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1. CARTE INTERNAIONAL DE ASIGURARE PENTRUAUTOVEHICULE

1. INTERNATIONALM OTOR INSURANCE CARD1. CARTE INTERNATIONALE D'ASSURANCE

AUTOMOBILE

2. EMIS SUB AUTORITATEA:ISSUED UNDER THE AUTHORITY OF:

BIROULUI ASIGURTORILOR DEAUTOVEHICULE DIN ROMNIA

(B.A.A.R.)

. VALABILITATE - V A L I DDE LA - FROM PN LA - TO

4. Codul rii/Codul asigurtorului/Numrul polieiCountry Code/Insurers Code / Number

RO/ XX / XXXZiua -Day Luna Month Anul - Year Ziua - Day Luna Month Anul - Year

(Aceste doudate inclusiv / Both Dates Inclusive)

. Nr. de circulaie sau, n lips, nr.identificare sau nr. motorRegistration No. (or if none) Chassis or Engine No.

6.Categoriavehiculului /Category of

Vehicle*

7. Marca vehicululuiMake of Vehicle

. VALABILITATEA TERITORIAL

Aceast carte este valabil n rile n care csua corespunztoare de mai jos nu este barat(pentru informaii suplimentare, v rugm accesai site-ulwww.cobx.org).

n fiecare ar vizitat, Biroul acelei ri garanteaz acoperirea prin asigurare pentru prejudiciulcauzat prin utilizarea vehiculului menionat mai sus, n conformitate cu legea din acea ar privindasigurarea obligatorie.

Pentru identificarea Biroului relevant, va rugm s verificai verso-ul crii.

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

GB GR H I IRL IS L LT LV M N

NL P PL RO S SK SLO CH AL AND BIH

BY HR IL IR MA MD MK MNE RUS SRB(2) TN

TR UA

(1) Rspunderea asigurtorului, prevzut n documentele de asigurare, eliberate pentru Cipru, este limitat la ariageografica acestui stat, care este sub controlul Guvernului Republicii Cipru.

(2) Rspunderea asigurtorului, prevzut n documentele de asigurare, eliberate pentru Serbia, este limitat la ariageografica acestui stat, care este sub controlul Guvernului Republicii Serbia.

9. Numelei adresa asiguratului (sau a uti lizatorului vehiculului)Name andAddress of thePol icyholder (or User of the vehicle)

10. Aceastcartea fosteliberatde / ThisCard has been issued by:

Denumire asigurtor / Nameof the Insurer: Adresasigurtor / Address of the Insurer

[Informaii suplimentare privind asigurtorul - opional: / Optional for theinsurer: Siglasigurtor / Logo ofthe company Numr/ere detelefon i/sau fax / Phone &/or Fax number(s) AdresWeb / Homepage AdresE-mail / E-mailaddress]

11.Semntura asigurtoruluiSignatureof Insurer

POLI DE ASIGURARE DE RSPUNDERE CIVIL AUTO RCA Seria Nr./XX/YYY/SS 123456789RODENUMIRE ASIGURTOR C.U.I.R.C.

Sucursala / Agenia _________ _________ ______________ Cod Broker / Agent ______________________________Cheltuiala medie de achiziie direct: ____ %*

Denumire Broker / Agent _________ ________________

Nume/Denumire Asigurat:PROPRIETAR

C.U.I. / C.N.P. Proprietar:

Nume/Denumire Asigurat:UTILIZATOR

C.U.I. / C.N.P. utilizator:

Adres / Utilizator/AsiguratTel.

Fel, ,Tip, MarcModel Vehicul:

Nr. nmatriculare/nregistrare:

Nr. identificare - Serie CIV /nventarnr. de i

C / Putere:apacitate cilindric

Nr. locuri / mas totalmaximautorizat:

Valabilitate poli: de la _ _ ______ nla: __ ____ ___ _______________ ___ ___ p _______misn data de: ________ _____

Prima de asigurare: ___ ____ RON ncasatcu: _ _________Clasa B/M: ___ ___ __ in data de: _____________

Cheltuiala medie de achizi omisionul inclusie direct i c sunt e n prima de asigurare

Limita de despgubire pentru

vtmri corporalei deces este de:Limita de despgubire pentru

pagube materiale este de:

utoritatea de Supraveghere Financiar primetei rspunde la toate sesizrilei reclamaiile privind activitateaigurtorilor, reasigurtorilori intermediarilor n asigurrii/sau reasigurri;

ondiiile contractuale sunt prevzute n Normele privind asigurare obligatorie de rspundere civil pentru prejudiciiaoduse prin accidente de vehicule adoptate de Autoritatea de Supraveghere Financiar.

EURO

EURO

Tel.:

Nr. nmatriculare /Serie caroserie:

Zi

Data la careexpirasigurarea:

Sigl/ denumire asigurtor

RO/ /XX YYY/SS

123456789

Luna An

Vignet RCA

*CODUL CATEGORIILOR DE VEHICULEA AUTOTURISM/CAR C AUTOCAMION SAUTRACTOR/LORRY OR TRACTOR E AUTOBUS SAU AUTOCAR/BUS G ALTELE/OTHERS

B MOTOCICLU/MOTORCYCLE D BICICLETCUMOTOR/CYCLE FITTED WITH AUXILIARY ENGINE F REMORC/TRAILER

Comision de intermediere: _____ % _ ____ lei, respectiv ___ *

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A AUSTRIA VERBAND DER VERSICHERUNGSUNTERNEHMEN STERREICHS, Schwarzenbergplatz 7, Postfach 248,

A-1030WIEN, [43] (1) 711560

AL ALBANIA BSHS BYROJASHQIPTAREE SIGURIMIT, Rruga"Gjergj Fishta", Pall. Edil-Al-It, Kati II-te, TIRANA [355] (42) 54033

AND ANDORRA OFICINA ANDORRANA DENTITATSDASSEGURANADAUTOMBIL, c/oMaria Pla., 33, 3r, 3a.

AD500 ANDORRA LA VELLA [376] 8600 17

B BELGIUM BUREAU BELGEDES ASSUREURS AUTOMOBILES, Rue de la Charit 33 Bte2, BE-1210BRUXELLES

[32] (2) 28718 11

BG BULGARIA NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS, 2, Graf Ignatiev Str, floor 2, SOFIA1000.

[359] (2) 981 11 03

BIH BOSNIA and HERZEGOVINA BIRO ZELENE KARTE UBOSNI I HERCEGOVINI, Kolodvorska 11A/II, 71000SARAJEVO

[387] (33) 213 674

BY BELARUS BELARUSIAN TRANSPORT INSURANCEBUREAU, 1 Kalvariyskaya St, 220004 MINSK, [375] (17) 2264 764

CH SWITZERLANDNATIONALES VERSICHERUNGSBRO SCHWEIZ (NVB) SWISS NATIONALBUREAU OFI NSURANCE (NBI)

Thurgauerstrasse 101,CH-8152Opfikon Glattbrugg, , [41] (44) 62865 19 - Secretariat

[41] (44) 62889 30 - For claims only:- Freephone 0800 831 831.

CY CYPRUS MOTOR INSURERSFUND, 23, Zenon Sozos Str., P.O. Box220 30, 1516 NICOSIA

[357] (22) 763 913 or 764 907

CZ CZECH REP. ESK KANCELPOJISTITEL tefnikova 248/32, 150 00 Praha 5,C ZECH REPUBLIC

[420] (2) 21 413660

D GERMANY DEUTSCHESBRO GRNEKARTEe.V., Glockengiesserwall 1, 20095HAMBURG

[49] (40) 3344 00

DK DENMARK DANSKFORENING FORINTERNATIONALMOTORKRETJSFORSIKRING, Amaliegade10,

1256KBENHAVN [45] (33) 4355 00

E SPAIN OFICINA ESPAOLADE ASEGURADORES DEAUTOMOVILES, Sagasta 18, 28004 MADRID

[34] (91) 44603 00

EST ESTONIA EESTI LIIKLUSKINDLUSTUSE FOND, Mustame tee 44, 10621TALLINN, [372] 667 1800

F FRANCE BUREAU CENTRALFRANAIS, 1, rueJules Lefebvre,75431 PARIS Cedex 09

[33] (1) 53 21 50 80

FIN FINLAND LIIKENNEVAKUUTUSKESKUS, Bulevardi 28, FIN-00120 HELSINKI 12. [358] (9) 680 401

GB UNITED KINGDOMOF GREAT-BRITAIN ANDNORTHERN IRELAND,MOTOR INSURERS' BUREAU, Linford Wood House,

6-12 Capital Drive, Linford Wood, MILTON KEYNESMK14 6XT [44] (1908) 830 001

GR GREECE MOTORINSURERS' BUREAU-GREECE, 9 XenophontosStreet, ATHENS 105 57

[30] (210) 3223 324/3236 562

H HUNGARY MAGYARBIZTOSTKSZVETSGE(MABISZ), HungarianMotor Insurance Bureau

Aradi utca 65-67, H-1062 BUDAPEST/ POB1297, H-1381BUDAPEST62 [36] (1)2669963

HR CROATIA HRVATSKI URED ZAOSIGURANJE, CroatianInsurance Bureau, 10000ZAGREB, Martieva73,

[385] (1) 46 16 755

I I TALY UFFICIO CENTRALEITALIANO, (UCI) Soc. Cons. a r.l, 20145 MILANO, Corso Sempione 39,

[39](02) 3496 81

IL ISRAEL Israel Insurance Association, THEGREEN CARDBUREAU, 11 MosheLevy Str. P.O.B.17160

Rishon-LeZion75070 [972] (3) 9424311

IR ISLAMICREPUBLIC OFI RAN - Green Card Bureau of Iran, c/o BIMEHMARKAZI IRAN, 72 AfricaAvenue 19157,

POB. 19395- 5588, TEHRAN [98] (21) 22050001 - 5

IRL IRELAND MOTORINSURERS' BUREAU OFI RELAND, Insurance House, 39 Molesworth Street,

DUBLIN 2 [353] (1) 6769944

IS ICELAND ALJLEGAR BIFREIATRYGGINGAR SLANDI, Borgartni 35, 105 REYKJAVK [354] 5681612

L LUXEMBOURG BUREAU LUXEMBOURGEOIS DES ASSUREURS, 75 rue de Mamer,

L-8081 BERTRANGE Luxembourg [352] 4573 04

LT LITHUANIA MOTORINSURERSBUREAUOF THE REPUBLIC OF LITHUANIA, Algirdo 38,

LT-03606 VILNIUS, [370]5 21628 60

LV LATVIA LATVIJAS TRANSPORTLDZEKU APDROINTJU BIROJS, 9, Lomonosova Street, RigaLV-1019 [371] 7114300

M MALT A MALTA GREEN CARD BUREAU, 43A/2St Paul's Buildings, West Street,

VALLETTAVL T 12 [356] 21 238253

MA MOROCCO BUREAU CENTRALMAROCAINDES STSD'ASSURANCES,154,

Blvdd' Anfa, 01 - CASABLANCA [212](22) 3918 57,39 1859

MD MOLDOVA "ARCA"NATIONAL AGENCY OF INSURERS, StefanCel Mare str., 182,of fice 508, 2012C HISINAU,

[373] 22 221970

MK F.Y.R.O.M. NATIONAL INSURANCEBUREAU, "Mitropolit Trodosij Galagnov" str. ,no.28/IV SKOPJE,

[389] (2) 3136172

MNE MONTENEGRO ASSOCIATION NATIONAL BUREAU OF MONTENEGRO INSURERS, PC Europoint, Bul. Sv. Petra

Cetinjsklog 1A/II, 81000PODGORICA [382] 20243 440

N NO RWAY TRAFIKKFORSIKRINGSFORENINGEN, Hansteens Gate 2, Postboks 2551 Solli,

0202OSLO [47] (22) 0486 00

NL NETHERLANDS NEDERLANDSBUREAU DER MOTORRIJTUIGVERZEKERAARS, Handelskade 49

NL-2288 BA RIJSWIJK, ZH ?[31] (70) 3408 280

P PORTUGAL GABINETE PORTUGUSDE CARTAVERDE-GPCV, RuaRodrigo de Fonsecano.41

P - 1250190 LISBOA [351](21) 384 8101/02

PL POLAND POLISH MOTOR INSURERSBUREAU, ul. Swietokrzyska14, PL 00-050WARSAW

[48] (22) 82646 33

RO ROMANIA BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA (BAAR), 40-40bis Vasile Lascr Street,

2 Bucharest, code 020502, Romania [40] (21) 31913 02, [40](21) 319 1303

RUS RUSSIA RUSSIAN ASSOCIATION OF MOTOR INSURERS , 27 bld. 3, Lusinovskaya str., 115093, Moscow ,

Secretariat - [7] (495) 77169 47. For claims [7] (495) 641 27 87

S SWEDEN TRAFIKFRSKRINGSFRENINGEN,Karlavagen108, STOCKHOLM/ Box24035, SE-10450 STOCKHOLM

[46] (8) 522 782 00

SRB SERBIA UDRUZENJEOSIGURAVACA SRBIJE, Bulevar DespotaStefana 68b, P.O. Box12-18, 11108BEOGRAD 12,

[381] (11) 2750 359, 2767 443

SK SLOVAK REP SLOVENSKKANCELRIAPOIST'OVATEL'OVTrnavsk cesta82,

826 58 BRATISLAVA2 9 [421] (2) 4444 1633

SLO SLOVENIA SLOVENSKOZAVAROVALNO ZDRUENJE, GIZ, 1001 LJUBLJANA,elezna cesta14,

P.O.Box2512 [386] (1) 4377 098/4735 322

TN TUNISIA BUREAU UNIFI AUTOMOBILE TUNISIEN, 5, Rue IBNZOHR cit Jardin le belvdre1002 Tunis,

[216](71)841 514 or [216] (71) 841 784

TR TURKEY TRKIYEMOTORL U TASIT BROSU (TURKISH MOTOR INSURANCEB UREAU) Bykdere Cad

Oya Sk. Devran Apt. 2/1, 34394 Gayrettepe, ISTANBUL, [90] (212) 217 5968, 217 5969,, 217 5970,217 5971

UA UKRAINE MOTOR (TRANSPORT) INSURANCEBUREAU OF UKRAINE P.O.B. 272, KYIV-2, 02002,UKRAINE, [38] (044) 23920 27