| Card relating to compulsory motor vehicle third party liability insurance (issued under the authority of Council of Bureaux)Carte relative a Eassuranc,e obligatoire de la responsabilite civil automobile (emise sous Eautorite du Conseil des Bureaux)Carta relativa ao seguro obrigatOrio de responsabilidade civil automovel (emitido pela autoridate do Conselho de Bureaux) | ORIGINAL: for the insured/pour l'assure/para o segu-rado |
| 2. Card serial No.No. de serie de la carteNo. da serie da carta |
| 1. Name and adress of the policy holderNom et adresse du preneur d'assuranceNome e endereco do portador de apolice seguro | 3. Valid fromValable duValido de | toauate |
| 4. Type of body and make of vehicleCarrosserie & marque du vehiculeCarrocaria e marca do vieculo | 5. Registration No.No. d'immatriculationNo. de matricula | dayjourdia | monthmoisnes | yearanneeano | dayjourdia | monthnoisnes | yearanneeano |
| (both dates inclusive)(ces deux jours compris)(ambos os dias inclusos) |
| 9. This card has been delivered by/Cette carte est delivree par /Esta carta foi emitida por :(Name and address of insurance company)(Nom et adresse de la societe d'assurance)(Nome e endereco da companhia de seguro) | 6. Chassis No.No. du ChasisNo. do Chassis | 7. Engine No.No. du moteurNo. do motor | 8. Insurance policyNo.No. de la policede'asurannceNo. da apolicedo seguro |
| 12. Code/CodigoCross items which do not applyBuffer les mentions inapproprieesRiscar mencoes inapropriadasA. Car/Voiture/CarroB. Lorry or Tractor/Camion ou traceur/Camiao ou tractorC. Bus/Autobus ou Autocar/Onibus ou AutocarroD. Trailer/Remorque/ReboqueE. Motor-cycle or other cycles fitted with auxiliary engine /Motorcyclettesou autres engins a deux roues/Motocicleta ou outros rnotoveiculos de | 10. Name and address of issuing BureauxNom et adresse du Bureau emetteurNome e enderego do Bureau emissor |
| 14. Signature of insured/Signature de Passure/assinatura do segurado | 11. Signature and stamp of insurerSignature et cachet de PassureurAssinatura e selo do segurador |
| In each country visited, the Bureau of the country assumes, in respect of the use of the vehicle referred to herein, the liability of the insurer in accordance with the laws in the country relative to compulsory insurance.Dans chaque pays visite, le Bureau de ce pays assume pour ce qui a trait a I'utilisation du vehicule docrit ci-contre, la responsabilite qu'aurait un assureur conformement aux-lois de ce pays relatives a ('obligation d'assurance.Em cada pais vistado, o respectivo bureau assume no que se relaciona corn a utilizacao do veiculo descrito, a responsabilidade que compite au segurador de acordo corn as leis do pais relatives ao seguro obrigatorio. | 13. Cancel country inapplicableReyar les pays dans lesquels cette carte n'est pas valable.Riscar os paises nos quais esta carta nao valida. |
| | | ANG | BOT | BUR | COM | DJI | ETH | KEN | LES | MAD | MAL |
| | | MAU | MOZ | RWA | SEY | SOM | SWA | TAN | UGA | ZAM | ZIM |
| (a) In case of an accident occuring in a country being visited the insured assumes responsibility to notify the National Bureaux of the country of accident.(b) The insured undertakes to co-operate fully with the National Bureaux of the country of the accident in all investigations relating to the accident.Notes pour I'assure:(a) En cas d'accident dans un pays visite, I'assure se chargers de contractor le Bureau National du pays oh I'accident est survenu.(b) I'assure s'engage a colter pleinement avec le Bureau National du pays oil est survenu I'accident dans I'instruction du dossier relatif a cet accident.Indiacoges para o segurado:(a) Em caso de acidente no pais visitado, o segurado devera encarregar-se de tomar contacto corn o Bureau National do pais em que se deu o acidente.(b) 0 segurado Pica sujeio a cooperar plenamente com o Bureau National do pais em que se deu o acidente no que respeita as investigacoes sobre o respectivo acidente. | 15. Names and addresses of National Bureaux/Noms et adresses des Bureaux-Nationaux/Nomes enderecos dos Bureaux nacionais. |