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Date despre Asigurat:

Nume: Tolontan CNP: 1710526131244
Prenume: Dan 'DWDQDɁWHUH26.05.1971
Adresa de domiciliu: Judet Iasi, Iasi, Str. Stefan Octavian Iosif, Nr. 4D, Ap. 2

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Date despre asigurare:

Perioada de asigurare: 12 luni Moneda contractului de asigurare: RON
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Oferta reînnoire: NU

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Tip Asigurat Ambulatoriu Spitalizare Pachet Preventiv
Asigurat Amb. Nelim. Suma asigurata 100 000 Ron/an ;

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Dan Tolontan 2,250 1,344 150

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1XPHOHGHQXPLUHDɁLVHPQăWXUD Semnatura Asiguratului (daca este 1XPHOHGHQXPLUHDɁLVHPQăWXUD

Contractantului diferit de Contractant)/ Semnatura Intermediarului:
Asiguratului dependent

-1710526131244-

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