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Asigurat :
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Telefon :
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CUI/CNP :
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Judet :
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E-mail :
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| Marca auto |
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Model :
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Capacitate :
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An fabricatie :
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Data primei inmatriculari :
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Masa maxima autorizata :
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Putearea (KW) :
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Numar locuri :
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Numar usi :
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Combustibil :
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| Numar de airbag-uri |
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| Fransiza furt total: |
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| Fransiza dauna totala: |
0%
10%
20% |
| Fransiza pe eveniment: |
0%
minima |
| Compania dorita: |
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| Observatii: |
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