CONSTATARE AMIABILA DE ACCIDENT Paagja 12 [BD Dat ceidentut & | asta Yl \ aa a [Hl Pagube materiale Martori: nume, adres, te la ake vehicle decet AGB mate=ese ata ce eae mo 6 mo do Warren) 12. IMPREJURARI Ik] AstouratDothator pots (sxcieunen esate) Marat cu fecarecasutautia [8] AslguatDopitor pola (os sara ac.r) ‘A pentru explcarea desenalui e392 ay sage ane comin || NUO: ht instainace prt Prenume 2“ tamomentul plocari Actes Tas: eschizandporiera 609 post nnn TORE (3 te moment opi Fel sau emai: 14 ngnd ato parcare ato, oc Fr] vericul ‘val crumia para Marca, fp [1S and into parcare auto, loc Marc, Bp eva, rum de pamant Ns inmatioularetnegisrare| Nt inmaticutreinregstare | (¢ —inrindint-un sens grstory — 6[] |) N-Iomaticulorfimegsrare| | Nc hmaticuarlinreistee| tion cn atrractepe| [tense rman aunannunarege 71 || tno rors) | enh renesnren [| Sociotte co asigurare (zicosumermce square) JE] Socitate deasigurare (rs coourars eo ava) [18 lovind spate unui vericol 8] DENIM In tnpuldeplasi pe cla! sere] DENUMIRE: - ? Polita ne: a = Vrceval eit Politanr:...... - ~ Cate Verde: = (19 _seslesinsvse mn acean sens 9] | cane verse — Polijé de asigurare sau Carte Verde: at packeeal ds deme een Polita de asiqurare sau Carte Verde ou vba de le [10 sehinvand banda de ckalajo 10¢] |] sate dete te Suciela (sau agen, sau broker Sucursala (sa agen, sal broke. (DENUMIRE: on eonend "0 | penuwire: a a ~ ae : “Po — wereto coop 200 | pons ee - a Tae 8 Wid tinga 13] fren Tat ssevnnne ns sera (14 merged cuspatsle 14 | Poe emat (aurle maior le wisn cpa pinto po CASCO?| wo oO ‘Conducitor vehi (ai paris decals) ‘snvanape ncn gxinan yg | AS ae eal antacye prs po cascor uO pentru cca in sens opus JE] Conductor vehicul (vx pariste comico) ae Oe Garaimemedey TINE nan - i _metamticcelle Fi Data nagterit: a Dioritale sau lumina rogie a semaforuiué OJ bata natn ae aE ae . 7 1 & speeticasinumaralde + 7] ae Permis de conduate nt: ee Categoria (A,B, .: vinmiacwamnniianared suis i950" | Categoria (A.B. Raa 2 ices ft] inca puna in Fa] iain punctual do Inge pro ei Soca ea qe A = i [Fu] Pagube vizbre [fi] Pagube vibe 5 pineal tea fe] Observati [i] observa: [E]__Semmaturieconduetonior do vhiewio [3]