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Sediul central S.C. Groupama Asigurri S.A. Str. Mihai Eminescu nr.

45, sector 1, 010513, Bucureti, Romnia Capital social subscris i vrsat: 1.170.774.450 lei; CUI 6291812; RC: J40/2857/2010; Autorizat de Comisia de Supraveghere a Asigurrilor sub nr. RA - 009; Operator de date cu caracter personal 10152 Alo Groupama 0374 110 110; Fax: 0040 21 310 99 67; www.groupama.ro; office@groupama.ro

CERERE DE ASIGURARE PRIVIND ASIGURAREA DE GARANIE DE PARTICIPARE LA LICITATIE PROPOSAL FORM REGARDING BID BOND INSURANCE

Not/Note:Pentru orice ntrebare din prezenta cerere de asigurare, n cazul n care spaiul nu este suficient, v rugam s ataai o anex / For any question on the hereunder Proposal Form, please attach an annex if necessary. 1. Informaii generale despre Asigurat/General information on the Insured
1.1 Date de identificare Denumire Asigurat/ Name of the Insured ASSA CONSTRUCT CONSULTING Cod Fiscal /Unique registration No RO29283894 Nr.Inreg. la Reg.Comertului/ J29/1625/30.10.2012 Registered at the Registry of Commerce under the no Capital social/ Social capital 200 Obiect principal de activitate/ Main object of activity CONSULTANTA TEHNICA IN CONSTRUCTII SI DIRIGENTIE DE SANTIER Adresa sediului social central/ Address of the Headquarter BDUL REPUBLICII, NR.118, BL.15B2, AP. 31, PLOIESTI-PRAHOVA Persoana de contact/ Contact Person OPREA SORINEL VASILE Telefon// fax/email/ 0740224005 Sucursale / Reprezentane /Puncte de lucru / Subsidiaries/ Representations/ Branches 1.2 Denumirea Asociailor/ Acionarilor firmei (Nume/Prenume) / Details regarding Companys Associates/Shareholders (Name-first and last) Asociai/Acionari Obiect de activitate (pentru societi) % pri sociale/aciuni deinute Denumire (Nume/Prenume)/ Profesie/Activiti anterioare (pentru persoane fizice)/ % of held shares/ parts ara/Country Associates/Shareholders Object of activity (for companies) (Name-first and last) Profession/ Previous activities (for individuals)

OPREA SORINEL VASILE

100

ROMANIA

CONSULTANTA TEHNICA IN CONSTRUCTII SI DIRIGENTIE DE SANTIER

1.3 Care sunt membrii Consiliului de Administraie/ Please indicate who are the Board members. Membrii Consiliului de Administraie (Nume/Prenume)/ Board Members Funcie/ Position in the company Profesie/Activiti anterioare i/sau curente/ Profession/Previous and/or current activities Data nregistrrii ca membru al Consiliului de Administraie/ Registration date as Board member

1.4 Detalii privind conducerea executiv a Asiguratului/ Details regarding the Executive Management of the Insured Data de la care este parte din Conducerea executiv/ Registration date as part of the Executive Management INFIINTARE

Conducere executiv (nume/prenume)/ Executive management

Funcie/ Position in the company

Profesie/Activiti anterioare/ Profession/Previous activities INGINER/SEF SERVICIU INVESTITII SI ACHIZITII PUBLICE-DIRECTIA GENERALA A FINANTELOR PUBLICE PRAHOVA

OPREA SORINEL VASILE

DIRECTOR GENERAL

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

1.5 Deinei aciuni sau pri sociale la alte companii? Dac DA, v rugm s detaliai./ Does the company have business participation?If YES, please detail: NU

Firme deinute/ Business Participants

% pri sociale/ aciuni deinute/ % of held shares/ parts

ara/ Country

Obiect de activitate/ Object of activity

NU

1.6 Suntei parte a unui GRUP de firme? Dac DA, v rugm s menionai numele grupului din care facei parte precum i celelalte societi care fac parte din acelai grup. / Is the company member of a GROUP? If YES, please mention the name of the Group you are part of and the other companies which are part of the same Group. NU/ No DA/Yes

announcement Data limit de transmitere a ofertei/ Due date for sending the 9.11.2012 tender offer 2.1 Valoarea ofertei de participare la licitaie (valoarea estimat 342281,41 a contractului, fr TVA)/ Value of the tender offer 2.2 Denumirea Beneficiarului garaniei/ PRIMARIA SECTOR 2 MUN. BUCURESTI Name of Beneficiary of the Bond 2.3 Valoarea garaniei (suma asigurat)/ 68456,62 Bond Amount(Sum insured) 2.4 Perioada de valabilitate a ofertei de participare la licitaie 120 ZILE 9.11.2012-9.03.2013 Validity of the tender offer 2.5 Perioada de valabilitate a Asigurrii de Garanie de 120 ZILE 9.11.2012-9.03.2013 participare la licitaie/ Validity of the Bid Bond Not/ Note: V rugm s anexai /Please attach: a) oferta de participare la licitaie (mpreun cu devizul, oferta de lucrri, graficul de lucrri, etc)/ the tender offer together with estimation of the costs of works and Works graphic, etc b) fia de date a achiziiei cuprinznd prevederile referitoare la garaniile solicitate / Please attach the paragraphs from the tender specification concering the Bonds requested; c) contractul de baz care urmeaz a fi ncheiat cu Beneficiarul, dac este disponibil /Basic agreement to be signed with the Beneficiary, if available.

2. Informaii referitoare la asigurarea de Garanie de participare la licitaie/ Information on the requested Bid Bond Numrul anunului de participare/ No of the tender 338281/25.10.2012

3. Informaii privind derularea licitaiei /Details regarding the tender


3.1 Tipul contractului/Type of agreement: 3.2 Procedura de atribuire/ncheiere /Award Procedure: contract de lucrri contract de furnizare contract de servicii licitaie deschis/ open tender licitaie restrns/ restricted tender dialogul competitive/ competitive discussion negociere/ negotiation concurs de soluii/ solution contest cerere de oferte/ offer request

3.3 Exist un model de garanie impus de Organizatorul licitaiei? Dac DA, v rugm s anexai modelul /There is a special form of the Bid Bond, as requested by the Tenderer? If YES, please attach the form. DA/Yes NU/No 3.4 Care este obiectul contractului? What is the object of the contract? SERVICII DE CONSULTANTA TEHNICA SI DIRIGENTIE DE SANTIER

3.5 Cum i de ctre cine se finaneaz execuia contracului (Beneficiar, surse proprii sau Finanator ter). V rugm s menionai sumele, condiiile i numele finanatorului ter/ How shall be financed the execution of the contract and by whom? Please mention the amounts, conditions and the name of the third party finance provider. PRIMARIA SECTOR 2 MUN. BUCURESTI -342281,41 LEI 3.6 Participarea la licitaie se face n baza unui Acord de Asociere / Your participation on the tender is based on a Joint-Venture Agreement? NU/No DA/Yes - dac DA, v rugm s menionai/ if yes, please detail: Lista societilor din cadrul asocierii/ List of companies which are part ofJoint-Venture Agreement Calitatea asociatului (lider sau asociat)/ The role of the company into JV Agreement (Leader or Associated Company)

3.7 n cazul n care Asiguratul ctig licitaia, se solicit ncheierea altor tipuri de garanii, cum ar fi:/ In case the Insured is declared the winner of the tender, there are other bonds requested to be issued after signing the contract:
Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

Garanie pentru Buna execuie a contractului/ Performance Bond Garanie privind returnarea avansului/ Advance Payment Bond Garanie pentru perioada de mentenan/intretinere post-executie/Maintenance Bond

4. Experiena anterioar a Asiguratului /The previous experience of the company


4.1 Numr de licitaii organizate la care societatea a participat pn n prezent/ Number of tender you have participated on-4 din care licitaii ctigate/ out of which contracts acquired-2 4.2 Numr de ani de experien n derularea de contracte similare cu cel pentru care se solicit garania/ Number of years in performing similar contracts: 1 AN 4.3 V rugm s menionai contractele derulate/finalizate n ultimii 3ani/ Number of important contracts finalysed in the last 3 years: Valoare contract, din care ncasat/ Perioada contractului/ Beneficiar/ Contract value, out of which Period of the contract Descriere (obiect/locaie)/ Name of the Beneficiary earned De la/pn la Description (object, location) POLITIA LOCALA PLOIESTI PRIMARIA BERTEA PRIMARIA BANESTI PRIMARIA CIORANI .............8500 LEI INCASAT.......... .............25000 LEI INCASAT.......... SERVICII CONSULTANTA TEHNICA SI DIRIGENTIE DE SANTIER IDEM IDEM IDEM

-35000 LEI INCASAT ...........6000 LEI-INCASAT..........

IAN-OCT 2012 .DEC 2011-MARTIE 2012. ..IUNIE-AUGUST 2012 ........-IULIE-OCT 2012

*dac spaiul nu este suficient, v rugm s detaliai pe o pagin separat

4.4 V rugm s menionai contractele n curs de execuie/derulare /Number of contracts in execution: Valoare contract, din care Perioada contractului/ ncasat/ Beneficiar/ Period of the contract Obiect i locaie/ Contract value, out of which Name of the Beneficiary De la/pn la Object & location earned PRIMARIA BANESTI ........59000 LEI...( 0 INCASAT)........ PRIMARIA BAICOI ...102000 LEI (0 INCASAT)........ PRIMARIA CAMPINA BANCA NATIONALA A ROMANIEI-PRAHOVA ..5000 LEI (2000 LEI INCASAT). ........5000 LEI ( 2000 LEI INCASAT). AUGUST 2012-DEC 2013..................../.............. IUNIE-NOIEMBRIE 2012-.................../............. . IUNIE-NOIEMBRIE 2012... IUNIE 2012-DEC 2013. IDEM IDEM IDEM IDEM

Stadiul execuiei/ Stage of the execution (%) FAZA DE PREGATIRE A LUCRARILOR FAZA DE PREGATIRE A LUCRARILOR 90% EXECUTAT 90% EXECUTAT

Perioada de garanie acordat 12 LUNI 12 LUNI 12 LUNI 12 LUNI

*dac spaiul nu este suficient, v rugm s detaliai pe o pagin separat

4.5 Subcontractani/ Subcontractors 4.5.1 Contractul se va execut cu participarea unor subcontractani?/ Does the contract involve subcontractors? DA/Yes NU/No , Dac DA, v rugm detaliai (ataai contractele ncheiate cu subcontractanii)/ If Yes, please detail (please attach the contracts signed with the subcontractors): Subcontractant (denumire/adres)/ Subcontractors (name and address) Lucrri care vor fi executate de subcontractant/ Works to be executed by subcontractor

Valoare (fr TVA)/ Value (without VAT)

4.5.2 Aportul subcontractanilor la executarea contractului este de aproximativ/ The percentage of works to be executed by subcontractors is aproximatively ................................ din total valoare contract/ from total value of the contract. 4.5.3 Se solicit garanii subcontractanilor? / Do you request guarantees to your subcontractors? DA/Yes NU/No 4.5.4 Tipuri de garanii solicitate subcontractanilor/ Type of guarantees required to subcontractors:

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

4.6 Detalii privind structura i experiena personalului/ Details on the structure and the experience of the staff: 4.6.1 Nr. total personal n anul precedent/ Total no. of employees in the previous year ..3.................................................................................................................. 4.6.2 Nr. total personal n anul curent, din care:/ Total number of employees in the current year, out of which: ............................................................................... Categoria/Category Nr. persoane/ No of Staff Angajai permaneni/ Permanent employees 1 Colaboratori/ Collaborators 2

1. Personal de conducere (directori, directori adjunci, efi departamente, efi secie etc.) / Management staff (managers, deputy managers, chiefs of departament etc) 2. Personal calificat direct productiv (care lucreaz n secii de producie)/ Qualified personnel directly involved in production. 3. Personal necalificat direct productiv (care lucreaz n secii de producie) / Unqualified personnel directly involved in production. 4. Personal tehnico-administrativ/ Technical and administrative staff Total:

4.6.3 Detalii semnificative privind experiena, specializarea personalului/ Details on the experience of the staff:

4.7 V-ai confruntat n decursul anilor cu reclamaii, cazuri de culp, litigii nregistrate n executarea obligaiilor contractuale? /Have you ever confrunted with complains, events of default, litigation registeres in the process of performing the contractual obligation? DA/Yes NU/No Dac DA, v rugm s anexai o situaie detaliat care cuprinde informaii privind reclamaiile primite, cazurile de culp de care societatea s-a fcut vinovat i litigiile soluionate sau n curs de soluionare, conform tabelului de mai jos./ If so, please attach a detailed situation that contains information on the complains received and the litigations solved and/or pending, as per the below table: Obiectul reclamaiei/culpei/ The object of complain Stadiul actual al reclamaiei/culpei (soluionat, n curs de soluionare)/ The actual stage of complain (solved, in process of being solved) Cauza/ The cause Modaliti de soluionare/ The method used for solving it Valoarea daunelor, penalitilor i a daunelor interese/ Loss amounts, penalties, interests

Contract

Beneficiar/ Beneficiary

5. Date contabile, financiare i comerciale/ Accounting financials and commercial data


5.1 Indicatori de rezultate /Result indicators Anul N-2/ Year N-2 Cifra de afaceri (fr export)/ Turnover (without export) Profit brut din exploatare/ Gross operating profit Profit net/ Net profit Investiii/ Investments An anterior N-1/ Previous year N-1 6580 LEI An curent N/ Current year Nr. luni/No. Of months 91735 LEI Estimare pentru anul n curs/ Estimation for the current year 150000

1787 LEI

31367 LEI

45000

5.2 Situaia creditelor acordate de bnci, societi de leasing i alte instituii financiare n sold la data solicitrii/ Bank loans, leasing or other loans at the date of request of cover Valuta Sold credit, din care/ Banca/ credit/ Credit curent/ Credit restant/ Scadena final/ Garanii constituite/ Outstanding balance Bank Currency of Remaining loan Outstanding loan Final due date Guarantees out of which the loan

Not: Dac Asiguratul este membru al unui grup, se va anexa o situaie similar cuprinznd creditele pe fiecare societate din grup/ If the Insured is part of a Group, please attach a similar situation containing the loans per each company of the Group .

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

5.3 Garanii/avaluri i alte angajamente de plat emise de bnci, Asigurtori i alte instituii financiare, n vigoare la data solicitrii/ Bonds and other payment obligations issued by banks and other financial institutions, in force at the date of the request Scadena Tip garanie,obiect/ final/termene de Garanii Banca/ Valuta angajament/ Sold angajament/ Type of guarantee, object valabilitate/ constituite/ Bank Currency Obligation balance Final due date, Guarantees validity

5.4 mprumuturi acordate ctre societile din care firma face parte sau pe care aceasta le deine sau mprumuturi acordate asociailor/acionarilor / Loan given to the associates, shareholders or to the other companies inside the group Nume firm/ Companys name Valut credit/ Currency Sold credit/ Loan balance Rambursare (rate sau integral)/ Repayment (installment or in full) Scadena final/ Final term

5.5 Situaia datoriilor ctre furnizori /Debts to the suppliers NU SUNT Termene i modaliti de plat utilizate n relaia cu principalii furnizori/ Terms Termene/ terms:................................................................ and payment method Mod plat/ Payment Method:............................................... used in relation to the main suppliers: Datorii cu scadene Datorii restane din care cu termen de restan/ overdue debts aged: Sold la 31 decembrie a Datorii cu scadena mai mari de 1 an/ anului precedent din care/ pn ntr-un an/ 60-180 zile/ 180-360 zile/ Debts with Sub 60 zile/ Peste 360 zile/ Balance at the 31st of Debts with maturities between 60between 180maturities greater under 60 days over 360 days December of the previous up to 1 year 180 days 360 days than 1 year year, out of which: .................................. Sold la ultima balan ncheiat (RON), din care/ Balance at the end of the previous month, out of which: - Datorii cu scadena mai mare de 1 an/ Debts with maturities greater than 1 year - Datorii curente cu scadena sub 1 an/ Debts with maturities up to 1 year - Datorii restante din care cu termen de restan/ overdue debts aged

Sub 60 zile/ under 60 days

60-180 zile/ days

180-360 zile/days

Peste 360 zile/ over 360 days

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

5.6 Situaia creanelor de ncasat de la clieni/ Receivables to be paid by the clients Termene i modaliti de plat utilizate n relaia cu principalii clieni / Terms Termene/ Terms:............................................................. and payment method Mod plat/ Payment Method:............................................. used in relation to the main clients Creane cu Creane restante/ Overdue receivables : Sold la 31 decembrie a scadena mai mare Creane cu scadena anului precedent din de 1an/ pn 1 an/ care:/ Balance at the 31st Sub 60 zile/ up 60-180 zile/ 180-360 Peste 360 zile/ Receivables with Receivables with of December of the to 60 days days zile/days over 360 days maturities higher maturities up to 1 year previous year, out of than 1 year which: ..................................... Sold la ultima balan ncheiat (RON), din care: / Balance at the end of the previous month, out of which: - Creane cu scadena mai mare de 1 an/ Receivables with maturities higher than 1 year - Creane curente cu scadena sub 1 an/ Receivables with maturities up to 1 year - Creane restante din care cu termen de restan/ Overdue receivables

Sub 60 zile/ under 60 days

60-180 zile/ days

180-360 zile/days

Peste 360 zile/ over 360 days

Soldul creanelor de ncasat la data de/Debtor balances at: _____________________________ 5.7 Care sunt datoriile ctre bugetul statului, bugetul asigurrilor sociale, bugetele locale?/ Debts to the state budget, the social security budget, local budgets? -RONPeste 360 zile/ over Sub 30 zile/ up to 30 days 30-90zile/ days 90-180 zile/days 180-360 zile/days 360 days Total Dac se nregistreaz datorii mai vechi de 90 zile, v rugm s anexai o not explicativ coninnd informaii suplimentare despre sumele nencasate/ If there are registred debts older than 90 days, please attach an explanation of this situation. 5.8 Situaia imobilizrilor corporale deinute de Asigurat/ List of the fixed assets held by the Insured Valoare contabil Valoare estimat rmas/ de pia/ Tip/ Descriere/ Situaie juridic (proprietate/nchiriate)/ Remaining accounting Market value Type Description Juridical status (owned, rented) value -RON-RONTerenuri/Lands Cldiri/ Properties Echipamente/Utilaje/ Equipments and tools Mijloace de transport/ Cars n funcie de tipul imobilizrii corporale se vor completa urmtoarele: localizare, suprafaa, tip construcie, an construcie/achiziie, tip/marca/destinaie, grad utilizare/ Depending on the type of assets, the following will be filled in: place, area, type of construction, year of construction/purchasing, type/brand/destination, degree of use.

6. Lista garaniilor propuse a fi constituite n favoarea Asigurtorului / List of bonds suggested to be constitued in favor of the Insurer
V rugm s anexai o situaie detaliat cuprinznd descrierea garaniilor propuse a fi constituite n favoarea Asigurtorului/ Please attach a list of the bonds proposed to be constitued in favor of the Insurer.

7. Informaii privind alte asigurri de garanii /Information regarding the other bonds insurance

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

Societatea a avut ncheiate alte asigurri de garanii?/ Did you have any other Bond Insurance? Dac DA, detaliai/ If Yes, please detail: Tip asigurare de garanie/ Type of Bond Insurance Perioada asigurat/ Insured Period

DA/ Yes

NU/No Daune nregistrate/ Registered claims

Asigurtor/ Name of the Insurer

La prezenta cerere de asigurare se vor ataa documentele cuprinse n anex/Please attach all the documents specified in the hereunder annex. Declar pe proprie rspundere c datele comunicate n aceast CERERE DE ASIGURARE sunt reale i sunt de acord ca acest document s fac parte integrant din contractul de asigurare i s stea la baza evalurii riscului de ctre Asigurtor. Sunt de acord ca Groupama Asigurri S.A. s nu m despgubeasc n cazul n care constat c datele furnizate n acest declaraie nu corespund adevrului, ori pe parcursul derulrii asigurrii nu am adus la cunotin orice informaie de natur s modifice condiiile de asigurare iniiale, nelegnd c declaraiile false pot implica, dup caz, rspunderea penal (conform legislaiei n vigoare). Sunt de acod ca societatea Groupama Asigurri S.A. s prelucreze datele cu caracter personal, pe care le-am furnizat n scopul administrrii contractului de asigurare, n conformitatea cu dispoziiile Legii 677/2011 pentru protecia persoanelor cu privire la prelucrarea datelor cu caracter personal i libera circulaie a acestor date./ I take it upon myself ti declare that all the data communicated by means of the hereby INSURANCE APPLICATION are real and I agree that this document should form an integral part of the insurance agreement and underlie the risk assesment by the Insurer. I duly agree that Groupama Asigurari S.A. shoul not grant any compensations to me if they should find that the data provided by means of the hereby statement are false or during the development period of the agreement I did not notify any information that should change the initial insurance conditions, understanding that the false statements may involve, as the case may be, criminal liability (acording to the enforced legislation). I grant my permission to Groupama Asigurari S.A. conceming the processing of my personal data, provided for the purpose if insurance agreement administration, in accordance with the provisions of the Law no. 677/2001 for the personal protection concerning the processing of personal data and the free circulation of these data. Pentru i n numele/ On behalf of: ASSA CONSTRUCT CONSULTING SRL Semntura (nume, prenume, semntura i tampila)/ Signed by (name, surname, signature and stamp) OPREA SORINEL VASILE Funcia n cadrul societii de asigurare/ Job title in the company DIRECTOR GENERAL Data/Date:30.10.2012

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

ANEX LA CEREREA DE ASIGURARE PRIVIND ASIGURAREA DE GARANII ANNEX TO THE PROPOSAL FORM
Urmtoarele documente/informaii sunt parte integrant din cererea de asigurare i v rugm s le completai/ataai prezentei cerere/ The following documents are part of the Proposal Form and therefore, please kindly attach/complete them ,as requested below. Anexa 1 Documentele de constituire ale societii/ Companies legal documents: a) Statut / Constitutive Deed b) Certificat Fiscal / Fiscal Registration certificate c) Certificat de nmatriculare la Registrul Comerului/ Registration Certificate issued by the Registry of Commerce d) Extras de la Registrul Comerului / Extract from the Registry of Commerce Anexa 2 Oferta de participare la licitaie/ Tender offer Anexa 3 Fia de date a achizitiei / Extras din caietul de sarcini referitor la garaniile solicitate / Acquisition Data Sheet/ Paragaphs from the tender book which reffer to the Bonds requested. Anexa 4 Graficele de rambursare a creditelor, extrasele conturilor de credite bancare care atest soldurile respective i extrasele conturilor de dobnzi/ please attach repayment graphics of the loans and the account Anexa 5 Dac societatea face parte dintr-un grup de firme, v rugm sa anexati o situaie similar cuprinzand creditele pe fiecare societate din grup/ If the company is part of a group, please attach the same situation for each company of the group Anexa 6 n cazul n care exist pierderi, v rugm s ataai o not prin care s explicai cauzele care au stat la baza nregistrrii pierderilor i care sunt msurile pe care dorii s le aplicai pentru acumularea de profit / If the company registered losses, please attach an explanation note containing the causes that determined negative results and the measures which are planed to be taken in order to ensure the recovery of the losses and the accumulation of profit Anexa 7 n cazul n care facei parte dintr-un grup de firme, v rugm s anexai o situaie similar ca cea de la punctul 5.1 din chestionar cuprinznd indicatorii de rezultate consolidai la nivelul grupului i bilanurile consolidate la nivelul grupului./ If the company is part of a Group, please attach a similar situation containing consolidated result indicators at the group level and consolidated balance sheet at group level (as per question 5.1.from Proposal form) Anexa 8 n cazul n care investiiile sunt semnificative pentru activitatea i rezultatele societii, v rugm s anexai o situaie cuprinznd investiiile realizate/ If the investments are significant, please attach a situation containing the investments already realized Anexa 9 Bilanurile contabile pentru ultimii 2 ani (inclusiv anexe i Rapoarte de gestiune)/ Accounting balance sheets- including attachments and management reports for the last 2 years Anexa 10 Balanele analitice de verificare/ Analytical balance Anexa 11 Raport anual cenzori /Yearly reported censors Anexa 12 Raport anual auditori /Yearly report auditors Anexa 13 Alte situaii ref. date financiar-contabile ntocmite conform precizrilor din cererea de asigurare / Other situations in accordance with the Proposal Form Anexa 14 V rugm s anexai balana analitic a contului de furnizori (ultima balan ncheiat)/ Please attach the last analytical balance of the suppliers account Anexa 15 V rugm s ataai balanele analitice ale conturilor de clieni 411 i 416 (ultima balan ncheiat)/ Please attach the analytical balances of the clients account-411 and 416. Anexa16 V rugm s anexai o situaie detaliat cuprinznd bunurile grevate de sarcini, valoarea i termenele de valabilitate ale contractelor de gaj sau ipotec / Please attach a list of the assets saddled by the charges, value and validity term of the pledge or mortgage agreement . Anexa 17 V rugm s anexai situaia necesarului de resurse umane, resurse materiale i echipamentelor utilajelor/ dotrilor utilizate n execuia contractului/ Please attach the situation of human resources, materials and equipments needs in order to execute the contract. Alte informaii/documente pe care le considerai utile/ necesare pentru evaluarea riscului de ctre Asigurtor / Other information, documents that you consider to be useful for the risk assessment. Reprezentant legal/ Legal representative ________________________________

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012

Cerere de asigurare Garanii _August 2012/ Proposal Form_August 2012