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Asigurat/Contractant Ivascu Stefan Ciprian CNP/CUI 1890619450011
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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,$6,*85Ă725,/25'( Ivascu Stefan Ciprian, Adresa: Ostrov,
1. CARTE INTERNATIONALE D'ASSURANCE AUTOVEHICULE DIN ROMÂNIA
AUTOMOBILE (B.A.A.R.) judet Constanta, str. 1 Mai, nr. 88, bl. 1, et.
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Code/Insurer`s Code/Number
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Denumire asigurator:$//,$1=ğ,5,$&$6,*85Ă5,6$
Broker / Agent Freya Insur Broker De Asigurare-Reasi Tel/Fax:
Agentia Brokeri - Delea Veche Cod RBK-763
Nume/Denumire Asigurat/ )HO7LS0DUFă0RGHO C, Autoutilitara, Nissan,
Ivascu Stefan Ciprian
Proprietar: Vehicul: L35
C.U.I. / C.N.P. Proprietar: 1890619450011 Nr. înmatriculare/înregistrare: CT44YVA
Nume/Denumire Asigurat/ Nr.identificare - Serie CIV / VSKL3514TLB345530 /
Utilizator: nr.de inventar: O164079
C.U.I. / C.N.P. Utilizator: &DSDFLWDWHFLOLQGULFă3XWHUH 2.820 cmc / 58 kw
$GUHVă$VLJXUDW8WLOL]DWRU Ostrov, judet Constanta, str. 1 Mai, nr. 1UORFXULPDVăWRWDOă
3 / 3.500 kg
Tel. / E-mail 88, bl. 1, et. 3, ap. 10 PD[LPăDXWRUL]DWă

Conducatori auto declarati:

IVASCU STEFAN CIPRIAN 1890619450011;
(Nume, prenume, CNP)
Valabilitate Contract de la 10.12.2022 SkQăOD 09.12.2023 Contract emis în data 09.12.2022
Prima de asigurare 2131 RON Clasa Bonus Malus B4 7DULIGHFRQWDUHGLUHFWă 168 RON 7RWDOSODWă 2299 RON
Nr. Rate* 1 Valoare rate Rata 1: 2299 RON Date scadente Rata 1: 09.12.2022
3ULPDUDWăvQFDVDWăFX RCA 22-079812 în data 09.12.2022
/LPLWDGHGHVSăJXELUHSHQWUXYăWăPDULFRUSRUDOHúLGHFHV 6.070.000 EURO
/LPLWDGHGHVSăJXELUHSHQWUXGDXQHPDWHULDOH 1.220.000 EURO
Acoperiri/servicii suplimentare: Decontare directa
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 NOTA PENTRU ASIGURAT
In ceea ce priveste (a) avarierea vehiculului asigurat, indiferent de modalitatea de producere a acesteia; (b) vatamarile corporale care nu sunt acoperite conform legislatiei privind asigurarea de raspundere civila obligatorie din tara in care a avut
loc accidentul; (c) reinnoirea unei Carti Verzi a carei valabilitate a expirat, Biroul din tara vizitata nu trebuie sa fie contactat, ci se va contacta direct asiguratorul , daca nu exista alte instructiuni din partea asiguratoruloui.
NOTE TO THE INSURED
In regard to (a) damage to the insured vehicle, however caused; (b) personal injuries not covered by the Compulsory Third Party Insurance Law in force in the country of accident; c) renewal of a card the validity of wich has expired; the Bureau
of the country visited should not be approached but notification should be given (unless otherwise instructed by the Insurer) direct to the Insurer.
DENUMIRILE SI ADRESELE BIROURILOR

A AUSTRIA VERBAND DER VERSICHERUNGSUNTERNEHMEN OSTERREICHS IS ICELAND ALPJÓDLEGAR BIFREIDATRYGGINGAR Á ISLANDI, Borgartuni 35, 105
Schwarzenbergplats 7, Postfach 248, A-1030 WIEN :[43] (1) 711 560 REYKJAVIK, :[354] 568 1612,
AL ALBANIA BSHS BYROJA SHQIPTARE E SIGURIMIT, Rruga µ¶Gjergj Fishta´Pall Edil-Al-lt, Kati L LUXENBOURG BUREAU LUXEMBOURGEOIS DES ASSUREURS,12, rue Erasme, L-1468,
II-te, TIRANA : [355] (42) 54033 LUXEMBOURG :[352] 45 73 04
AND ANDORRA OFICINA ANDORRANA D¶ENTITATS D¶ASSEGURANCA D¶AUTOMOBIL, c/o Maria LT LITHUANIA MOTOR INSURERS¶BUREAU OF THE REPUBLIC OF LITHUANIA , Algirdo 38, LT-
Pla., 33, 3r, 3a, AD500 ANDORRA LA VELLA : [376] 86 00 17 03606 VILNIUS, :[370] 5 216 28 60
AZ AZERBAIJAN COMPULSORY INSURANCE BUREAU SAT PLAZA, 11-th floor, 133 Bashir Safaroglu LV LATVIA LATVIJAS TRANSPORTIDZEKLU APDROŠINATAJU BIROJS (Motor insurers¶bureau
Street., BAKU, AZ1009 : [+994 12] 595 00 20 of Latvia) , 9 Lomonosova Street, Riga LV-1019 :[371] 67 114 30
B BELGIUM BUREAU BELGE DES ASSUREURS AUTOMOBILES, Rue de la Charité 33 Bte 2, BE- M MALTA MALTA GREEN CARD BUREAU, 43A/4 St. Paul¶s Buildings, West Street, VALLETTA
1210 BRUXELLES : [32] (2) 287 18 VLT 1532, :[356] 21 238 253, [356] 21 232 640,
BG BULGARIA NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS, 2, Graf Ignatiev Str, 2nd MA MAROCCO BUREAU CENTRAL MAROCAIN DES STES D¶ASSURANCES, 154 Blvd d¶Anfa, 01-
floor, SOFIA 1000 : [359] (2) 981 11 03 CASABLANCA 20050, :[212] (522) 39 18 57 :[212] (522) 39 18 59
BIH BOSNIA AND HERTEGOVINA BIRO ZELENE KARTE U BOSNI I HERCEGOVINI, Dervisa Numica MD MOLDOVA NATIONAL BUREAU OF MOTOR INSURERS OF MOLDOVA (NBMIM), 16
7, 71000 SARAJEVO : [387] (33) 610 744 .RJăOQLFHDQXVWU&+,6,1$8 :[373] 22 221 970
BY BELARUS BELARUSIAN TRANSPORT INSURANCE BUREAU, 29-70 Pritytskogo Str., MINSK MK NORTH MACEDONIA NATIONAL INSURANCE BUREAU, ³Mitropolit Trodosij Galanov´str.
: [375] (17) 209 85 25 no.28/IV SKOPJE, : [389] (2) 3136 172
CH SWITZERLAND NATIONALES VERSICHERUNGSBURO SCHWEIZ (NVB)/ SWISS NATIONAL MNE ASSOCIATION NATIONAL BUREAU OF MONTENEGRO INSURES, PC Europoint,
BUREAU OF INSURANCE (NBI),P.O. Box, CH-8085 Zurich :[41] (44) 628 65 19 ± MONTENEGRO Svetlane Kane Radevic 3/II Podgorica 81000 PODGORICA, :[382] (20) 243 440
Secretariat,[41] (44) 628 89 30 ±Claims N NORWAY TRAFIKKFORSIKRINGSFORENINGEN, Hansteens gate 2, Postboks 2551 Solli, 0202
CY CYPRUS MOTOR INSURERS¶FUND, 23, Zenon Sozos Str, P.O. Box 22025 1516 NICOSIA : OSLO, :[47] (23) 28 42 0
[357] (22) 763 913 ,[357] (22) 764 907 NL NETHERLANDS NEDERLANDS BUREAU DER MOTORRIJTUIGVERZEKERAARS, Handelskade 49
CZ CZECH REP CESKA KANCELAR POJISTITELU, Na Pankraci 1724/129, 140 00 PRAHA 4, :[420] NL-2288 BA RIJSWIJK ZH, :[31] (70) 340 82 80
221 413 660 P PORTUGAL GABINETE PORTUGUÊS DE CARTA VERDE-GPCV, Rua Rodrigo da Fonseca no.41, P-
D GERMANY DEUTSCHES BURO GRUNE KARTE E.V. Wilhelmstrasse 43/43 G, D-10117 Berlin , : 1250 190 LISBOA, :[351] (21) 384 8101/ 02
[49] (30) 2020 57 57 PL POLAND POLISH MOTOR INSUERS¶BUREAU, Ul. Swietokrzyska 14, PL 00-050 WARSAW, :
DK DENMARK DANSK FORENING FOR INTERNATIONAL MOTORKORETOJSFORSIKRING, Philip [48] (22) 826 46 33
Heymans Alle 1, DK-2900 HELLERUP, :[45] (41) 91 91 91 RO ROMANIA BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA (B.A.A.R.) 40-
E SPAIN OFICINA ESPAÑOLA DE ASEGURADORES DE AUTOMOVILES, Sagasta 18, 28004 ELV9DVLOH/DVFăU6WUHHW%8&+$5(67FRGH :[40] (21) 319 13 02/ 03
MADRID, :[34] (91) 446 03 00 RUS RUSSIA RUSSIAN ASSOCIATION OF MOTOR INSURERS, 27 bld. 3, Lusinovskaya str., 115093
EST ESTONIA EESTI LIIKLUSKINDLUSTUSE FOND, Mustamäe tee 46, 10621 TALLINN, :[372] 667 MOSKOW, Secretariat: [7] (495) 771 69 47 Claims: [7] (495) 641 27 8
1800 S SWEDEN TRAFIKFORSAKRINGSFORENINGEN, Karlavagen 108, STOCKHOLM/ Box 24035,
F FRANCE BUREAU CENTRAL FRANÇAIS, 1, rue Jules Lefebvre, 75431 Paris Cedex 09 , :[33] SE-104 50 STOCKHOLM, :[46] (8) 522 782 00
(1) 53 21 50 80 SRB SERBIA UDRUZENJE OSIGURAVACA SRBIJE, Milentija Popovica 5b/11, 11000 BELGRADE,
FIN FINLAND LIIKENNEVAKUUTUSKESKUS, Itämerenkatu 11-13 HELSINKI FIN-00180, :[358] (0) :[381] (11) 29 27 950
404 504 520 SK SLOVAK REP SLOVENSKÁ KANCELÁRIA POIST¶OVATEL¶OV, Bajikalska 19B, 826 58
GR GREECE MOTOR INSURERS¶BUREAU ±GREECE, 9 Xenophontos Street, ATHENS 105 57, : BRATISLAVA 29, :[421] 2 4444 5452
[30] (210) 32 23 324 [30] (210) 32 36 562 SLO SLOVENIA SLOVENSKO ZAVAROVALNO ZDRUZENJE, GIZ, 1001 LJUBLJANA, Zelezna cesta
H HUNGARY MAGYAR BISTOSITOK SZOVETSEGE (MABISZ) Hungarian Motor Insurance Bureau, 14, :[386] (1) 4735 322
Andrassy ut 93, H-1062 BUDAPEST/, POB 1297, H-1381 BUDAPEST 62, :[36] (1) 802 TN TUNISIA BUREAU UNIFIE AUTOMOBILE TUNISIEN, 85-87 Rue Palestine, 1002 TUNIS
8400 Belvedere , :[ 216] 71 841 514, [216] 71 841 784
HR CROATIA HRVATSKI URED ZA OSIGURANJE, Croatian Insurance Bureau, 10000 ZAGREB, TR TURKEY TURKIYE MOTORLU TASIT BUROSU (TURKISH MOTOR INSURANCE BUREAU) ,
Martieva 71, :[385] (1) 46 96 600 Buyukdere Cad. Oya Sk. Devran Apt. 2/1, 34394 Gayrettepe, ISTANBUL, :[90] (212) 217
I ITALY UFFICIO CENTRALE ITALIANO, (U.C.I.) SOC. CONS. A.R.L., 20145 MILANO, Corso 5968 69/ 70 /71
Sempione 39, :[39] (02) 34 96 81 UA UKRAINE MOTOR (TRANSPORT) INSURANCE BUREAU OF UKRAINE, , P.O.B. 272, KYIV-2,
IR ISLAMIC REP. GREEN CARD BUREAU OF IRAN, C/O BIMEH MARKAZI IRAN ,No. 2, corner of 02002, :[38] (044) 239 20 27
OF IRAN Maryam St., Nelson Mandela Ave. -196776411 ±POB 19395-5588 ±TEHRAN-IRAN, : UK UNITED KINGDOM OF GREAT-BRITAIN AND NORTHERN IRELAND MOTOR
[98] (21) 24 55 1000 INSURERS¶BUREAU ±UK, Linford Wood House 6-12, Capital Drive, Linford
IRL IRLANDA MOTOR INSURERS¶BUREAU OF IRELAND 5 Harbourmaster Place, IFSC, Dublin 1, Wood, MILTON KEYNES MK14 6XT, Telefon:[44] (1908) 830 0
IRELAND : [353] (1) 676 9944

Pentru informatii suplimentare va rugam sa accesati: www.cobx.org

Conditiile contractuale sunt cele prevazute prin dispozitiile Legii nr. 132/2017 privind asigurarea obligatorie de raspundere civila
auto pentru prejudicii produse tertilor prin accidente de vehicule si tramvaie si cele ale legislatiei secundare emise de catre A.S.F.
(Norma RCA 20/2017) in aplicarea acesteia ce se regasesc postate pe siteul Allianz Tiriac.
Acestea pot fi completate si cu alte prevederi/clauze suplimentare ce sunt stabilite de comun acord de catre asigurat si asigurator si
sunt prevazute intr-un act aditional la prezentul contract.
Contractul RCA, inclusiv orice act aditional sau anexa la acesta constituie titlu executoriu pentru ratele scadente si neachitate, in
conformitate cu prevederile Art. 5 alin. (3) din Legea nr. 132/2017 privind asigurarea obligatorie de raspundere civila auto pentru
prejudicii produse tertilor prin accidente de vehicule si tramvaie.
In cazul in care Contractantul/Asiguratul nu plateste prima de asigurare conform prevederilor agreate, la termenele stabilite
in polita de asigurare, Asiguratorul va rezilia (inceta) polita fara nicio notificare prealabila, iar aceasta nu va mai produce
niciun efect fata de tertii pagubiti sau autoritatile statului.
Contractul RCA da dreptul persoanei prejudiciate, in cazul producerii unui prejudiciu, sa se poata adresa pentru efectuarea reparatiei
oricarei unitati reparatoare auto, in conditiile legii, fara nicio restrictie sau constrangere din partea asiguratorului RCA sau a unitatii
reparatoare auto, care ar putea sa-i influenteze optiunea.
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Data : 09.12.2022

Am primit de la: IVASCU STEFAN CIPRIAN, CNP/CUI 1890619450011

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Obligatorie Auto nr. 120124790 din 09.12.2022

Intermediar : FREYA INSUR BROKER DE ASIGURARE-

REASIGURARE SRL
Cod RAF: RBK-763
Semnatura :
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România Codul LEI 529900XKNXM9MBH8GS45
Telefon 021 20 10 100 Operator de date cu caracter personal nr. 779
Fax 021 2082 211 EN ISO 9001:2008
www.allianztiriac.ro

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Data : 09.12.2022

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Obligatorie Auto nr. 120124790 din 09.12.2022

Intermediar : FREYA INSUR BROKER DE ASIGURARE-

REASIGURARE SRL
Cod RAF: RBK-763
Semnatura :
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România Codul LEI 529900XKNXM9MBH8GS45
Telefon 021 20 10 100 Operator de date cu caracter personal nr. 779
Fax 021 2082 211 EN ISO 9001:2008
www.allianztiriac.ro