MULTITRAVEL

3ROLĠDGHDVLJXUDUHPHGLFDOăGHFăOăWRULHvQVWUăLQăWDWHFXYDODELOLWDWHXQDQQU
MTL126250411
(Travel Health Insurance Policy with One Year Validity)
ÌQED]DFRQGLĠLLORUGHDVLJXUDUHúLvQVFKLPEXOvQFDVăULLSULPHLGHDVLJXUDUHFRUHVSXQ]ăWRDUH$//,$1=ğ,5,$&$6,*85Ă5,6$
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(Throughout Terms and Conditions, in exchange of insurance premium collection, ALLIANZ TIRIAC ASIGURARI S.A. insures:)
Nume (Name): Popovici Prenume (First Name): Luca Andrei
&131USDúDSRUW(Serial ID/Passport No): 5100904450055 'DWDQDúWHULL(Date of birth): 04.09.2010
Tel. (Telephone no.): 740031553 Email (E-mail address): sir_cosmin@yahoo.com
Adresa ORFVWUQUMXGHĠVHFWRU Bucuresti; Sector 4; Str. Alexandru Obregia; Nr. 2A; Bl. 2A; Ap. 77;
(Address: town, street, no., county):
'DWDLQWUăULLvQYLJRDUH(Date of entry into force): 31.07.2022 'DWDH[SLUăULL(Expiry date): 30.07.2023
Planul de asigurare: 3/$18/vQWRDWHĠăULOHFXH[FHSĠLD68$&DQDGD5RPkQLDúLDĠăULLGHUH]LGHQĠăD$VLJXUDWXOXL
(Insurance Plan) (PLAN 1 ±All countries with the exception of USA, Canada, Romania and residential country of the
Insured)
6XPDDVLJXUDWă 30.000 EUR ±cheltuieli medicale, din care Sport de agrement: Prima de asigurare:
(Sum Insured) 7.000 EUR ±cheltuieli repatriere (Recreational Sport) (Insurance Premium)
1.000 EUR ±cheltuieli medicale ca urmare a unui puseu acut 236RON
DOXQHLDIHFĠLXQLSUHH[LVWHQWHVDXDXQHLEROLFURQLFH(medical
expenses as a result of acute flare of pre-existing condition or
cronic disease)
Data emiterii: (Issue Date): 27.07.2022
352&('85Ă'(850$7Ì1&$='(85*(1ğĂ PROCEDURE TO BE FOLLOWED IN CASE OF EMERGENCY
ÌQFD]GHDFFLGHQWVDXvPEROQăYLUHVXELWă$VLJXUDWXOVDXXQ In case of sudden accident or illness, the Insured or his/her
UHSUH]HQWDQWDODFHVWXLDWUHEXLHVăUDSRUWH]HXUJHQĠDPHGLFDOă representative has to report medical emergency immediately to the
LPHGLDWOD&RPSDQLDGHDVLVWHQĠă MONDIAL ASSISTANCE GmBH, Vă Company of Assistance MONDIAL ASSISTANCE GmBH, to provide the
RIHUHXUPăWRDUHOHLQIRUPDĠLL following information:
ƒQXPHOHúLSUHQXPHOH ƒ name and surname
ƒ QXPăUXOSROLĠHLGHDVLJXUDUH ƒ insurance policy number
ƒ QXPăUXOGHWHOHIRQúLDGUHVDODFDUHSXWHĠLILFRQWDFWDWvQ ƒ telephone number and contact address details from abroad;
VWUăLQăWDWH ƒ reason for requesting assistance
ƒ PRWLYXOSHQWUXFDUHVROLFLWDĠLDVLVWHQĠă and to follow the instructions received from the Company of Assistance.
úLVăUHVSHFWHLQVWUXFĠLXQLOHSULPLWHGHOD&RPSDQLDGHDVLVWHQĠă

IMPORTANT: &RQWUDFWXOGHDVLJXUDUHHVWHYDODELOOXQLSHQWUXXQQXPăUQHOLPLWDWGHFăOăWRULLvQVWUăLQăWDWH$VLJXUăWRUXO
DFRUGăLQGHPQL]DĠLLSHQWUXULVFXULOHFDUHLQWHUYLQvQSULPHOHGH]LOHDOHILHFăUHLFăOăWRULLThe current insurance contract is
valid for 12 months, for an unlimited number of travels. The Insurer covers the risks from the first 25 days of each travel.)

MULTITRAVEL MULTITRAVEL
$VLJXUDUHPHGLFDOăGHFăOăWRULH Travel Health Insurance
ÌQFD]GHXUJHQĠăYăUXJăPVăFRQWDFWDĠL In case of emergency please contact
Mondial Assistance GmBH Mondial Assistance GmBH Pottendorfer
Pottendorfer Strasse 25-27, A-1120 Wien, Strasse 25-27, A-1120 Wien,
Tel.: 00 43 (1) 525 03 53, 0040 (21) 312 22 39 Tel.: 00 43 (1) 525 03 53, 0040 (21) 312 22 39
Centrul de Daune Allianz-Tiriac Asigurari:0040 (21) 201 91 81 Claim Center Allianz-Tiriac Asigurari:0040 (21) 201 91 81
1XPDUSROLĠă07/ Policy number: MTL126250411
Nume/Prenume: Luca Andrei/Popovici Name/Surname: Luca Andrei/Popovici
Perioada de valabilitate: 31.07.2022 - 30.07.2023 Validity period: 31.07.2022 - 30.07.2023
$POXDWODFXQRúWLQĠăGHFHOHvQVFULVHvQ&HUHUHDGH$VLJXUDUHIPID, &RQGLĠLLOHGH$VLJXUDUHYHUVLXQHD&$0úLGHFODUSHSURSULDUăVSXQGHUHFă
GDWHOHLQFOXVHvQ&HUHUHDGH$VLJXUDUHVXQWUHDOHúLvQFRQIRUPLWDWHFXLQIRUPDĠLLOHGHFDUHGLVSXQDVWIHOVXQWGHDFRUGFXvQFKHLHUHDcontractului
de asigurare vQDFHVWHFRQGLĠLLI have been notified with respect to the Application Form, Insurance Product Information Document and Terms
and Conditions CAM09 and I declare on my own responsibility that the dates included in the Application Form are real and in agreement with the
information I set, therefore, I agree to conclude the insurance contract under this conditions.)
3UH]HQWDSROLĠDHVWHvQFKHLDWăvQGRXăH[HPSODUHThe current policy is concluded in two indents.)

ASIGURAT (Insured) INTERMEDIAR (Intermediarry) $6,*85Ă725(Insurer)

POPOVICI LUCA ANDREI BONUS INSURANCE - AGENT DE ASIGURARE
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signature) mark)

6&$OOLDQ]ğLULDF$VLJXUăUL6$ &DSLWDOVRFLDOVXEVFULVúLYăUVDWOHL
6WU&ăGHUHD%DVWLOLHLQU Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
6HFWRU%XFXUHúWL5RPDQLD 6RFLHWDWH$XWRUL]DWăGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
Telefon 0212019100 &RGXODORFDWvQ5HJLVWUXO$VLJXUăWRULORUúLUHDVLJXUăWRULORU RA-017
Fax 021 2082 211 Codul LEI 529900XKNXM9MBH8GS45
www.allianztiriac.ro 1 Operator de date cu caracter personal nr. 779
SR EN ISO 9001:2015