&$57(,17(51$ğ,21$/Ă'($6,*85$5( (0,6Ă68%$8725,7$7($ 1XPHOHúLDGUHVDDVLJXUDWXOXLVDXDXWLOL]DWRUXOXLYHKLFXOXOXL

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'( Morano Trans Srl, Adresa: Onesti, judet
1. CARTE INTERNATIONALE D'ASSURANCE AUTOVEHICULE DIN ROMÂNIA
AUTOMOBILE (B.A.A.R.) Bacau, str. Spicului, nr. 33
VALABILITATE - V A L I D 4. &RGXOĠăULL&RGXODVLJXUăWRUXOXL1XPăUXOSROLĠHL $FHDVWăFDUWHDIRVWHOLEHUDWăGH 6HPQăWXUDDVLJXUăWRUXOXL
3. Signature of Insurer
This Card has been issued by :
'(/$)5203Æ1Ă/$72
Country
Ziua - Day Luna - Month Anul - Year Ziua - Day Luna - Month Anul - Year
Code/Insurer`s Code/Number 6&$//,$1=ğ,5,$&$6,*85Ă5,6$
6WU&ăGHUHD%DVWLOLHL1U
04 10 2021 02 11 2021 6HFWRU%XFXUHúWL5RPkQLD
RO/07/R7/YD
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117590896
1UGHFLUFXODĠLHVDXvQOLSVăQULGHQWLILFDUHVDXQUGH 6. Categoria 7. Marca vehiculului
motor vehiculului / Make of Vehicle
Registration No.(or if none) Chassis or Engine No. Category of
&DSLWDOVRFLDOVXEVFULVúLYăUVDWOHL
Vehicle*
Înregistrat la ORC sub nr. J40/15882/1994, CUI: 6120740
6RFLHWDWHDXWRUL]DWăGH$XWRULWDWHDGH6XSUDYHJKHUH)LQDQFLDUă
BC36MEL C Renault &RGXODORFDWvQ5HJLVWUXODVLJXUăWRULORUúLUHDVLJXUăWRULORU5$
Codul LEI 529900XKNXM9MBH8GS45
9$/$%,/,7$7(7(5,725,$/Ă7(55,725,$/9$/,',7<
Operator de date cu caracter personal nr. 779
$FHDVWăFDUWHHVWHYDODELOăvQĠăULOHvQFDUHFăVXĠDFRUHVSXQ]ăWRDUHGHPDLMRVQXHVWHEDUDWăSHQWUXLQIRUPDĠLL EN ISO 9001:2015
VXSOLPHQWDUHYăUXJăPDFFHVDĠLVLWHXOZZZFRE[RUJ

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A B BG CY CZ D DK E EST F FIN
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N NL P PL RO S SK SLO CH AL AND
(2) (3)
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TN TR UA CODUL CATEGORIILOR DE VEHICULE:

A. AUTOTURISM/CAR E. AUTOBUS SAU AUTOCAR/BUS

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OLPLWDWăODDULDJHRJUDILFăDDFHVWXLVWDWFDUHHVWHVXEFRQWUROXO*XYHUQXOXL5HSXEOLFLL&LSUX B. MOTOCICLU/MOTORCYCLE F. REMORCA/TRAILER
C. AUTOCAMION SAU TRACTOR/LORRY OR TRACTOR G. ALTELE/OTHERS
5ăVSXQGHUHDDVLJXUăWRUXOXLSUHYă]XWăvQGRFXPHQWHOHGHDVLJXUDUHHOLEHUDWHSHQWUX$]HUEDLGMDQ
HVWHOLPLWDWăODDULDJHRJUDILFăDDFHVWXLVWDWFDUHHVWHVXEFRQWUROXO*XYHUQXOXL5HSXEOLFLL$]HUEDLGMDQ D. BICICLETA CU MOTOR/CYCLE FITTED WITH AUXILIARY ENGINE

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&2175$&7'($6,*85$5('(5Ă6381'(5(&,9,/Ă$8725&$
R.C
Seria RO/07/R7/YD Nr.
J40/15882/1994 C.U.I. 6120740
117590896
Denumire asigurator:$//,$1=ğ,5,$&$6,*85Ă5,6$
Broker / Agent Campion Broker De Asigurare Si Reasi Tel/Fax:
Agentia Ardeal - Brokeri Cod RBK-324
Nume/Denumire Asigurat/ )HO7LS0DUFă0RGHO C, Autoutilitara, Renault,
Morano Trans Srl
Proprietar: Vehicul: Premium 430dxi
C.U.I. / C.N.P. Proprietar: 26542269 Nr. înmatriculare/înregistrare: BC36MEL
Nume/Denumire Asigurat/ Nr.identificare - Serie CIV / VF624GPA000036034 /
Utilizator: nr.de inventar: n/a
C.U.I. / C.N.P. Utilizator: &DSDFLWDWHFLOLQGULFă3XWHUH 10.837 cmc / 323 kw
$GUHVă$VLJXUDW8WLOL]DWRU 1UORFXULPDVăWRWDOă
Onesti, judet Bacau, str. Spicului, nr. 33 2 / 19.000 kg
Tel. / E-mail PD[LPăDXWRUL]DWă

Conducatori auto declarati:

(Nume, prenume, CNP)
Valabilitate Contract de la 04.10.2021 SkQăOD 02.11.2021 Contract emis în data 02.10.2021
Prima de asigurare 1080 RON Clasa Bonus Malus B2 7DULIGHFRQWDUHGLUHFWă - 7RWDOSODWă 1080 RON
Nr. Rate 1 Valoare rate Rata 1: 1080 RON Date scadente Rata 1: 03.10.2021
3ULPDUDWăvQFDVDWăFX 1 în data 02.10.2021

/LPLWDGHGHVSăJXELUHSHQWUXYăWăPDULFRUSRUDOHúLGHFHV 6.070.000 EURO

/LPLWDGHGHVSăJXELUHSHQWUXGDXQHPDWHULDOH 1.220.000 EURO
Acoperiri/servicii suplimentare: -
2EVHUYDЙLL Canal comunicare oferta reinnoire RCA: Posta
Versiunea 1 din data 02.10.2021
 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 IR ISLAMIC REP. OF GREEN CARD BUREAU OF IRAN, C/O BIMEH MARKAZI IRAN ,No. 2, corner of
Schwarzenbergplats 7, Postfach 248, A-1030 WIEN :[43] (1) 711 560 IRAN Maryam St., Nelson Mandela Ave. -196776411 ±POB 19395-5588 ±TEHRAN-IRAN, :
AL ALBANIA BSHS BYROJA SHQIPTARE E SIGURIMIT, Rruga µ¶Gjergj Fishta´Pall Edil-Al-lt, Kati [98] (21) 24 55 1000
II-te, TIRANA : [355] (42) 54033 IRL IRLANDA MOTOR INSURERS¶BUREAU OF IRELAND 5 Harbourmaster Place, IFSC, Dublin 1,
AND ANDORRA OFICINA ANDORRANA D¶ENTITATS D¶ASSEGURANCA D¶AUTOMOBIL, c/o Maria IRELAND : [353] (1) 676 9944
Pla., 33, 3r, 3a, AD500 ANDORRA LA VELLA : [376] 86 00 17 IS ICELAND ALPJÓDLEGAR BIFREIDATRYGGINGAR Á ISLANDI, Borgartuni 35, 105
AZ AZERBAIJAN COMPULSORY INSURANCE BUREAU SAT PLAZA, 11-th floor, 133 Bashir Safaroglu REYKJAVIK, :[354] 568 1612,
Street., BAKU, AZ1009 : [+994 12] 595 00 20 L LUXENBOURG BUREAU LUXEMBOURGEOIS DES ASSUREURS,12, rue Erasme, L-1468,
B BELGIUM BUREAU BELGE DES ASSUREURS AUTOMOBILES, Rue de la Charité 33 Bte 2, LUXEMBOURG :[352] 45 73 04
BE-1210 BRUXELLES : [32] (2) 287 18 11 LT LITHUANIA MOTOR INSURERS¶BUREAU OF THE REPUBLIC OF LITHUANIA , Algirdo 38,
BG BULGARIA NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS, 2, Graf Ignatiev Str, 2nd LT-03606 VILNIUS, :[370] 5 216 28 60
floor, SOFIA 1000 : [359] (2) 981 11 03 LV LATVIA LATVIJAS TRANSPORTIDZEKLU APDROŠINATAJU BIROJS (Motor insurers¶bureau
BIH BOSNIA AND HERTEGOVINA BIRO ZELENE KARTE U BOSNI I HERCEGOVINI, Dervisa Numica of Latvia) , 9 Lomonosova Street, Riga LV-1019 :[371] 67 114 300
7, 71000 SARAJEVO : [387] (33) 610 744 M MALTA MALTA GREEN CARD BUREAU, 43A/4 St. Paul¶s Buildings, West Street, VALLETTA
BY BELARUS BELARUSIAN TRANSPORT INSURANCE BUREAU, 29-70 Pritytskogo Str., MINSK VLT 1532, :[356] 21 238 253, [356] 21 232 640,
: [375] (17) 209 85 25 MA MAROCCO BUREAU CENTRAL MAROCAIN DES STES D¶ASSURANCES, 154 Blvd d¶Anfa, 01-
CH SWITZERLAND NATIONALES VERSICHERUNGSBURO SCHWEIZ (NVB)/ SWISS NATIONAL CASABLANCA 20050, :[212] (522) 39 18 57 :[212] (522) 39 18 59
BUREAU OF INSURANCE (NBI),P.O. Box, CH-8085 Zurich :[41] (44) 628 65 19± MD MOLDOVA NATIONAL BUREAU OF MOTOR INSURERS OF MOLDOVA (NBMIM), 16
Secretariat,[41] (44) 628 89 30±Claims .RJăOQLFHDQXVWU2001, CHISINAU, :[373] 22 221 970
CY CYPRUS MOTOR INSURERS¶FUND, 23, Zenon Sozos Str, P.O. Box 22025 1516 NICOSIA : MK NORTH MACEDONIA NATIONAL INSURANCE BUREAU, ³Mitropolit Trodosij Galanov´str.
[357] (22) 763 913 ,[357] (22) 764 907 no.28/IV SKOPJE, : [389] (2) 3136 172
CZ CZECH REP CESKA KANCELAR POJISTITELU, Na Pankraci 1724/129, 140 00 PRAHA 4, :[420] MNE MONTENEGRO ASSOCIATION NATIONAL BUREAU OF MONTENEGRO INSURES, PC Europoint,
221 413 660 Svetlane Kane Radevic 3/II Podgorica 81000 PODGORICA, :[382] (20) 243 440
D GERMANY DEUTSCHES BURO GRUNE KARTE E.V. Wilhelmstrasse 43/43 G, D-10117 Berlin , : N NORWAY TRAFIKKFORSIKRINGSFORENINGEN, Hansteens gate 2, Postboks 2551 Solli, 0202
[49] (30) 2020 57 57 OSLO, :[47] (23) 28 42 00
DK DENMARK DANSK FORENING FOR INTERNATIONAL MOTORKORETOJSFORSIKRING, Philip NL NETHERLANDS NEDERLANDS BUREAU DER MOTORRIJTUIGVERZEKERAARS, Handelskade 49
Heymans Alle 1, DK-2900 HELLERUP, :[45] (41) 91 91 91 NL-2288 BA RIJSWIJK ZH, :[31] (70) 340 82 80
E SPAIN OFICINA ESPAÑOLA DE ASEGURADORES DE AUTOMOVILES, Sagasta 18, 28004 P PORTUGAL GABINETE PORTUGUÊS DE CARTA VERDE-GPCV, Rua Rodrigo da Fonseca no.41,
MADRID, :[34] (91) 446 03 00 P-1250 190 LISBOA, :[351] (21) 384 8101/ 02
EST ESTONIA EESTI LIIKLUSKINDLUSTUSE FOND, Mustamäe tee 46, 10621 TALLINN, :[372] PL POLAND POLISH MOTOR INSUERS¶BUREAU, Ul. Swietokrzyska 14, PL 00-050 WARSAW, :
667 1800 [48] (22) 826 46 33
F FRANCE BUREAU CENTRAL FRANÇAIS, 1, rue Jules Lefebvre, 75431 Paris Cedex 09 , :[33] RO ROMANIA BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA (B.A.A.R.) 40-
(1) 53 21 50 80 40ELV9DVLOH/DVFăU6WUHHW2, BUCHAREST, code 020502 :[40] (21) 319 13 02/ 03
FIN FINLAND LIIKENNEVAKUUTUSKESKUS, Itämerenkatu 11-13 HELSINKI FIN-00180, :[358] RUS RUSSIA RUSSIAN ASSOCIATION OF MOTOR INSURERS, 27 bld. 3, Lusinovskaya str., 115093
(0) 404 504 520 MOSKOW, Secretariat: [7] (495) 771 69 47 Claims: [7] (495) 641 27 87
UK UNITED KINGDOM OF GREAT-BRITAIN AND NORTHERN IRELAND MOTOR S SWEDEN TRAFIKFORSAKRINGSFORENINGEN, Karlavagen 108, STOCKHOLM/ Box 24035,
INSURERS¶BUREAU ±UK, Linford Wood House 6-12, Capital Drive, Linford SE-104 50 STOCKHOLM, :[46] (8) 522 782 00
Wood, MILTON KEYNES MK14 6XT, Telefon:[44] (1908) 830 001 SRB SERBIA UDRUZENJE OSIGURAVACA SRBIJE, Milentija Popovica 5b/11, 11000 BELGRADE,
GR GREECE MOTOR INSURERS¶BUREAU ±GREECE, 9 Xenophontos Street, ATHENS 105 57, : :[381] (11) 29 27 950
[30] (210) 32 23 324 [30] (210) 32 36 562 SK SLOVAK REP SLOVENSKÁ KANCELÁRIA POIST¶OVATEL¶OV, Bajikalska 19B, 826 58
H HUNGARY MAGYAR BISTOSITOK SZOVETSEGE (MABISZ) Hungarian Motor Insurance Bureau, BRATISLAVA 29, :[421] 2 4444 1633
Andrassy ut 93, H-1062 BUDAPEST/, POB 1297, H-1381 BUDAPEST 62, :[36] (1) 802 SLO SLOVENIA SLOVENSKO ZAVAROVALNO ZDRUZENJE, GIZ, 1001 LJUBLJANA, Zelezna cesta
8400 14, :[386] (1) 4735 322
HR CROATIA HRVATSKI URED ZA OSIGURANJE, Croatian Insurance Bureau, 10000 ZAGREB, TN TUNISIA BUREAU UNIFIE AUTOMOBILE TUNISIEN, 85-87 Rue Palestine, 1002 TUNIS
Martieva 71, :[385] (1) 46 96 600 Belvedere , :[ 216] 71 841 514, [216] 71 841 784
I ITALY UFFICIO CENTRALE ITALIANO, (U.C.I.) SOC. CONS. A.R.L., 20145 MILANO, Corso TR TURKEY TURKIYE MOTORLU TASIT BUROSU (TURKISH MOTOR INSURANCE BUREAU) ,
Sempione 39, :[39] (02) 34 96 81 Buyukdere Cad. Oya Sk. Devran Apt. 2/1, 34394 Gayrettepe, ISTANBUL, :[90] (212)
IL ISRAEL ISRAEL INSURANCE ASSOCIATION ±THE GREEN CARD BUREAU, Etzel 1 P.O.B. 217 5968 69/ 70 /71
17160, Rishon-LeZion, 75070, :[972] (3) 94 24 311 UA UKRAINE MOTOR (TRANSPORT) INSURANCE BUREAU OF UKRAINE, , P.O.B. 272, KYIV-2,
02002, :[38] (044) 239 20 27

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 .
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