Приказ МПС РФ от 16 июня 2003 г. N 20"Об утверждении Правил составления учетной карточки выполнения заявки на перевозку грузов железнодорожным транспортом" стр. 4

|наз | | | |
| +-----------------------+--------------------+ |
| |Сумма сбора (руб.) | |Сальдо по штрафам (руб.) в пользу: |
+----------+-----------------------+--------------------+ |
|Сбор за |Количество изменений | |перевозчика - | перевозчик
|изменение +-----------------------+ | |
|заявки |вагонов (конт.)/тонн | |грузоотправителя - |
| +-----------------------+--------------------+ |
| |Сумма сбора (руб.) | | | _________________
| | | | | (подпись) Ф.И.О.
+----------+-----------------------+--------------------+-------------------------------------+
Приложение N 2
к Правилам составления учетной карточки
выполнения заявки на перевозку грузов
железнодорожным транспортом
(Форма ГУ-1)

Учетная карточка N

Выполнения принятой заявки ___________________________ на перевозку груза
(с по месяц, год)
статическая нагрузка 50 т/ваг
____________
Станция и железная дорога отправления ___________________________________
Наименование номенклатурной группы ______________________________________
Перевозчик ______________________________________________________________
Грузоотправитель ________________________________________________________
(полное наименование, фактический адрес и банковские реквизиты)
_________________________________________________________________________
Часть I
+--------+----------------+--------+----------------+-------------------------------------------------------------------------------------+--------------------------------------+---------------+
| Дата | Заявка | Подано | Погружено | в т.ч. вагонов (контейнеров) по железнодорожным станциям назначения | Причины невыполнения заявки | Подписи |
|погрузки+--------+-------+вагонов +---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+ | ответственных |
| | Вагоны | Тонны |(конт.) | Вагонов | Тонн |Ожере-|Наль- | Нара | Авто | Мульды | | | | | | | | | | работников |
| |(конт.) | | | (конт.) | | лье | чик | | Завод | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | +----------------------+---------------+-------+-------+
| | | | | | | | | | | | | | | | | | | | Общий недогруз | Причина |Перево-|Грузоо-|
| | | | | | | | | | | | | | | | | | | | | освобождения | зчик |тправи-|
| | | | | | | | | | | | | | | | | | | | | | | тель |
| | | | | | | | | | | | | | | | | | | +-----+--------+-------+-------+-------+ | |
| | | | | | | | | | | | | | | | | | | | ваг |Перевоз-|Грузоо-|Перево-|Грузоо-| | |
| | | | | | | | | | | | | | | | | | | | | чик |тправи-| зчик |тправи-| | |
| | | | | | | | | | | | | | | | | | | | | | тель | | тель | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 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 |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+---------------+-------+-------+
| | 300 | 15000 | | | | 60 | 60 | 60 | 60 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+---------------+-------+-------+
| Изменение заявки увеличение +, уменьшение - |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| | | | | | | | | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 1 | 10 | 500 | 10 | 10 | 500 | | | | | 10 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 2 | 10 | 500 | 5 | 5 | 250 | | | 5 | | | | | | | | | | | 5 | | 405-5 | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 3 | 10 | 500 | 5 | 5 | 250 | 1 | | 2 | | 2 | | | | | | | | | 5 | 101-5 | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 4 | 10 | 500 | 5 | 10 | 250 | | 5 | | | | | | | | | | | | 5 | | 202-5 | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 5 | 10 | 500 | 10 | 10 | 500 | 5 | | 3 | 1 | 1 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 6 | 10 | 500 | 10 | 10 | 500 | | 10 | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 7 | 10 | 500 | 10 | 5 | 250 | 5 | | | | | | | | | | | | | 5 | | 202-5 | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 8 | 10 | 500 | 5 | 5 | 250 | 5 | | | | | | | | | | | | | 5 | 101-5 | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 9 | 10 | 500 | 10 | 0 | 0 | | | | | | | | | | | | | | 10 | |202-10 | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 10 | 10 | 500 | 10 | 10 | 500 | | | 4 | | 6 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 11 | 10 | 500 | 10 | 10 | 500 | | | | 10 | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 12 | 10 | 500 | 5 | 5 | 250 | | | 1 | | 4 | | | | | | | | | 5 | 101-5 | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 13 | 10 | 500 | 10 | 0 | 0 | | | | | | | | | | | | | | 10 | | | |304-10 | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 14 | 10 | 500 | 0 | 0 | 0 | | | | | | | | | | | | | | 10 | | | |304-10 | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 15 | 10 | 500 | 0 | 0 | 0 | | | | | | | | | | | | | | 10 | | | |304-10 | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 16 | 10 | 500 | 10 | 10 | 500 | | | | 5 | 5 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
| 17 | 10 | 500 | 10 | 10 | 500 | 10 | | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+------+------+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+-------+-------+-------+-------+-------+
Форма ГУ-1 (оборот)
+--------+----------------+--------+----------------+-------------------------------------------------------------------------------------+----------------------------------------+--------------+
| Дата | Заявка | Подано | Погружено | в т.ч. вагонов (контейнеров) по железнодорожным станциям назначения | Причины невыполнения заявки | Подписи |
|погрузки+--------+-------+вагонов +---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+ |ответственных |
| | Вагоны | Тонны |(конт.) | Вагонов | Тонн |Ожере-|Нальчик|Нара | Авто | Мульды | | | | | | | | | | работников |
| |(конт.) | | | (конт.) | | лье | | | Завод | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | +------------------------+---------------+------+-------+
| | | | | | | | | | | | | | | | | | | | Общий недогруз в т.ч | Причина |Пере- |Грузоо-|
| | | | | | | | | | | | | | | | | | | | | освобождения |возчик|тправи-|
| | | | | | | | | | | | | | | | | | | | | | | тель |
| | | | | | | | | | | | | | | | | | | +-----+--------+---------+------+--------+ | |
| | | | | | | | | | | | | | | | | | | | ваг |Перевоз-|Грузоотп-|Пере- |Грузоот-| | |
| | | | | | | | | | | | | | | | | | | | | чик |равитель |возчик| прави- | | |
| | | | | | | | | | | | | | | | | | | | | | | | тель | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 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 |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 18 | 10 | 500 | 10 | 10 | 500 | | | 10 | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 19 | 10 | 500 | 10 | 10 | 500 | | | | | 10 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 20 | 10 | 500 | 10 | 10 | 500 | | 10 | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 21 | 10 | 500 | 0 | 0 | 0 | | | | | | | | | | | | | | 10 | 101-10 | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 22 | 10 | 500 | 5 | 5 | 250 | 5 | | | | | | | | | | | | | 5 | 101-5 | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 23 | 10 | 500 | 10 | 10 | 500 | | | | 10 | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 24 | 10 | 500 | 10 | 10 | 500 | | | | | 10 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 25 | 10 | 500 | 10 | 10 | 500 | 10 | | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 26 | 10 | 500 | 10 | 5 | 250 | | | | 5 | | | | | | | | | | 5 | | 202-5 | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 27 | 10 | 500 | 10 | 5 | 250 | | | | | 5 | | | | | | | | | 5 | | 202-5 | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 28 | 10 | 500 | 10 | 10 | 500 | 5 | | | | 5 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 29 | 10 | 500 | 10 | 10 | 500 | | 10 | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 30 | 10 | 500 | 10 | 10 | 500 | | | 8 | | 2 | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| 31 | | | | | | | | | | | | | | | | | | | | | | | | | |
+--------+--------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+------+--------+------+-------+
| Итого 300 | 15000 | 245 | 205 |10250 | 60 | 60 | 60 | 60 | 60 | | | | | | | | | 95 | 30 | 35 | 30 | |
| | | | | | ---- | --- | --- | --- | --- | | | | | | | | | | | | | |
| | | | | | 46 | 35 | 33 | 31 | 60 | | | | | | | | | | | | | |
+-----------------+-------+--------+---------+------+------+-------+-----+-------+--------+-----+-----+-----+-----+-----+-----+------+----+-----+--------+---------+---------------+--------------+
Часть II

Имущественная ответственность за невыполнение принятой заявки относится на:

грузоотправителя перевозчика
|Невыполне-|В вагонах (конт.) | 35 |В вагонах | 30 | Отметка об уплате
|ние заявки| | |(конт.) | | штрафа, сбора
| | | | | | грузоотправителем
| +-----------------------+--------------------+------------+------------------+
| |В тоннах | 1750 |В тоннах | 1500 |
| +-----------------------+--------------------+------------+------------------+
| |Сумма штрафа | 17500 |Сумма штрафа| 15000 |
+----------+-----------------------+--------------------+------------+------------------+
|По стан. |В вагонах (конт.) | 65/3250 | |
|наз | | | |
| +-----------------------+--------------------+ |
| |Сумма сбора (руб.) | 13000 |Сальдо по штрафам (руб.) в |
| | | |пользу: |
+----------+-----------------------+--------------------+ |
|Сбор за |Количество изменений | - |перевозчика - 2500 | перевозчик
|изменение +-----------------------+ | | _________________