56 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|57 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|58 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|59 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
|60 | | | | | | | | | | | | | |
+---+----+------+---+----+------+---+----+-----+---+----+------+---+----+
Отправитель ________________________________
(должность и подпись разборчиво)