###&$57(#,17(51$ğ,21$/Ă#'(#$6,*85$5(

#####(0,6Ă#68%#$8725,7$7($#
1XPHOH#úL#DGUHVD#DVLJXUDWXOXL# VDX#D#XWLOL]DWRUXOXL#YHKLFXOXOXL ###########

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,#$6,*85Ă725,/25#'(# Dinescu Marius,
Adresa: Alunu, judet
1. CARTE INTERNATIONALE D'ASSURANCE
AUTOVEHICULE DIN ROMÂNIA
AUTOMOBILE
(B.A.A.R.) Valcea, str. Ocracu, nr.
FN, bl. -, ap. -
VALABILITATE - V A L I D
4. &RGXO#ĠăULL#&RGXO#DVLJXUăWRUXOXL#1XPăUXO#SROLĠHL
####$FHDVWă#FDUWH#D#IRVW#HOLEHUDWă#GH###
####6HPQăWXUD#DVLJXUăWRUXOXL
3.
Signature of Insurer

This Card has been issued by :

'(#/$###)520################################3Æ1Ă#/$###72

Country
Ziua - Day Luna - Month Anul - Year Ziua - Day Luna - Month Anul - Year

Code/Insurer`s Code/Number 6#&#$//,

$1=#ğ,5,$&#$6,*85Ă5,#6#$#

6WU##&ăGHUHD#%DVWLOLHL##1U######
18 12 2021 17 12 2022
6HFWRU####%XFXUHúWL##########5RPkQLD

RO/07/R7/YD
$FHVWH#GRXă#GDWH#LQFOXVLY###%RWK#'DWHV#LQFOXVLYH

118239703
###1U#GH#FLUFXODĠLH#VDX##vQ#OLSVă##QU##LGHQWLILFDUH#VDX#QU##GH#
6. Categoria 7. Marca vehiculului
motor
vehiculului / Make of Vehicle
Registration No.(or if none) Chassis or Engine No.
Category of

&DSLWDO#VRFLDO#VXEVFULV#úL#YăUVDW#############OHL

Vehicle*

Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740

6RFLHWDWH#DXWRUL]DWă#GH#$XWRULWDWHD#GH#6XSUDYHJKHUH#)LQDQFLDUă
VL43ANE
A Bmw
&RGXO#DORFDW#vQ#5HJLVWUXO#DVLJXUăWRULORU#úL#UHDVLJXUăWRULORU##5$####
Codul LEI 529900XKNXM9MBH8GS45
###9$/$%,/,7$7(#7(5,725,$/Ă###7(55,725,$/#9$/,',7<

Operator de date cu caracter personal nr. 779

$FHDVWă#FDUWH#HVWH#YDODELOă#vQ#ĠăULOH#vQ#FDUH#FăVXĠD#FRUHVSXQ]ăWRDUH#GH#PDL#MRV#QX#
HVWH#EDUDWă# SHQWUX#LQIRUPDĠLL# EN ISO
9001:2015
VXSOLPHQWDUH##Yă#UXJăP#DFFHVDĠL#VLWH#XO#ZZZ#FRE[#RUJ #

ÌQ#ILHFDUH#ĠDUă#YL]LWDWă##
%LURXO#DFHOHL#ĠăUL#JDUDQWHD]ă#DFRSHULUHD#SULQ#DVLJXUDUH#SHQWUX#SUHMXGLFLXO#FDX]DW#S
ULQ#XWLOL]DUHD#
YHKLFXOXOXL#PHQĠLRQDW#PDL#VXV##vQ#FRQIRUPLWDWH#FX#OHJHD#GLQ#DFHD#ĠDUă#SULYLQG#DVLJX
UDUHD#REOLJDWRULH#

3HQWUX#LGHQWLILFDUHD#%LURXOXL#UHOHYDQW##Yă#UXJăP#Vă#YHULILFDĠL#YHUVR#XO#FăUĠLL#

(1)
A B BG CY CZ D
DK E EST F FIN

(2)
GR H HR I IRL IS
L LT LV M N

(3)
NL P PL RO S SK
SLO CH AL AND AZ
BIH BY IL IR MA MD
MK MNE RUS SRB TN
TR UA UK
CODUL CATEGORIILOR DE VEHICULE:

A. AUTOTURISM/CAR E. AUTOBUS SAU

AUTOCAR/BUS
#
#########5ăVSXQGHUHD#DVLJXUăWRUXOXL##SUHYă]XWă#vQ#GRFXPHQWHOH#GH#DVLJXUDUH##HOLEHUD
WH#SHQWUX#&LSUX##HVWH#

OLPLWDWă#OD#DULD#JHRJUDILFă#D#DFHVWXL#VWDW##FDUH#HVWH#VXE#FRQWUROXO#*XYHUQXOXL#5HSX
EOLFLL#&LSUX# B.
MOTOCICLU/MOTORCYCLE F. REMORCA/TRAILER

C. AUTOCAMION SAU TRACTOR/LORRY OR TRACTOR G. ALTELE/OTHERS

#
#########5ăVSXQGHUHD#DVLJXUăWRUXOXL##SUHYă]XWă#vQ#GRFXPHQWHOH#GH#DVLJXUDUH##HOLEHUD
WH#SHQWUX#$]HUEDLGMDQ##

HVWH#OLPLWDWă#OD#DULD#JHRJUDILFă#D#DFHVWXL#VWDW##FDUH#HVWH#VXE#FRQWUROXO#*XYHUQXOXL
#5HSXEOLFLL#$]HUEDLGMDQ# D. BICICLETA CU
MOTOR/CYCLE FITTED WITH AUXILIARY ENGINE

#
#########5ăVSXQGHUHD#DVLJXUăWRUXOXL##SUHYD]XWă#vQ#GRFXPHQWHOH#GH#DVLJXUDUH##HOLEHUD
WH#SHQWUX#6HUELD##HVWH#

OLPLWDWă#OD#DULD#JHRJUDILFă#D#DFHVWXL#VWDW##FDUH#HVWH#VXE#FRQWUROXO#*XYHUQXOXL#5HSX
EOLFLL#6HUELD#

&2175$&7#'(#$6,*85$5(#'(#5Ă6381'(5(#&,9,/Ă#$872#5&$ Seria
RO/07/R7/YD Nr.
R.C J40/15882/1994
C.U.I. 6120740

118239703
Denumire asigurator:#$//,$1=###ğ,5,$&#$6,*85Ă5,#6#$#
Broker / Agent Transilvania Broker De Asigurare Sa / / Tel/Fax:
Agentia Oltenia - Brokeri Cod
RBK-374
Nume/Denumire
Asigurat/ )HO##7LS##0DUFă#0RGHO#
A, Autoturism, Bmw, X4
Dinescu Marius
Proprietar:
Vehicul: Xdrive30d At
C.U.I. / C.N.P. Proprietar: 1690810386351 Nr.
înmatriculare/înregistrare: VL43ANE
Nume/Denumire Asigurat/
Nr.identificare - Serie CIV / WBAXX310900K83635 /
Utilizator:
nr.de inventar: M805430
C.U.I. / C.N.P. Utilizator:
&DSDFLWDWH#FLOLQGULFă###3XWHUH# 2.993 cmc / 190 kw
$GUHVă#$VLJXUDW###8WLOL]DWRU## Alunu, judet Valcea, str. Ocracu, nr. FN,
1U##ORFXUL###PDVă#WRWDOă

5 / 2.410 kg
Tel. / E-mail bl. -, ap. -
PD[LPă#DXWRUL]DWă#

Conducatori auto declarati:

Dinescu Marius 1690810386351;

(Nume, prenume, CNP)
Valabilitate Contract de la 18.12.2021 SkQă#OD# 17.12.2022 Contract emis în data
15.12.2021
Prima de asigurare 1384 RON Clasa Bonus Malus B2 7DULI#GHFRQWDUH#GLUHFWă
- 7RWDO#SODWă 1384 RON
Nr. Rate 1 Valoare rate Rata 1: 1384 RON Date scadente Rata
1: 17.12.2021
3ULPD#UDWă#vQFDVDWă#FX TBK9129342 în data 15.12.2021

/LPLWD#GH#GHVSăJXELUH#SHQWUX#YăWăPDUL#FRUSRUDOH#úL#GHFHV#
6.070.000 EURO
/LPLWD#GH#GHVSăJXELUH#SHQWUX#GDXQH#PDWHULDOH#
1.220.000 EURO
Acoperiri/servicii suplimentare: -
2EVHUYDЙLL# Canal comunicare oferta reinnoire RCA: Intermediar
Versiunea 1 din data 15.12.2021
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
.RJăOQLFHDQX#VWU########&+,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
##ELV#9DVLOH#/DVFăU#6WUHHW#####%8&+$5(67##FRGH######## :[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,
IL ISRAEL ISRAEL INSURANCE ASSOCIATION ±#THE GREEN CARD BUREAU, Etzel 1
P.O.B. 02002, :[38] (044)
239 20 27
17160, Rishon-LeZion, 75070, :[972] (3) 94 24 311
UK UNITED KINGDOM OF GREAT-BRITAIN AND NORTHERN IRELAND MOTOR
IR ISLAMIC REP. GREEN CARD BUREAU OF IRAN, C/O BIMEH MARKAZI IRAN ,No. 2,
corner of
INSURERS¶#BUREAU ±#UK, Linford Wood House 6-12, Capital Drive, Linford
OF IRAN Maryam St., Nelson Mandela Ave. -196776411 ±#POB 19395-5588
±#TEHRAN-IRAN, : Wood, MILTON
KEYNES MK14 6XT, Telefon:[44] (1908) 830 0
[98] (21) 24 55 1000
IRL IRLANDA MOTOR INSURERS¶#BUREAU OF IRELAND 5 Harbourmaster Place, IFSC,
Dublin 1,
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.
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 .
&XP#DQXQĠL#SURGXFHUHD#XQHL#GDXQH"
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DFWHD]ă#QH#vQ#FHO#PDL#VFXUW#WLPS#vQ#YHGHUHD#DYL]ăULL#
daunei si iti vom comunica cum trebuie sa procedezi.
3HUVRDQD#SUHMXGLFLDWă#WUHEXLH#Vă#QH#FRQWDFWH]H#QXPDL#vQ#FD]XO#vQ#FDUH#GRUHúWH#Vă#IL
H#GHVSăJXELW#GH#$OOLDQ]#ğLULDF#$VLJXUDUL#6$#vQ#ED]D#
DVLJXUăULL#WDOH#5&$#
Cum ne contactezi in caz de dauna?
www.allianztiriac.ro
021.201.91.80 Descarca aplicatia
Allianz Tiriac Asigurari SA

nr. cu tarif normal disponibila pentru

iOS sau Android

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3XWHWL#RSWD#SHQWUX#&RQVWDWDUHD#DPLDELOă#vQ#XUPăWRDUHOH#VLWXDĠLL##GDFD#DFFLGHQWXO#nu
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www.allianztiriac.ro/politica-reclamatii.