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Cerere de asigurare - Voiaj Data întocmirii: 17.08.2021
Date despre Asigurat
(*)Cod numeric Personal: 5020610324789 (*)'DWD1DúWHULL 10.06.2002
Date despre Asigurare
(*)'XUDWDFăOăWRULHL 11 zile
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(*)Plan de asigurare
Asiguratului
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A - Toate tarile cu exceptia SUA,Canadei,României
(*)Planul de asigurare ales
si tarii de rezidenta a Asiguratului
(*)Suma asigurată pentru Asigurarea Medicală:
- cheltuieli medicale 30.000 EUR
- cheltuieli de repatriere(***) 10.000 EUR
- cheltuieli medicale ca urmare a unui puseu acut al unor 1.000 EUR
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(*)Suma asigurată pentru Asigurarea de Accidente Persoane: 5.000 EUR
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Prima de Asigurare 39 RON
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Am primit Nota de informare, IPID ‫܈‬LFRQGLĠLLOHGHDVLJXUDUHSHQWUXDVLJXUDUHDGHFălătorie în străinătate VoiajYHUVLXQHD&$9 DWD‫܈‬DWHSUH]HQWHL DP
luat la cunoúWLQWăGHVSUHSUHYHGHULOHDFHVWRUDLDUGDWHOHLQFOXVHvQFHUHUHDGHDVLJXUDUHVXQWUHDOHFRUHFWHúi complete. Emiterea politei de asigurare
este conditionata de existenta sau furnizarea numarului de telefon mobil si a adresei de e-mail valide, declarate de Contractant.
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Client/Solicitant: 6&$OOLDQ]‫܉‬LULDF$VLJXUăUL6$
Sucursala/Agentia
Nume, prenume, semnatura Reprezentant

Intocmit la data 17.08.2021, ora 8:04 Pagina 1 din 2

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ƌĞƉƚƵƌŝůĞƔŝŽďůŝŐĂԑŝŝůĞŽŶƚƌĂĐƚĂŶƚƵůƵŝͬƐŝŐƵƌĂƚƵůƵŝ͕
ĐŽƌĞƐƉƵŶnjĉƚŽĂƌĞĐŽŶƚƌĂĐƚĞůŽƌĚĞĂƐŝŐƵƌĂƌĞƐƵŶƚƐƚĂďŝůŝƚĞƉƌŝŶ
ĐŽŶĚŝԑŝŝůĞĚĞĂƐŝŐƵƌĂƌĞĂĨĞƌĞŶƚĞƉƌŽĚƵƐƵůƵŝĂůĞƐ͘
E&///͕sE/DEd^/'hZd͕/EDE/Ԑ//
ASIGURARE
2ŶďĂnjĂĐŽŶƚƌĂĐƚƵůƵŝĚĞĂƐŝŐƵƌĂƌĞĂůĞƐƔŝŠŶĨƵŶĐԑŝĞĚĞĂĐŽƉĞƌŝƌŝůĞ
ĂůĞƐĞ͕ƐŝŐƵƌĉƚŽƌƵůƐĞŽďůŝŐĉƐĉĂĐŽƌĚĞŝŶĚĞŵŶŝnjĂԑŝŝĚĞ
asigurare/rambursare costuri la producerea riscurilor asigurate,
ĂƔĂĐƵŵƐƵŶƚĚĞƐĐƌŝƐĞŠŶĐŽŶĚŝԑŝŝůĞĚĞĂƐŝŐƵƌĂƌĞŵĂŝƐƵƐ
ŵĞŶԑŝŽŶĂƚĞ͘>ŝŵŝƚĞůĞĚĞƐƵŵĉĂƐŝŐƵƌĂƚĉƔŝƚĞƌŝƚŽƌŝĂůŝƚĂƚĞƐƵŶƚ
ƐƉĞĐŝĨŝĐĂƚĞŠŶŽĨĞƌƚĉ͘
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ZĉƐƉƵŶĚĞƌĞĂƐŝŐƵƌĉƚŽƌƵůƵŝŠŶĐĞƉĞůĂĚĂƚĂŵĞŶԑŝŽŶĂƚĉŠŶƉŽůŝԑĉ
ca fiind data începerii perioadei de valabilitate a contractului de
asigurare, dar nu înainte de trecerea frontierei de stat a României
ƉĞŶƚƌƵĞĨĞĐƚƵĂƌĞĂĐĉůĉƚŽƌŝĞŝŠŶƐƚƌĉŝŶĉƚĂƚĞƔŝĂĞĨĞĐƚƵĉƌŝŝƉůĉԑŝŝ
primei de asigurare, ŵĂŝƉƵԑŝŶŠŶĐĂnjƵůĂƐŝŐƵƌĉƌŝŝ^ƚŽƌŶŽƉĞŶƚƌƵ
ĐŚĞůƚƵŝĞůŝůĞĚĞĂŶƵůĂƌĞĂĐĉůĉƚŽƌŝĞŝ͕ĐąŶĚƌĉƐƉƵŶĚĞƌĞĂ
ƐŝŐƵƌĉƚŽƌƵůƵŝŠŶĐĞƉĞůĂĚĂƚĂŵĞŶԑŝŽŶĂƚĉŠŶƉŽůŝԑĉ͕ĚƵƉĉ
ĞĨĞĐƚƵĂƌĞĂƉůĉԑŝŝƉƌŝŵĞŝĚĞĂƐŝŐƵƌĂƌĞ͘
ĂĐĉůĂŵŽŵĞŶƚƵůŠŶĐŚĞŝĞƌŝŝĐŽŶƚƌĂĐƚƵůƵŝĚĞĂƐŝŐƵƌĂƌĞ͕ƐŝŐƵƌĂƚƵů
ŶƵƐĞĂĨůĉƉĞƚĞƌŝƚŽƌŝƵůZŽŵąŶŝĞŝ͕ƌĉƐƉƵŶĚĞƌĞĂƐŝŐƵƌĉƚŽƌƵůƵŝ
ŠŶĐĞƉĞĚƵƉĉϳnjŝůĞĐĂůĞŶĚĂƌŝƐƚŝĐĞ͕ĐĂůĐƵůĂƚĞĚŝŶnjŝƵĂƵƌŵĉƚŽĂƌĞ
ĞŵŝƚĞƌŝŝĐŽŶƚƌĂĐƚƵůƵŝĚĞĂƐŝŐƵƌĂƌĞƔŝĞĨĞĐƚƵĉƌŝŝƉůĉԑŝŝƉƌŝŵĞŝĚĞ
asigurare.
În cazul în care data de emitere a contractului de asigurare
ĐŽƌĞƐƉƵŶĚĞĐƵĚĂƚĂƉůĞĐĉƌŝŝŠŶƐƚƌĉŝŶĉƚĂƚĞ͕ĐŽŶƚƌĂĐƚƵůĚĞĂƐŝŐƵƌĂƌĞ
ǀĂŝŶƚƌĂŠŶǀŝŐŽĂƌĞĚƵƉĉϮŽƌĞĚĞůĂŵŽŵĞŶƚƵůĞŵŝƚĞƌŝŝƐĂůĞ͘
ZĉƐƉƵŶĚĞƌĞĂĐŽŶƚƌĂĐƚƵĂůĉĂƐŝŐƵƌĉƚŽƌƵůƵŝŠŶĐĞƚĞĂnjĉŠŶ
ƵƌŵĉƚŽĂƌĞůĞĐĂnjƵƌŝ͗
 ůĂŝŶŝԑŝĂƚŝǀĂŽŶƚƌĂĐƚĂŶƚƵůƵŝ͕ĐĂƵƌŵĂƌĞĂ
ŠŶƌĞŐŝƐƚƌĉƌŝŝƐŽůŝĐŝƚĉƌŝŝĚĞƌĞnjŝůŝĞƌĞůĂƐĞĚŝƵů
ƐŝŐƵƌĉƚŽƌƵůƵŝ͖
 ůĂŝŶŝԑŝĂƚŝǀĂƐŝŐƵƌĉƚŽƌƵůƵŝ͕ĐŽŶĨŽƌŵƉƌĞǀĞĚĞƌŝůŽƌ
ĐŽŶĚŝԑŝŝůŽƌĚĞĂƐŝŐƵƌĂƌĞ͕ĂĚŝƐƉŽnjŝԑŝŝůŽƌůĞŐĂůĞŽƌŝŠŶ
ďĂnjĂƉƌĞǀĞĚĞƌŝůŽƌƐĂŶĐԑŝƵŶŝůŽƌŝŶƚĞƌŶĂԑŝŽŶĂůĞ͖
 la ora 24:00 a zilei specificate ca data de
maturitate;
 ůĂĚĂƚĂůĂĐĂƌĞƐƵŵĂƌĂŵďƵƌƐĉƌŝůŽƌ
ĞĨĞĐƚƵĂƚĞͬŝŶĚĞŵŶŝnjĂԑŝŝůŽƌĚĞĂƐŝŐƵƌĂƌĞŠŶďĂnjĂ
ĐŽŶƚƌĂĐƚƵůƵŝĚĞĂƐŝŐƵƌĂƌĞĞŐĂůĞĂnjĉƐƵŵĂĂƐŝŐƵƌĂƚĉ͘
EXCLUDERI
Excluderile pentru riscurile asigurate prin contractul de asigurare
ƐƵŶƚĞŶƵŵĞƌĂƚĞŠŶĐŽŶĚŝԑŝŝůĞĚĞĂƐŝŐƵƌĂƌĞ͘
^ƵŶƚĞdžĐůƵƐĞƌŝƐĐƵƌŝůĞĐĂƵnjĂƚĞĚŝƌĞĐƚƐĂƵŝŶĚŝƌĞĐƚĚĞĞǀŽůƵԑŝĂƵŶĞŝ
ďŽůŝŝŶĨĞĐԑŝŽĂƐĞ ĐĞĚĞďƵƚĞĂnjĉŠŶĐŽŶƚĞdžƚƵůƵŶĞŝ
ĞƉŝĚĞŵŝŝͬƉĂŶĚĞŵŝŝĚĞĐůĂƌĂƚĞŠŶŵŽĚŽĨŝĐŝĂůĚĞĐĉƚƌĞƵƚŽƌŝƚĂƚĞĂ
ĂďŝůŝƚĂƚĉ͖ƉƌŝŶĞdžĐĞƉԑŝĞƐƵŶƚĂĐŽƉĞƌŝƚĞĐŚĞůƚƵŝĞůŝůĞŵĞĚŝĐĂůĞƔŝĚĞ
ƌĞƉĂƚƌŝĞƌĞĂĨĞƌĞŶƚĞŠŵďŽůŶĉǀŝƌŝŝĐƵKs/ͲϭϵĚĂĐĉĂĐĞƐƚĞĂŶƵ
ƐƵŶƚŐĞŶĞƌĂƚĞƉĞƚĞƌŝƚŽƌŝƵů^h͕ĂŶĂĚĂƐĂƵĂůƵŶĞŝԑĉƌŝŠŶĐĂƌĞ͕ŠŶ
njŝƵĂĂŶƚĞƌŝŽĂƌĉŝŶƚƌĉƌŝŝŠŶǀŝŐŽĂƌĞĂƐŝŐƵƌĉƌŝŝDĞĚŝĐĂůĞ͕ĞƐƚĞŠŶ
ǀŝŐŽĂƌĞƐƚĂƌĞĂĚĞƵƌŐĞŶԑĉƚŽƚĂůĉůĂŶŝǀĞůĨĞĚĞƌĂůͬŶĂԑŝŽŶĂůƐĂƵ
ƐƚĂƌĞĂĚĞƵƌŐĞŶԑĉƉĂƌԑŝĂůĉůĂŶŝǀĞůƵůƉƌŽǀŝŶĐŝĞŝͬƌĞŐŝƵŶŝŝŠŶĐĂƌĞƐĞ
ĞĨĞĐƚƵĞĂnjĉĐĉůĉƚŽƌŝĂ͖ŶƵƐƵŶƚĂĐŽƉĞƌŝƚĞĐŚĞůƚƵŝĞůŝůĞĐƵĐĂnjĂƌĞĂŠŶ
ƵƌŵĂĐĂƌĂŶƚŝŶĉƌŝŝŝŵƉƵƐĞŠŶƐĐŽƉƉƌĞǀĞŶƚŝǀĚĞĂƵƚŽƌŝƚĉԑŝůĞůŽĐĂůĞ
ƐĂƵĚŝŶĐĂƵnjĂĚŝĂŐŶŽƐƚŝĐĉƌŝŝĐƵKs/ͲϭϵƉĞĚƵƌĂƚĂƵŶĞŝĐĉůĉƚŽƌŝŝ
ŠŶƐƚƌĉŝŶĉƚĂƚĞ͘
$OOLDQ]ğLULDF$VLJXUăUL6$
6WU&ăGHUHD%DVWLOLHLQU
6HFWRU%XFXUHúWL5RPDQLD
Telefon 021 2019100,
Fax 021 2082 211, www.allianztiriac.ro
Intocmit la data 17.08.2021, ora 8:04
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WƌŝŵĂĚĞĂƐŝŐƵƌĂƌĞƐĞǀĂƉůĉƚŝŽŶͲůŝŶĞƐĂƵŽĨĨͲůŝŶĞ͕ŠŶĨƵŶĐԑŝĞĚĞ
ŵŽĚĂůŝƚĂƚĞĂĚĞĂĐŚŝnjŝԑŝĞĂůĞĂƐĉ͕ŠŶ>/͕ĂŶƚŝĐŝƉĂƚƔŝŝŶƚĞŐƌĂůƉĞŶƚƌƵ
ŠŶƚƌĞĂŐĂƉĞƌŝŽĂĚĉĂƐŝŐƵƌĂƚĉŵĞŶԑŝŽŶĂƚĉŠŶƉŽůŝԑĉ͘
/ŶĚĞŵŶŝnjĂԑŝŝůĞĚĞĂƐŝŐƵƌĂƌĞƐĞƉůĉƚĞƐĐŠŶŵĂdžŝŵƵŵϯϬĚĞnjŝůĞĚĞůĂ
ĚĞƉƵŶĞƌĞĂŠŶƚƌĞŐŝŝĚŽĐƵŵĞŶƚĂԑŝŝůĂŽŵƉĂŶŝĂĚĞƐŝƐƚĞŶԑĉƐĂƵůĂ
ƐŝŐƵƌĉƚŽƌ͕ŠŶďĂnjĂƐŽůŝĐŝƚĉƌŝŝƐĐƌŝƐĞĂƐŝŐƵƌĂƚƵůƵŝͬĞŶĞĨŝĐŝĂƌƵůƵŝ
privind sumele datorate.
INFORMATII GENERALE PRIVIND DEDUCERILE PREVAZUTE DE
LEGISLATIA FISCALA CARE SE APLICA
CONTRACTELOR DE ASIGURARE
Conform Codului Fiscal, primele de asigurare aferente
ĐŽŶƚƌĂĐƚĞůŽƌĚĞĂƐŝŐƵƌĂƌĞĚĞĐĉůĉƚŽƌŝĞŶƵƐƵŶƚĚĞĚƵĐƚŝďŝůĞĨŝƐĐĂů͘
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2ŶǀĞĚĞƌĞĂƌĞnjŽůǀĉƌŝŝƉĞĐĂůĞĂŵŝĂďŝůĉĂƌĞĐůĂŵĂԑŝŝůŽƌĨŽƌŵƵůĂƚĞĚĞ
client,ǀĉƌƵŐĉŵƐĂƚƌĂŶƐŵŝƚĞԑŝŽƌĞĐůĂŵĂԑŝĞƐĐƌŝƐĉůĂŽƌŝĐĂƌĞ
dintre adresele de mai jos:
1. WŽƔƚĂͬZĞŐŝƐƚƌĂƚƵƌĉ͗ĂĚƌĞƐĂĉĚĞƌĞĂĂƐƚŝůŝĞŝϴϬͲϴϰ͕
Sector 1 Bucuresti;
2. E-mail: reclamatii@allianztiriac.ro;
3. Fax: 021.208.22.11;
4. Site: www.allianztiriac.ro la rubricile Contact si
Reclamatii;
5. dĞůĞĨŽŶ͗ϬϮϭϮϬϭϵϭϬϬĚĞůƵŶŝƉąŶĉǀŝŶĞƌŝĚĞůĂϴ͗ϬϬ
la 20:00.
ŽŶƐƵŵĂƚŽƌƵůĂƌĞĚƌĞƉƚƵůĚĞĂĂƉĞůĂůĂƐŽůƵԑŝŽŶĂƌĞĂĂůƚĞƌŶĂƚŝǀĉĂ
ůŝƚŝŐŝŝůŽƌ͕ƉƌŝŶŝŶƚĞƌŵĞĚŝƵůĞŶƚŝƚĉԑŝŝ^>Ͳ&/E͕ĐĂƌĞĨƵŶĐԑŝŽŶĞĂnjĉ
ĞdžĐůƵƐŝǀŠŶĐĂĚƌƵů͘^͘&͘2ŶƉƌĞĂůĂďŝůƚƌĞďƵŝĞƐĉĨĂĐĞԑŝĚŽǀĂĚĂĐĉĂԑŝ
ŠŶĐĞƌĐĂƚƐĉƐŽůƵԑŝŽŶĂԑŝůŝƚŝŐŝƵůĚŝƌĞĐƚĐƵĐŽŵĞƌĐŝĂŶƚƵůŠŶĐĂƵnjĉ͘DĂŝ
ŵƵůƚĞŝŶĨŽƌŵĂԑŝŝƐĞŐĉƐĞƐĐůĂĂĚƌĞƐĂ
https://www.allianztiriac.ro/solutionare-litigii/.
De asemenea, ĂǀĞԑŝƉŽƐŝďŝůŝƚĂƚĞĂƐĉĂĚƌĞƐĂԑŝƌĞĐůĂŵĂԑŝŝƵƚŽƌŝƚĉԑŝŝ
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ĐŽŶƚĂĐƚ͗ĚƌĞƐĂ͗^ƉůĂŝƵů/ŶĚĞƉĞŶĚĞŶƚĞŝŶƌ͘ϭϱ͕ƐĞĐƚŽƌϱ͕ƵĐƵƌĞƔƚŝ
050092, Telefon: 0822 825 627, Fax: 021.659.60.51/021.
659.64.36 E-mail: office@asfromania.ro.
FONDUL DE GARANTARE
2ŶƐĐŽƉƵůƉƌŽƚĞũĉƌŝŝĐƌĞĚŝƚŽƌŝůŽƌĚĞĂƐŝŐƵƌĉƌŝ;ĂƐŝŐƵƌĂԑŝ͕ďĞŶĞĨŝĐŝĂƌŝ
ĂŝĂƐŝŐƵƌĉƌŝŝƔŝƚĞƌԑĞƉĞƌƐŽĂŶĞƉĉŐƵďŝƚĞͿĚĞĐŽŶƐĞĐŝŶԑĞůĞ
ŝŶƐŽůǀĞŶԑĞŝƐŝŐƵƌĉƚŽƌƵůƵŝ͕ĞƐƚĞĐŽŶƐƚŝƚƵŝƚ&ŽŶĚƵůĚĞŐĂƌĂŶƚĂƌĞĂ
ĂƐŝŐƵƌĂԑŝůŽƌ͕ƉĞƌƐŽĂŶĉũƵƌŝĚŝĐĉĚĞĚƌĞƉƚƉƵďůŝĐŠŶĨŝŝŶԑĂƚĉŠŶďĂnjĂ
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ŝŶĚĞŵŶŝnjĂԑŝŝͬĚĞƐƉĉŐƵďŝƌŝƌĞnjƵůƚĂƚĞĚŝŶĐŽŶƚƌĂĐƚĞůĞĚĞĂƐŝŐƵƌĂƌĞ
ĨĂĐƵůƚĂƚŝǀĞƔŝŽďůŝŐĂƚŽƌŝŝ͕ŠŶĐŚĞŝĂƚĞ͕ŠŶĐŽŶĚŝԑŝŝůĞůĞŐŝŝ͕ŠŶĐĂnjƵů
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Codul LEI 529900XKNXM9MBH8GS45
Operator de date cu caracter personal nr. 779
SR EN ISO 9001:2015
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