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Cerere de asigurare Auto


6HULHFDOFXODĠLH4687997724
,QIRUPDĠLLGHVSUHSURSULHWDUXOXWLOL]DWRUXOYHKLFXOXOXL
1XPHúLSUHQXPH Becheanu Florin
Proprietar CNP 1771028284379
-XGHĠXOúLORFDOLWDWHDGHUHɁHGLQĠă Slatina, Olt
,QIRUPDĠLLGHVSUHDVLJXUDUH
'DWDLQWUăULLvQYDODELOLWDWH 01/03/2021
Perioada de asigurare 12 luni, de la 01/03/2021 la 28/02/2022
5HvQQRLUHSROLĠDQU - CPS101542294
)UHFYHQĠDGHSODWăDSROLĠHLGHDVLJXUDUH 10 rate 10 rate
Rca Casco
Moneda în care se va îQFKHLDSROLĠDGHDVLJXUDUH RON RON
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Categorie Autoturism Model Tip Duster I (03.2010->)
Marca Dacia Versiune Versiune SL Black Touch 4x2
0DVDPD[LPăDXWRUL]DWă 1697 1XPăUGHORFXUL 5
&DSDFLWDWHFLOLQGULFă 1598 Putere 84
Sursa de energie Benzina $QIDEULFDĠLH 2017
.0vQUHJLVWUDĠLODERUGXOYHKLFXOXOXL 42481 6XPDDVLJXUDWăDYHKLFXOXOXL 38,744
9DORDUHDWRWDOăDGRWăULORUVXSOLPHQWDUH 0
Istoricul daunelor RCA
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Vehiculul este înmatriculat în România
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datelor cu caracter personal (detalii suplimentare pe https://www.allianztiriac.ro/ro_RO/aspecte-legale.html ).
'HFODUFăDPSULPLWWRDWHLQIRUPD‫܊‬LLOHSUHFRQWUDFWXDOHLQFOXVLYGRFXPHQWXOGHLQIRUPDUHFXSULYLUHODSURGXVXOGHDVLJXUDUH 3,' ‫܈‬L*KLGGH
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Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
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Telefon 021 2082 222 Codul LEI 529900XKNXM9MBH8GS45
Fax 021 2082 211 Operator de date cu caracter personal nr. 779
www.allianztiriac.ro EN ISO 9001

&ODVLILFDUH&RQILGHQĠLDO
2IHUWăGHDVLJXUDUH

Acoperiri RCA Confort Plus Extra Max )UDQúL]ă

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Protec‫܊‬ie MXULGLFă
15,000 RON 15,000 RON 15,000 RON 15,000 RON

$VLVWHQ‫܊‬ăUXWLHUă
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Accidente persoane
%D]ă Extins Extins Extins
'HFHV,QYDOLGLWDWHWHPSRUDUă 5,000 RON 10,000 RON 10,000 RON 10,000 RON
,QYDOLGLWDWHSHUPDQHQWăWRWDOă 10,000 RON 20,000 RON 20,000 RON 20,000 RON
Fenomene naturale 0
Incendiu, explozie 0
Daune provocate de animale 0
Furt 0
Vandalism 0
Elemente vitrate 0
&ROL]LXQH]JkULHUH‫܈‬LDOWHULVFXUL 0
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Service Partener

Prima de asigurare - Cost Total RCA Confort Plus Extra Max

RON (RCA/CASCO) 531 RON 597 RON 832 RON 950 RON 2141 RON

Detalierea primelor de asigurare RCA Confort Plus Extra Max

5ăVSXQGHUHFLYLOăDXWR 5&$ 531 RON 531 RON 531 RON 531 RON 531 RON
3URWHF‫܊‬LHMXULGLFă - 20 RON 20 RON 20 RON 20 RON
$VLVWHQĠăUXWLHUă - 30 RON 55 RON 55 RON 55 RON
Accidente Persoane - 16 RON 44 RON 44 RON 44 RON
Acoperiri Casco - - 182 RON 300 RON 1491 RON

Tip Reducere RCA Casco

Reduceri aplicate pentru 5HGXFHUHFRPHUFLDOă 0 RON -176 RON


pachetul selectat Reducere pachet -59 RON -196 RON
Reducere Service Partener - 0
5HGXFHUH&RPXQLFDUH(OHFWURQLFă 0 RON -10 RON
Total -59 RON -382 RON
Comisionul de intermediere inclus în prima RCA Confort Plus Extra Max
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primei de asigurare (12 %) (12 %) (12 %) (12 %) (12 %)

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Emiterea politei de asigurare este conditionata de existenta sau furnizarea numarului de telefon mobil si a adresei de e-mail valide,
declarate de Contractant.
DĞŶƜŝƵŶŝ
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a) YHKLFXOXOHUDGHVWLQDWDILIRORVLWvQDOWHVFRSXULGHFkWFHOSHUVRQDOGHFODUDWODvQFKHLUHDDVLJXUăULLVDXvQWUXQVXSOLPHQWGH
DVLJXUDUH UHVSHFWLYHVWHIRORVLWSHQWUXDFWLYLWă‫܊‬LSUHFXPWD[LúFRDOăúRIHULSD]ă‫܈‬LSURWHF‫܊‬LHUHQWDFDU 
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asigurare sau într-un supliment de asigurare emis anterior producerii riscului asigurat.

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la alegerea Pachetului Max.
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x3R‫܊‬LRSWD‫܈‬LSHQWUXFODX]D'HFRQWDUHGLUHFWă±prima de asigurare 88 RON
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Client / Solicitant Agent / Broker $OOLDQ]ğLULDF$VLJXUăUL6$


Becheanu Florin Gronea Ileana (RAF415371) Slatina - Vasile Mirela

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6WU&ăGHUHD%DVWLOLHLQU Înregistratla ORC sub nr. J40/15882/1994, CUI:6120740
Sector 1%XFXUHúWL010616, România 6RFLHWDWHDXWRUL]DWăGH$XWRULWDWHDGH6XSUDYHKHUH)LQDQFLDUă
Telefon 021 2082 222 &RGXODORFDWvQ5HJLVWUXODVLJXUăWRULORUúLUHDVLJXUăWRULORU5$
Fax 021 2082 211 Codul LEI 52990XKNXM9MBH8GS45
www.allianztiriac.ro Operatorul de date cu caracter personal nr. 779
SR EN ISO 9001
Scrisoare de informare
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Telefon: 0801.0801.08 sau 021.20.19.100 (de luni asigurare
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$VLJXUăWRULORU 2. E-mail: info@allianztiriac.ro;
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ÌQUHJLVWUDWăvQ5HJLVWUXOGHHYLGHQ‫܊‬ăDSUHOXFUăULORUGH 4. Site: www.allianztiriac.roODUXEULFLOH&RQWDFW‫܈‬L
date cu caracter personal sub nr. 779; 5HFODPD‫܊‬LL
EN ISO 9001. 5. Telefon: 021.20.19.100 sau 0801.0801.08 de luni
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conform prevederilor legale, persoanele asigurate, XUPăWRDUHOHGDWHGHFRQWDFW
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În conformitate cu prevederile Legii 517/2003 (Codul FOLHQWXOXL&HOHODOWHLQIRUPD‫܊‬LLUHIHULWRDUHODFRQWUDFWXO
ILVFDO FKHOWXLHOLOHFXSULPHOHGHDVLJXUăULJHQHUDOH GHDVLJXUDUHVXQWFXSULQVHvQ&RQGL‫܊‬LLOHVSHFLDOHGH
încheiate de persoane fizice nu sunt deductibile fiscal, DVLJXUDUH‫܈‬L&ODX]HOHVSHFLDOHFDUHYDXIRVWUHPLVH
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nu sunt venituri impozabile.

Subsemnatul Becheanu Florin GHFODUFăDPSULPLWLQIRUPD‫܊‬LLOHSULYLQGDVLJXUăWRUXOOHJHD


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cuprinse în Ghidul de beneficii auto cod GBA v.2/ian 2019.
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6&$OOLDQ]‫܉‬LULDF$VLJXUăUL6$ Client/Solicitant
6XFXUVDOD$JHQ‫܊‬LD Slatina Becheanu Florin
1XPH3UHQXPH6HPQăWXUă
Reprezentant Gronea Ileana (RAF415371)

Data 18.02.2021 (zz.ll.aaaa)

6&$OOLDQ]ğLULDF$VLJXUăUL6$ &DSLWDOVRFLDOVXEVFULVúLYăUVDWOHL
6WU&ăGHUHD%DVWLOLHLQU Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
6HFWRU%XFXUHúWL5RPkQLD 6RFLHWDWHDXWRUL]DWăGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
Telefon 021 2082 222 &RGXODORFDWvQ5HJLVWUXODVLJXUăWRULORUúLUHDVLJXUăWRULORU5$
Fax 021 2082 211 Codul LEI 529900XKNXM9MBH8GS45
www.allianztiriac.ro Operator de date cu caracter personal nr. 779
EN ISO 9001

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