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S.C. Asigurare Reasigurare ARDAF S.A.
A OPEL, ASTRA 011062, Bucuresti, Sector 1,Str. Polizu, Nr. 58-60
W0L0TGF3528044509 Tel.: +40 21 317 12 20; Fax: +40 21 317 60 76
E-mail: office@ardaf.ro; Homepage: www.ardaf.ro
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S.C. ASIGURARE REASIGURARE ARDAF S.A.
011972, Bucuresti, Sector 1, B-dul Primaverii nr.29 R.C.: J40 / 17484 / 2007 C.U.I.: 2886621
AGENTIA SUCEAVA Cocris Elena Daniela
Denumire broker / Agent .......................................
Sucursala / Agentia ....................................................
Tel. / Fax ................................................................. Cod broker / Agent ..................................................
Nume/Denumire Asigurat: GAINA CONSTANTIN )HO7LS0DUFă Autoturism, OPEL,
PROPRIETAR 0RGHOYHKLFXO ASTRA

C.U.I. / C.N.P. PROPRIETAR: 1730309334931 Nr. înmatriculare / înregistrare : SV71YRI/

Nume/Denumire Asigurat: Nr. identificare - Serie CIV/ W0L0TGF3528044509


UTILIZATOR: nr. de inventar: /
C.U.I. / C.N.P. UTILIZATOR: Capacitate cilindrica / Putere : 1686cmc/ 55Kw
$GUHVă$VLJXUDW8WLOL]DWRU7HO Str.AMURGULUI,Nr.10,Bl.1O6,Sc.B,Et.1,Ap.5,SU 1UORFXULPDVăWRWDOă 5 loc. / 1815 kg
CEAVA,Jud.SUCEAVA,Tel./0745167606 PD[LPăDXWRUL]DWă

13.11.2010 12.05.2011 12.11.2010


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Clasa B/M: _____ Prima de asigurare : _________ CH/nr.660626
327,84 RON, incasata cu :________________ 12.11.2010
Din data de : _________

Pentru Anul 2010 Pentru Anul 2011


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/LPLWDGHGHVSăJXELUHSHQWUX 500 000 EURO 750 000 EURO
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