Account information

• *Last Name:
• *First Name:
• *Email:
• *Phone:
• *Password:
• *Confirm password:

The insured person

• *Type of person:
  Individual Legal
*Personal identification number:
*Seria si nr. CI:
*Name:
*Single registration number:
*Registration number:
*IBAN:
*Bank:
• *Address:
• *County:
  Choose county Alba Arad Arges Bacau Bihor Bistrita-Nasaud Botosani Braila Brasov Bucuresti Buzau Calarasi Caras-Severin Cluj Constanta Covasna Dambovita Dolj Galati Giurgiu Gorj Harghita Hunedoara Ialomita Iasi Ilfov Maramures Mehedinti Mures Neamt Olt Prahova Salaj Satu Mare Sibiu Suceava Teleorman Timis Tulcea Valcea Vaslui Vrancea
• *Locality:
  Choose city
• 
  I hereby confirm that I have read the Information regarding the processing of my personal data and I express my consent to the processing of my personal data for the processing, issuance and delivery of the insurance;
  Pentru alte solicitari in privinta drepturilor GDPR click aici.