LA AL A . _________________________ r. e registrare: ______________________ Asiguratu gubitu_________________________________ rrietar a auteicuuui cu r. e atricuare rereetat ri ____________________________________ cr utericirii euse a sar rg s arbaŃi ata esgubirii reetuui sar e au aste: aas e baa rrei aeate arŃia e baa cueter aeate ia e baa cueter e rearaŃie aeate regie rrie e baa eiuui estiati tcit e Aiairiac .A.. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ : ri casieria Aia iriac Asigurri .A. ctu r. escis a baca ___________________________ tituar ct _______________________________ . ctu r. escis a baca ___________________________ tituar ct _______________________________ . . . A A. A A . . L A A A . . DA O D A OD AA D AA T AT ATO AT A AT OT D AA. DA O D A TD D T AT T D A O AT OTAT D A A OAA OAT. ut u sut e acr cu reŃierea i esgubire a riei suietare e retregire a suei asigurarate. ri ata suei e cire ________________________ aic itere __________________________ _____________________________________________________________________ ecar c u ai a ici reteŃie e esgubire e a Aia iriac Asigurri .A. asigurtru e rsuere cii i ersaa iat e rucerea accietuui aceast su rereet esgubirea itegra etru agubee suerite ca urare a eeietuui i ata e ___________ . ObiecŃii: _______________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ DATA _______________ TATAA___________________________

Cerere Despagubire Allianz

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LAALA._________________________

r.eregistrare:______________________Asiguratugubitu_________________________________rrietaraauteicuuuicur.eatricuarerereetatri____________________________________ crutericiriieuseasarrgsarbaŃiataesgubiriireetuuisareauaste:aasebaarreiaeatearŃiaebaacueteraeate

iaebaacuetererearaŃieaeateregierrieebaaeiuuiestiatitciteAiairiac.A..

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________:ricasieriaAiairiacAsigurri.A.ctur.escisabaca___________________________tituarct_______________________________.

ctur.

escisabaca___________________________tituarct_______________________________.

. AA.

AA. . L A A A .

DA O D A OD AA D AA TATATOATAATOTDAA.

DA O D A TD D T ATTDAOATOTATDAAOAAOAT.

utusuteacrcureŃiereaiesgubirearieisuietareeretregireasueiasigurarate.riatasueiecire________________________aicitere_______________________________________________________________________________________________ecarcuaiaicireteŃieeesgubireeaAiairiacAsigurri.A.asigurtruersuereciiiersaaiaterucereaaccietuuiaceastsurereetesgubireaitegraetruagubeesueritecaurareaeeietuuiiatae___________.

ObiecŃii:___________________________________________________________________________________________________________________________________________________________________________________________________________DATA_______________TATAA___________________________