YD 115573823

Primus Srl 3243411

- -

$VLVWHQĠăUXWLHUă 100 EUR/echivalentul în RON la cursul 10 RON

%15GHODGDWDHIHFWXăULLSOă‫܊‬LL
Accidente persoane din 5.000 RON invaliditate permanenta, deces
vehicul 1.000 RON cheltuieli medicale 10 RON

ASIGURAT/CONTRACTANT, ASIGURATOR,
$//,$1=±ğ,5,$&$6,*85$5,6$
Primus Srl Hrescu Mihai /
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6&$OOLDQ]ğLULDF$VLJXUăUL6$ &DSLWDOVRFLDOVXEVFULVúLYăUVDW94.393.890 lei

6WU&ăGHUHD%DVWLOLHLQU80-84 Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
Sector 1%XFXUHúWL010616, România 6RFLHWDWHDXWRUL]DWăGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
Telefon 021 2082 222 &RGXODORFDWvQ5HJLVWUXODVLJXUăWRULORUúLUHDVLJXUăWRULORU5$017
Fax 021 2082 211 Codul LEI 529900XKNXM9MBH8GS45
www.allianztiriac.ro Operator de date cu caracter personal nr. 779
EN ISO 9001:2008

29
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9.
PENTRU AUTOVEHICULE ISSUED UNDER THE AUTHORITY OF: Name and Address of the Policyholder (or User of the vehicle)
1. INTERNATIONAL MOTOR INSURANCE CARD %,528/8,$6,*85Ă725,/25'( Primus Srl, Adresa: Pitesti, judet Arges, str. D-Na Balasa, nr.
1. CARTE INTERNATIONALE D'ASSURANCE AUTOVEHICULE DIN ROMÂNIA 13
AUTOMOBILE (B.A.A.R.)
$FHDVWăFDUWHDIRVWHOLEHUDWăGH 6HPQăWXUDDVLJXUăWRUXOXL
This Card has been issued by : Signature of Insurer
3. VALABILITATE - V A L I D 4.
'(/$)5203Æ1Ă/$72 Codul
ĠăULL&RGXODVLJXUăWRUXOXL1XPăUXOSROLĠHL 6&$//,$1=ğ,5,$&$6,*85Ă5,6$
Ziua - Day Luna - Month Anul - Year Ziua - Day Luna - Month Anul - Year
Country 6WU&ăGHUHD%DVWLOLHL1U
Code/Insurer`s Code/Number 6HFWRU%XFXUHúWL5RPkQLD
29 12 2016 28 12 2017
$FHVWHGRXăGDWHLQFOXVLY%RWK'DWHVLQFOXVLYH
RO/07/R7/YD

115573823
6. Categoria 7. Marca vehiculului
51UGHFLUFXODĠLHVDX vehiculului / Make of Vehicle
vQOLSVăQULGHQWLILFDUHVDXQUGHPRWRU Category of &DSLWDOVRFLDOVXEVFULVúLYăUVDW94.393.890 lei
Registration No.(or if Vehicle* Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
none) Chassis or Engine No. 6RFLHWDWHDXWRUL]DWăGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
&RGXODORFDWvQ5HJLVWUXODVLJXUăWRULORUúLUHDVLJXUăWRULORU5$017
AG10MGN A Dacia Codul LEI 529900XKNXM9MBH8GS45
9$/$%,/,7$7(7(5,725,$/Ă7(55,725,$/9$/,',7< Operator de date cu caracter personal nr. 779
EN ISO 9001:2008
$FHDVWăFDUWHHVWHYDODELOăvQĠăULOHvQFDUHFăVXĠDFRUHVSXQ]ăWRDUHGHPDLMRVQXHVWHEDUDWăSHQWUXLQIRUPDĠLL
VXSOLPHQWDUHYăUXJăPDFFHVDĠLVLWHXOZZZFRE[RUJ

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3HQWUXLGHQWLILFDUHD%LURXOXLUHOHYDQWYăUXJăPVăYHULILFDĠLYHUVRXOFăUĠLL

(1)
A B BG CY CZ D DK E EST F FIN
GB GR H HR I IRL IS L LT LV M
N NL P PL RO S SK SLO CH AL AND
(2) (3)
AZ BIH BY IL IR MA MD MK MNE RUS SRB
* CODUL CATEGORIILOR DE VEHICULE:
TN TR UA
A. AUTOTURISM/CAR E. AUTOBUS SAU AUTOCAR/BUS

5ăVSXQGHUHDDVLJXUăWRUXOXLSUHYă]XWăvQGRFXPHQWHOHGHDVLJXUDUHHOLEHUDWHSHQWUX&LSUXHVWH B. MOTOCICLU/MOTORCYCLE F. REMORCA/TRAILER

OLPLWDWăODDULDJHRJUDILFăDDFHVWXLVWDWFDUHHVWHVXEFRQWUROXO*XYHUQXOXL5HSXEOLFLL&LSUX C. AUTOCAMION SAU TRACTOR/LORRY OR TRACTOR G. ALTELE/OTHERS

5ăVSXQGHUHDDVLJXUăWRUXOXLSUHYă]XWăvQGRFXPHQWHOHGHDVLJXUDUHHOLEHUDWHSHQWUX$]HUEDLGMDQ D. BICICLETA CU MOTOR/CYCLE FITTED WITH AUXILIARY ENGINE

HVWHOLPLWDWăODDULDJHRJUDILFăDDFHVWXLVWDWFDUHHVWHVXEFRQWUROXO*XYHUQXOXL5HSXEOLFLL$]HUEDLGMDQ

5ăVSXQGHUHDDVLJXUăWRUXOXLSUHYD]XWăvQGRFXPHQWHOHGHDVLJXUDUHHOLEHUDWHSHQWUX6HUELDHVWH
OLPLWDWăODDULDJHRJUDILFăDDFHVWXLVWDWFDUHHVWHVXEFRQWUROXO*XYHUQXOXL5HSXEOLFLL6HUELD

32/,ğĂ'($6,*85$5('(5Ă6381'(5(&,9,/Ă$8725&$ Seria RO/07/R7/YD Nr.

R.C J40/15882/1994 C.U.I. 6120740
115573823
$//,$1=ğ,5,$&$6,*85Ă5,6$
Sucursala / $JHQĠLD Hanul lui Manuc Denumire Broker / Agent Hrescu Mihai /
Tel. / Fax 021-303.82.41, 021-303.82.41 / 021-313.29.52 Cod Broker / Agent RAF366370
&KHOWXLDODPHGLHGHDFKL]LWLHGLUHFWă Comision de intermediere: 5%, respectiv: 32 lei *
Nume/Denumire Asigurat: )HO7LS0DUFă A, Autoturism, Dacia,
Primus Srl Logan
PROPRIETAR Model Vehicul:

C.U.I. / C.N.P. Proprietar: 3243411 Nr. înmatriculare/înregistrare: AG10MGN

Nume/Denumire Asigurat: Nr.identificare - Serie CIV / nr.de UU1LSDJJH36168637 /

UTILIZATOR inventar: F051240

C.U.I. / C.N.P. utilizator: &DSDFLWDWHFLOLQGULFă3XWHUH 1.461 cmc / 48 kw

$GUHVă$VLJXUDW8WLOL]DWRU 1UORFXULPDVăWRWDOă
Pitesti, judet Arges, str. D-Na Balasa, nr. 13 5 / 1.600 kg
Tel. PD[LPăDXWRUL]DWă

9DODELOLWDWHSROLĠăGHOD 29.12.2016 3kQăOD 28.12.2017 HPLVăvQGDWDGH 02.12.2016

Clasa B/M: B10 Prima de asigurare: 615 RON

vQFDVDWăFX 001256074397 Din data de: 02.12.2016

/LPLWDGHGHVSăJXELUHSHQWUXYăWăPDUL
FRUSRUDOHúLGHFHVHVWHGH 5.000.000 EURO
/LPLWDGHGHVSăJXELUHSHQWUXSDJXEH
materiale este de: 1.000.000 EURO
$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUăSULPHúWHúLUăVSXQGHODWRDWHVHVL]ăULOHúLUHFODPDĠLLOH
SULYLQGDFWLYLWDWHDDVLJXUDWRULORUUHDVLJXUDWRULORUúLLQWHUPHGLDULORUvQDVLJXUăULúLVDXUHDVLJXUăUL
6WU6SODLXO,QGHSHQGHQĠHLQU15, sector 5FRGSRúWDO050092%XFXUHúWL
Tel: 0800.825.627 Fax registratura:021.659.60.51 sau 021.659.64.36 e-mail:noffice@asfromania.ro
&RQGLĠLLOHFRQWUDFWXDOHVXQWSUHYă]XWHvQ1RUPHOHSULYLQGDVLJXUDUHDREOLJDWRULHGHUăVSXQGHUHFLYLOăSHQWUX
AG10MGN
SUHMXGLFLLSURGXVHSULQDFFLGHQWHGHYHKLFXOHDGRSWDWHGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
Versiunea 1 din data 02.12.2016

28 12 2017
Seria RO/07/R7/YD
115573823