www.ams-claims.ro
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173.249.10.54
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Submitted URL: https://www.ams-claims.ro/
Effective URL: https://www.ams-claims.ro/avizare/
Submission: On July 23 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://www.ams-claims.ro/avizare/
Submission: On July 23 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
POST ./
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<input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
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<div class="aspNetHidden">
<input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="96CD2ED8">
</div>
<div class="main-panel">
<!-- Navbar -->
<!-- End Navbar -->
<div class="content">
<div class="col-md-10 mr-auto ml-auto">
<!-- Wizard container -->
<div class="wizard-container">
<div class="card card-wizard active" data-color="green" id="wizardProfile">
<!-- You can switch " data-color="primary" " with one of the next bright colors: "green", "orange", "red", "blue" -->
<div class="card-header text-center" style="padding-bottom:0; padding-top:0px; background-color:white;">
<table style="text-align:left; width:100%; border:1px;">
<tbody>
<tr>
<td>
<img id="imgLogo" src="Images/Logos_3.png">
</td>
<td>
<h3 class="card-title" style="margin-bottom:0px; font-size:14px;"> Notificare online </h3>
</td>
</tr>
</tbody>
</table>
</div>
<div class="card-header text-center">
<div id="wizard_navigation" class="wizard-navigation">
<div class="progress-with-circle">
<div id="divProgressBar" class="progress-bar" role="progressbar" aria-valuenow="1" aria-valuemin="1" aria-valuemax="5" style="width:0%;"></div>
</div>
<ul class="nav nav-pills">
<li class="nav-item" style="width: 20%;">
<a id="lnkPasul0" class="nav-link" href="#" data-toggle="tab">
<i class="tim-icons icon-bullet-list-67"></i>
<p>Pas 1</p>
</a>
</li>
<li class="nav-item" style="width: 20%;">
<a id="lnkPasul1" class="nav-link" navigateurl="#" data-toggle="tab" href="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("lnkPasul1", "", true, "", "", false, true))">
<i class="tim-icons icon-single-02"></i>
<p>Pas 2</p>
</a>
</li>
<li class="nav-item" style="width: 20%;">
<a id="lnkPasul2" class="nav-link" navigateurl="#" data-toggle="tab" href="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("lnkPasul2", "", true, "", "", false, true))">
<i class="tim-icons icon-bus-front-12"></i>
<p>Pas 3</p>
</a>
</li>
<li class="nav-item" style="width: 20%;">
<a id="lnkPasul3" class="nav-link" href="#" data-toggle="tab">
<i class="tim-icons icon-delivery-fast"></i>
<p>Pas 4</p>
</a>
</li>
<li class="nav-item" style="width: 20%;">
<a id="lnkPasul4" class="nav-link" href="#" data-toggle="tab">
<i class="tim-icons icon-camera-18"></i>
<p>Pas 5</p>
</a>
</li>
</ul>
</div>
</div>
<div class="card-body">
<div class="tab-content" style="padding:initial;">
<div id="Pasul0" class="tab-pane show active">
<h3 class="info-text">Pentru notificarea daunei online va rugam sa pregatiti urmatoarele documente:</h3>
<div class="row justify-content-center mt-5">
<div class="col-sm-10">
<ul>
<li>Carte de identitate sofer/utilizator</li>
<li>Permis de conducere sofer/utilizator</li>
<li>Certificat de inmatriculare autoturism</li>
<li>Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista)</li>
<li>Documente vinovat (in cazul in care raspunzator de producerea evenimentului este o terta persoana identificata): Carte de identitate, Permis de conducere, Certificat de inmatriculare, Polita RCA (daca exista)</li>
</ul>
<h6> * la documentele mentionate anterior se vor efectua fotografii care vor fi solicitate si incarcate intr-un pas ulterior</h6>
<h3 class="info-text"> Fotografii necesare:</h3>
<h5>Pentru a putea identifica bunul asigurat si prejudiciul produs in urma unui eveniment, vor fi necesare urmatoarele fotografii (se vor selecta din memoria dispozitivului sau se vor efectua si incarca intr-un pas ulterior):
</h5>
<ul>
<li>Colt stanga fata</li>
<li>Colt dreapta fata</li>
<li>Colt dreapta spate</li>
<li>Colt stanga spate</li>
<li>Numar kilometri totali (fotografie bord)</li>
<li>Serie de sasiu (parbriz, stalp stanga fata etc.)</li>
<li>Avarii (poza de ansamblu urmata de cateva fotografii in detaliu pentru fiecare element avariat)</li>
</ul>
</div>
</div>
</div>
<div id="Pasul1" class="tab-pane">
<h5 class="info-text"> Informatii necesare despre vehicul si eveniment </h5>
<div class="row justify-content-center mt-5">
<div class="col-sm-10" style="padding-bottom:0px;">
<div class="input-group">
</div>
</div>
<div class="col-sm-10">
<table>
<tbody>
<tr>
<td>
<label>Numar de inmatriculare vehicul (format B01AAA): </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-key-25"></i>
</div>
</div>
<input name="txtNrInmatriculareVehicul" type="text" maxlength="15" id="txtNrInmatriculareVehicul" class="form-control" placeholder="Format: B01AAA">
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="col-sm-5">
<table>
<tbody>
<tr>
<td>
<label>Data evenimentului (format AAAA-LL-ZZ): </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-calendar-60"></i>
</div>
</div>
<input name="txtDataEveniment" type="text" maxlength="10" id="txtDataEveniment" class="form-control" placeholder="Data eveniment - format AAAA-LL-ZZ">
</div>
</td>
<td>
<span style="display:none"> </span>
<script language="javascript"
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</script>
<link rel="stylesheet" href="/avizare/calendar/styles/expedia/style.css" display="all"><img src="/avizare/calendar/styles/calendar.jpg" id="_dtpDataEvenimentButton" alt="Select date" title="Select date"
class="calendarDatePickerButton" onclick="dtpDataEveniment.displayCalendar(event);"><input type="hidden" name="dtpDataEveniment$hidden" id="dtpDataEveniment_hidden">
<div id="_dtpDataEvenimentContainer" style="overflow:hidden;position:relative;display:none;" class="calendarCalendar" onclick="event.cancelBubble=true; if(event.stopPropagation) {event.stopPropagation();}">
<table border="0" cellspacing="0" cellpadding="0" width="100%">
<tbody>
<tr>
<td>
<div class="calendarArrowLeft" onclick="dtpDataEveniment.addToQueue('dtpDataEveniment.prependMonths()');"><<</div>
</td>
<td width="100%">
<div class="calendarTitle">Tuesday, July 23, 2024</div>
</td>
<td>
<div class="calendarArrowRight" onclick="dtpDataEveniment.addToQueue('dtpDataEveniment.appendMonths()');">>></div>
</td>
</tr>
</tbody>
</table>
<div style="position:relative;overflow:hidden;left:0px;width:800%;">
<table border="0" cellspacing="0" cellpadding="0" style="position:relative;">
<tbody>
<tr></tr>
</tbody>
</table>
</div>
</div><iframe id="_dtpDataEvenimentiframe" style="DISPLAY:none; POSITION:absolute; LEFT:0px; TOP:0px;" src="javascript:false;" frameborder="0" scrolling="no"></iframe>
<script language="javascript">
function initCalendar_dtpDataEveniment(attempts) {
if (typeof(oboutCalendar) == "undefined") {
if (attempts < 10) {
window.setTimeout("initCalendar_dtpDataEveniment(" + (attempts + 1) + ")", 500);
} else {
alert("There was a problem referencing obout Calendar javascript file. Please contact support@obout.com for support.");
}
return;
}
try {
window.dtpDataEveniment = new oboutCalendar("dtpDataEveniment", 25, 175, 160, 5, 1, 1, new Date(2024, 6, 23), null, null, new Date(2024, 6, 23),
"January,February,March,April,May,June,July,August,September,October,November,December,", "Jan,Feb,Mar,Apr,May,Jun,Jul,Aug,Sep,Oct,Nov,Dec,", "Sunday,Monday,Tuesday,Wednesday,Thursday,Friday,Saturday",
"Su,Mo,Tu,We,Th,Fr,Sa", 1, new Array(), new Array(), new Array(), new Array(), new Array(), null, [], null, true, 0, 0, "txtDataEveniment", "yyyy-MM-dd", "MMMM yyyy", 0, true, true, true, true, null, null,
true, false, false, "calendarMonth", "calendarMonthTitle", "calendarDayName", "calendarDay", "calendarDayOver", "calendarDayDisabled", "calendarDayDisabledOver", "calendarDaySpecial", "calendarDaySpecialOver",
"calendarDayToday", "calendarDayTodayOver", "calendarDaySelected", "calendarDaySelectedOver", "calendarYearSelector", "calendarYearSelected", "calendarMonthSelector", "calendarMonthSelected",
"calendarHourSelector", "calendarHourSelected", "calendarMinuteSelector", "calendarMinuteSelected", "calendarSecondSelector", "calendarSecondSelected", 100, 0, 100, 0, 100, 0, 100, 0, false, false, false,
"Cursor", null);
} catch (e) {
alert("There was an error initializing obout Calendar with ID dtpDataEveniment.\n\n" + e.Message + "\n\nPlease contact support@obout.com for help.");
}
}
initCalendar_dtpDataEveniment(0);
</script>
</td>
</tr>
</tbody>
</table>
</div>
<div class="col-sm-5">
<div class="input-group">
<div class="input-group-prepend">
</div>
<table>
<tbody>
<tr>
<td>
<label>Ora evenimentului (format hh:mm): </label>
<div class="input-group">
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-time-alarm"></i>
</div>
</div>
<input name="txtOraEveniment" type="text" maxlength="10" id="txtOraEveniment" class="form-control" placeholder="Format hh:mm Ex: 12:00">
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-10">
<div class="input-group">
<div class="input-group-prepend">
</div>
<table>
<tbody>
<tr>
<td>
<input id="chkGdprConsent" type="checkbox" name="chkGdprConsent">
</td>
<td style="width:10px;">
</td>
<td>
<span id="lblGdprInfo" class="text-justify">Confirm ca am citit si imi exprim acordul privind prelucrarea datelor cu caracter personal conform
<a id="lnkGdprInfo" class="text-success" href="Formular_GDPR.pdf" target="_blank">Notei de informare privind prelucrarea datelor cu caracter personal.</a></span>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<div id="Pasul2" class="tab-pane">
<h5 class="info-text"> Informatii despre conducator/utilizator</h5>
<div class="row justify-content-center mt-5">
<div class="col-sm-10" style="padding-bottom:0px;">
<div class="input-group">
</div>
</div>
<div class="col-sm-5">
<label>Subsemnatul (nume, prenume)</label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-single-02"></i>
</div>
</div>
<input name="txtNumeUtilizator" type="text" maxlength="150" id="txtNumeUtilizator" class="form-control" placeholder="Nume si Prenume">
</div>
<label>Permis de conducere (numarul) </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-key-25"></i>
</div>
</div>
<input name="txtNrPermisConducere" type="text" maxlength="15" id="txtNrPermisConducere" class="form-control" placeholder="Numar permis conducere">
</div>
</div>
<div class="col-sm-5">
<label>Cod numeric personal: </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-key-25"></i>
</div>
</div>
<input name="txtCNP" type="text" maxlength="13" id="txtCNP" class="form-control" placeholder="CNP">
</div>
<label>Telefon: </label>
<div class="input-group">
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-mobile"></i>
</div>
</div>
<input name="txtTelefon" type="text" maxlength="20" id="txtTelefon" class="form-control" placeholder="Telefon">
</div>
</div>
</div>
<div class="col-sm-10">
<label>Adresa de e-mail: </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-email-85"></i>
</div>
</div>
<input name="txtEmail" type="text" maxlength="128" id="txtEmail" class="form-control" placeholder="Address">
</div>
</div>
</div>
</div>
<div id="Pasul2Eveniment" class="tab-pane">
<h5 class="info-text"> Informatii despre eveniment</h5>
<div class="row justify-content-center mt-5">
<div class="col-sm-10" style="padding-bottom:0px;">
<div class="input-group">
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<label>Starea autovehicului la momentul evenimentului</label>
<span id="rblStareAutovehicul" style="display:inline-block;width:100%;"><span style="margin-right:30px; vertical-align:central;"><input id="rblStareAutovehicul_0" type="radio" name="rblStareAutovehicul" value="PARCAT"
onclick="javascript:setTimeout('__doPostBack(\'rblStareAutovehicul$0\',\'\')', 0)"><label for="rblStareAutovehicul_0"> PARCAT</label></span><span style="margin-right:30px;"><input id="rblStareAutovehicul_1"
type="radio" name="rblStareAutovehicul" value="CONDUS" checked="checked"><label for="rblStareAutovehicul_1"> CONDUS</label></span></span>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<label>Vinovat de producerea evenimentului este un tert identificat?</label>
<span id="rblVinovatTertIdentificat" style="display:inline-block;width:100%;"><span style="margin-right:30px; vertical-align:central;"><input id="rblVinovatTertIdentificat_0" type="radio" name="rblVinovatTertIdentificat"
value="1"><label for="rblVinovatTertIdentificat_0"> DA</label></span><span style="margin-right:30px;"><input id="rblVinovatTertIdentificat_1" type="radio" name="rblVinovatTertIdentificat" value="0"
checked="checked"><label for="rblVinovatTertIdentificat_1"> NU</label></span></span>
</div>
</div>
<div class="col-sm-5">
<div class="form-group">
<label>Tipul evenimentului:</label>
<div class="btn-group bootstrap-select"><button type="button" class="dropdown-toggle btn btn-success" data-toggle="dropdown" role="button" data-id="drpTipEveniment" title="Alege Optiunea..."><span
class="filter-option pull-left">Alege Optiunea...</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">Alege Optiunea...</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="1">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">In mers – parbriz avariat</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="2">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Culpa Asigurat/utilizator – avariat in parcare (stalp, gard, bordura)</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="3">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Culpa Asigurat/utilizator – a lovit un alt auto</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="4">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Coliziune cu animale</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="5">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Altele</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
</ul>
</div><select name="drpTipEveniment" id="drpTipEveniment" class="selectpicker" data-size="7" data-style="btn btn-success" tabindex="-98">
<option value="Alege Optiunea...">Alege Optiunea...</option>
<option value="1">In mers – parbriz avariat</option>
<option value="6">Culpa Asigurat/utilizator – avariat in parcare (stalp, gard, bordura)</option>
<option value="7">Culpa Asigurat/utilizator – a lovit un alt auto</option>
<option value="9">Coliziune cu animale</option>
<option value="10">Altele</option>
</select>
</div>
</div>
</div>
<div class="col-sm-5">
<div class="form-group">
<label>Localitate eveniment: </label>
<input name="txtLocalitateEveniment" type="text" maxlength="128" id="txtLocalitateEveniment" class="form-control" placeholder="Localitate eveniment">
</div>
</div>
<div class="col-sm-5">
<div class="form-group">
<label>Judet/Sector:</label>
<div class="btn-group bootstrap-select"><button type="button" class="btn dropdown-toggle btn-default" data-toggle="dropdown" role="button" data-id="drpJudet" title="Bucuresti"><span
class="filter-option pull-left">Bucuresti</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">Bucuresti</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Alba</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Arad</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="3"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Arges</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="4"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bacau</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bihor</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="6">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bistrita-Nasaud</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="7">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Botosani</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="8">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Brasov</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="9">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Braila</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="10">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Buzau</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="11">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Caras-Severin</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="12">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Calarasi</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="13"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cluj</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="14">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Constanta</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="15">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Covasna</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="16">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dâmbovita</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="17"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dolj</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="18">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Galati</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="19">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Giurgiu</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="20"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Gorj</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="21">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Harghita</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="22">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Hunedoara</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="23">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ialomita</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="24"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Iasi</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="25">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ilfov</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="26">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Maramures</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="27">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mehedinti</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="28">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mures</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="29">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Neamt</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="30"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Olt</span><span class="tim-icons icon-check-2 check-mark"></span></a>
</li>
<li data-original-index="31">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Prahova</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="32">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Satu Mare</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="33">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Salaj</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="34">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sibiu</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="35">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Suceava</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="36">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Teleorman</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="37">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Timis</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="38">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tulcea</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="39">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vâlcea</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="40">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vaslui</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
<li data-original-index="41">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vrancea</span><span class="tim-icons icon-check-2 check-mark"></span></a></li>
</ul>
</div><select name="drpJudet" id="drpJudet" class="selectpicker" data-size="7" tabindex="-98">
<option value="1">Bucuresti</option>
<option value="2">Alba</option>
<option value="3">Arad</option>
<option value="4">Arges</option>
<option value="5">Bacau</option>
<option value="6">Bihor</option>
<option value="7">Bistrita-Nasaud</option>
<option value="8">Botosani</option>
<option value="9">Brasov</option>
<option value="10">Braila</option>
<option value="11">Buzau</option>
<option value="12">Caras-Severin</option>
<option value="13">Calarasi</option>
<option value="14">Cluj</option>
<option value="15">Constanta</option>
<option value="16">Covasna</option>
<option value="17">Dâmbovita</option>
<option value="18">Dolj</option>
<option value="19">Galati</option>
<option value="20">Giurgiu</option>
<option value="21">Gorj</option>
<option value="22">Harghita</option>
<option value="23">Hunedoara</option>
<option value="24">Ialomita</option>
<option value="25">Iasi</option>
<option value="26">Ilfov</option>
<option value="27">Maramures</option>
<option value="28">Mehedinti</option>
<option value="29">Mures</option>
<option value="30">Neamt</option>
<option value="31">Olt</option>
<option value="32">Prahova</option>
<option value="33">Satu Mare</option>
<option value="34">Salaj</option>
<option value="35">Sibiu</option>
<option value="36">Suceava</option>
<option value="37">Teleorman</option>
<option value="38">Timis</option>
<option value="39">Tulcea</option>
<option value="40">Vâlcea</option>
<option value="41">Vaslui</option>
<option value="42">Vrancea</option>
</select>
</div>
</div>
</div>
<div class="col-sm-5">
<div class="form-group">
<label>Strada/Soseaua: </label>
<input name="txtEvenimentAdresa" type="text" maxlength="1200" id="txtEvenimentAdresa" class="form-control" placeholder="Adresa eveniment">
</div>
</div>
<div class="col-sm-4">
<div class="form-group">
<label>In dreptul imobilului cu numarul / kilometrul</label>
<input name="txtInDreptulImobKM" type="text" maxlength="50" id="txtInDreptulImobKM" class="form-control" placeholder="Km sau alt punct de reper">
</div>
</div>
<div class="col-sm-3">
<div class="form-group">
<label>Din directia</label>
<input name="txtDinDirectia" type="text" maxlength="50" id="txtDinDirectia" class="form-control" placeholder="Din directia">
</div>
</div>
<div class="col-sm-3">
<div class="form-group">
<label>Catre</label>
<input name="txtCatre" type="text" maxlength="50" id="txtCatre" class="form-control" placeholder="Catre">
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<label>Descrierea evenimentului:</label>
<textarea name="txtDescriereEveniment" id="txtDescriereEveniment" rows="3" class="auto_height" oninput="auto_height(this)" style="height:50px;" placeholder="Mai multe detalii despre eveniment" maxlength="4000"></textarea>
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<label>Localitate reparatie:</label>
<input name="txtLocalitateReparatie" type="text" maxlength="128" id="txtLocalitateReparatie" class="form-control" placeholder="Localitate reparatie">
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<br>
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<span class="text-justify" style="font-size:smaller;"> Declar pe proprie răspundere că, în urma evenimentului rutier, <input id="chkYesVictims" type="checkbox" name="chkYesVictims"> au rezultat / <input id="chkNoVictims"
type="checkbox" name="chkNoVictims" checked="checked"> nu au rezultat decesul sau rănirea vreunei persoane ori producerea de pagube altor persoane, respectiv <input name="txtObsDeclaratie" type="text" maxlength="50"
id="txtObsDeclaratie" placeholder="">
</span>
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<br>
</div>
</div>
<div class="col-sm-10">
<div class="form-group">
<span class="text-justify" style="font-size:smaller;"> Evenimentul rutier <input id="chkNoCercetarePolitie" type="checkbox" name="chkNoCercetarePolitie" checked="checked"> nu a făcut / <input id="chkYesCercetarePolitie"
type="checkbox" name="chkYesCercetarePolitie"> a făcut obiectul cercetării organelor de poliţie şi <input id="chkNoProcesVerbal" type="checkbox" name="chkNoProcesVerbal" checked="checked"> nu este emis / <input
id="chkYesProcesVerbal" type="checkbox" name="chkYesProcesVerbal"> este emis proces verbal de contravenţie şi autorizaţie de reparaţie. </span>
</div>
</div>
</div>
</div>
<div id="Pasul3" class="tab-pane">
<div id="pnlSchitaDescriere">
<h5 class="info-text"> Schita producerii evenimentului </h5>
</div>
<div class="row justify-content-center" style="padding-top:0px;padding-bottom:0px;">
<div class="col-sm-10" style="text-align:left; padding-top:0px;">
<table style="width:100%;">
<tbody>
<tr>
<td>
<label>Schita evenimentului (se deseneaza in chenarul de mai jos)</label>
<label style="color:red; font-weight:normal;">In cazul in care nu se realizeaza schita in chenarul de mai jos, aceasta poate fi desenata manual si incarcata sub forma unei fotografii intr-un pas ulterior sau poate fi
preluata din constatul amiabil (daca exista) prin fotografiere si incarcata intr-un pas ulterior.</label>
<canvas id="drawing_canvas" height="360" width="1050.6666656">
<input type="submit" name="drawing_submitBtn" value="Salveaza"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("drawing_submitBtn", "", true, "", "", false, false))" id="drawing_submitBtn"
style="height:0px;width:0px;">
<textarea name="drawing_dataUrl" id="drawing_dataUrl" style="height:0px; width:0px;" cssclass="form-control"></textarea>
</canvas>
<input type="hidden" name="HiddenFieldDrawing" id="HiddenFieldDrawing">
</td>
</tr>
<tr>
<td style="text-align:left;">
<input type="submit" name="drawing_clearBtn" value="Sterge"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("drawing_clearBtn", "", true, "", "", false, false))" id="drawing_clearBtn" class="btn-default">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div id="Pasul4" class="tab-pane">
<div class="row justify-content-center">
<div class="col-sm-3" hidden="hidden" aria-hidden="true"> <label>Fata</label> <input id="rblFata" type="radio" name="rblFata" value="rblFata">
<div class="input-group">
<input type="image" name="btnImgFata" id="btnImgFata" src="Images/fata.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("btnImgFata", "", true, "", "", false, false))" style="width:90%;">
</div>
</div>
<div class="col-sm-4" hidden="hidden" aria-hidden="true"> <label>Stanga</label> <input id="rblStanga" type="radio" name="rblStanga" value="rblStanga">
<div class="input-group">
<input type="image" name="btnImgStanga" id="btnImgStanga" src="Images/stanga.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("btnImgStanga", "", true, "", "", false, false))" style="width:90%;">
</div>
</div>
<div class="col-sm-3" hidden="hidden" aria-hidden="true"> <label>Spate</label> <input id="rblSpate" type="radio" name="rblSpate" value="rblSpate">
<div class="input-group">
<input type="image" name="btnImgSpate" id="btnImgSpate" src="Images/spate.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("btnImgSpate", "", true, "", "", false, false))" style="width:90%;">
</div>
</div>
<div class="col-sm-4" hidden="hidden" aria-hidden="true"> <label>Dreapta</label> <input id="rblDreapta" type="radio" name="rblDreapta" value="rblDreapta">
<div class="input-group">
<input type="image" name="btnImgDreapta" id="btnImgDreapta" src="Images/dreapta.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("btnImgDreapta", "", true, "", "", false, false))" style="width:90%;">
</div>
</div>
<div class="col-sm-4" hidden="hidden" aria-hidden="true"> <label>Plafon</label> <input id="rblPlafon" type="radio" name="rblPlafon" value="rblPlafon">
<div class="input-group">
<input type="image" name="btnImgPlafon" id="btnImgPlafon" src="Images/plafon.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("btnImgPlafon", "", true, "", "", false, false))" style="width:90%;">
</div>
</div>
<div class="col-sm-10"><br></div>
<div class="col-sm-10">
<div class="form-group">
<label>Denumirea elementelor avariate (exemplu: bara fata, proiector de ceata dreapta, usa stanga fata etc.)</label>
<textarea name="txtAlteElementeAvariate" id="txtAlteElementeAvariate" rows="6" class="auto_height" oninput="auto_height(this)" style="height:100px;" placeholder="" maxlength="4000"></textarea>
</div>
</div>
</div>
</div>
<div id="Pasul5" class="tab-pane">
<div class="row justify-content-center" style="padding-top:0px;padding-bottom:0px;">
<div class="col-sm-10" style="text-align:left; padding-top:0px;">
<table style="width:100%;">
<tbody>
<tr>
<td>
<label>Prin semnatura de mai jos declar pe propria raspundere veridicitatea informatiilor si a datelor furnizate</label>
<canvas id="sig_canvas" height="360" style="text-align:center;" width="1050.6666656">
<input type="submit" name="sig_submitBtn" value="Salveaza"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("sig_submitBtn", "", true, "", "", false, false))" id="sig_submitBtn" class="btn-default"
style="height:0px;width:0px;">
<textarea name="sig_dataUrl" id="sig_dataUrl" style="height:0px; width:0px;" cssclass="form-control"></textarea>
</canvas>
<img id="sig_image">
<input type="hidden" name="HiddenFieldSignature" id="HiddenFieldSignature">
</td>
</tr>
<tr>
<td style="text-align:left;">
<input type="submit" name="sig_clearBtn" value="Sterge"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("sig_clearBtn", "", true, "", "", false, false))" id="sig_clearBtn" class="btn-default">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div id="Pasul6" class="tab-pane">
<h5 class="info-text"> Incarcare fotografii si documente </h5>
<div class="row justify-content-center mt-5">
<div class="col-sm-10" style="padding-bottom:0px;">
<div class="input-group">
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Carte de identitate sofer/utilizator </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl00" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadCarteIdentitate" id="fileUploadCarteIdentitate">
<span id="RequiredFieldValidator1" style="color:Red;visibility:hidden;">Document obligatoriu!</span>
<span id="regexValidatorCarteIdentitate" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Permis de conducere sofer/utilizator </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl01" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl01", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadPermisConducere" id="fileUploadPermisConducere">
<span id="RequiredFieldValidator2" style="color:Red;visibility:hidden;">Document obligatoriu!</span>
<span id="RegularExpressionValidator1" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Certificat de inmatriculare autoturism </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl02" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl02", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadCertificatInmatriculare" id="fileUploadCertificatInmatriculare">
<span id="RequiredFieldValidator3" style="color:Red;visibility:hidden;">Document obligatoriu!</span>
<span id="RegularExpressionValidator2" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista) </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div id="pnlPreviewConstat" class="fileinput-preview fileinput-exists thumbnail">
</div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl03" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl03", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadPVConstatareAmiabila" id="fileUploadPVConstatareAmiabila">
<span id="RegularExpressionValidator3" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Documente vinovat (in cazul in care raspunzator de producerea evenimentului este o terta persoana identificata): Carte de identitate, Permis de conducere, Certificat de inmatriculare, Polita RCA
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl04" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl04", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadDocumenteVinovat" id="fileUploadDocumenteVinovat">
<span id="RegularExpressionValidator4" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Schita eveniment (daca nu a fost desenata anterior) </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl05" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl05", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadSchitaEveniment" id="fileUploadSchitaEveniment">
<span id="RegularExpressionValidator5" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Alte documente </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl06" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl06", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAlteDocumente" id="fileUploadAlteDocumente">
<span id="RegularExpressionValidator6" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;">
<span class="" style="border:none;"> Colt stanga fata <a href="#" class="tooltipStangaFata" alt="Model imagine de incarcat">
<img id="imgInfo1" src="Images/warning_4_32.png">
</a>
</span>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl07" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl07", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadColtStangaFata" id="fileUploadColtStangaFata">
<span id="RegularExpressionValidator7" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Colt dreapta fata <a href="#" class="tooltipDreaptaFata" alt="Model imagine de incarcat">
<img id="Image6" src="Images/warning_4_32.png">
</a>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl08" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl08", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadDreaptaFata" id="fileUploadDreaptaFata">
<span id="RegularExpressionValidator8" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Colt dreapta spate <a href="#" class="tooltipDreaptaSpate" alt="Model imagine de incarcat">
<img id="Image1" src="Images/warning_4_32.png">
</a>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl09" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl09", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadColtDreaptaSpate" id="fileUploadColtDreaptaSpate">
<span id="RegularExpressionValidator9" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Colt stanga spate <a href="#" class="tooltipStangaSpate" alt="Model imagine de incarcat">
<img id="Image2" src="Images/warning_4_32.png">
</a>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl10" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl10", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadColtStangaSpate" id="fileUploadColtStangaSpate">
<span id="RegularExpressionValidator10" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Numar kilometri totali (fotografie bord) <a href="#" class="tooltipNrKmBord" alt="Model imagine de incarcat">
<img id="Image3" src="Images/warning_4_32.png">
</a>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl11" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl11", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadNrKmTotali" id="fileUploadNrKmTotali">
<span id="RegularExpressionValidator11" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Serie de sasiu (parbriz, stalp stanga fata etc.) <a href="#" class="tooltipSerieSasiu" alt="Model imagine de incarcat">
<img id="Image4" src="Images/warning_4_32.png">
</a>
</td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl12" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl12", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadSerieSasiu" id="fileUploadSerieSasiu">
<span id="RegularExpressionValidator12" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii (poza de ansamblu urmata de cateva fotografii in detaliu pentru fiecare element avariat) </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl13" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl13", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAlteAvarii" id="fileUploadAlteAvarii">
<span id="RegularExpressionValidator13" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup1" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 1 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl14" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl14", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup1" id="fileUploadAvariiSup1">
<span id="RegularExpressionValidator14" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup2" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 2 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl15" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl15", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup2" id="fileUploadAvariiSup2">
<span id="RegularExpressionValidator15" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup3" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 3 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl16" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl16", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup3" id="fileUploadAvariiSup3">
<span id="RegularExpressionValidator16" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup4" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 4 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl17" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl17", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup4" id="fileUploadAvariiSup4">
<span id="RegularExpressionValidator17" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup5" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 5 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl18" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl18", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup5" id="fileUploadAvariiSup5">
<span id="RegularExpressionValidator18" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup6" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 6 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl19" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl19", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup6" id="fileUploadAvariiSup6">
<span id="RegularExpressionValidator19" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup7" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 7 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl20" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl20", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup7" id="fileUploadAvariiSup7">
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</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-5" id="divAvariiSup8" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 8 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
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<div class="col-sm-5" id="divAvariiSup9" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 9 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
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<span class="btn btn-simple btn-file" style="border:none;">
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<span class="fileinput-exists">Modifica</span>
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</td>
</tr>
</tbody>
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<div class="col-sm-5" id="divAvariiSup10" style="display:none;">
<div class="input-group">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Avarii 10 </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail"></div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl23" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl23", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadAvariiSup10" id="fileUploadAvariiSup10">
<span id="RegularExpressionValidator23" style="color:Red;visibility:hidden;">Invalid file type.</span>
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</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-sm-10" hidden="hidden">
<table style="width:100%;">
<tbody>
<tr>
<td style="width:30%;"> Carte de identitate sofer/utilizator </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail">
</div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl24" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl24", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
<input type="file" multiple="multiple" name="fileUploadCIOld" id="fileUploadCIOld">
<span id="RegularExpressionValidator24" style="color:Red;visibility:hidden;">Invalid file type.</span>
</span>
<a href="#pablo" class="btn btn-danger btn-round fileinput-exists" data-dismiss="fileinput" hidden="hidden"><i class="fa fa-times"></i> Sterge</a>
</div>
</div>
</div>
</td>
<td style="width:25%;"> Permis de conducere sofer/utilizator </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail">
</div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl25" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl25", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
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<span id="RegularExpressionValidator25" style="color:Red;visibility:hidden;">Invalid file type.</span>
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<a href="#pablo" class="btn btn-danger btn-round fileinput-exists" data-dismiss="fileinput" hidden="hidden"><i class="fa fa-times"></i> Sterge</a>
</div>
</div>
</div>
</td>
</tr>
<tr>
<td style="width:25%;"> Certificat de inmatriculare autoturism </td>
<td style="text-align:left;width:25%;">
<div class="col-lg-4 text-center">
<div class="fileinput fileinput-new text-center" data-provides="fileinput">
<div class="fileinput-new thumbnail">
</div>
<div class="fileinput-preview fileinput-exists thumbnail"></div>
<div>
<span class="btn btn-simple btn-file" style="border:none;">
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<span class="fileinput-exists">Modifica</span>
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<span id="RegularExpressionValidator26" style="color:Red;visibility:hidden;">Invalid file type.</span>
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</div>
</div>
</div>
</td>
<td style="width:25%;"> Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista) </td>
<td style="text-align:left; width:25%;">
<div class="col-lg-4 text-center">
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<div class="fileinput-new thumbnail">
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<div>
<span class="btn btn-simple btn-file" style="border:none;">
<span class="fileinput-new"><input type="image" name="ctl27" src="Images/plus32_32.png"
onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl27", "", true, "", "", false, false))"></span>
<span class="fileinput-exists">Modifica</span>
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<span id="RegularExpressionValidator27" style="color:Red;visibility:hidden;">Invalid file type.</span>
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<a href="#pablo" class="btn btn-danger btn-round fileinput-exists" data-dismiss="fileinput" hidden="hidden"><i class="fa fa-times"></i> Sterge</a>
</div>
</div>
</div>
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
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</div>
</div>
<div id="Pasul7" class="tab-pane">
<h3 class="info-text"> Va multumim! </h3>
<div class="row justify-content-center mt-5">
<img src="Images/Checkmark_64_64.png">
<div class="col-sm-10">
<h4>Am primit notificarea dumneavoastra si urmeaza sa fiti contactat de catre un inspector de daune in cel mai scurt timp. Va multumim!</h4>
</div>
</div>
</div>
<div id="PasOmniasig" class="tab-pane">
<h5 class="info-text"> Informatii despre conducator/utilizator</h5>
<div class="row justify-content-center mt-5">
<div class="col-sm-10" style="padding-bottom:0px;">
<div class="input-group">
</div>
</div>
<div class="col-sm-5">
<label>Subsemnatul (nume, prenume)</label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-single-02"></i>
</div>
</div>
<input name="txtNumeUtilizator_Omniasig" type="text" id="txtNumeUtilizator_Omniasig" class="form-control" placeholder="Nume si Prenume">
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<div class="input-group">
<label>Vinovat / Pagubit</label>
<span id="rbl_Pagubit_Vinovat_Omniasig" style="display:inline-block;width:100%;"><span style="margin-right:30px; vertical-align:central;"><input id="rbl_Pagubit_Vinovat_Omniasig_0" type="radio"
name="rbl_Pagubit_Vinovat_Omniasig" value="Pagubit"><label for="rbl_Pagubit_Vinovat_Omniasig_0"> Pagubit</label></span><span style="margin-right:30px;"><input id="rbl_Pagubit_Vinovat_Omniasig_1" type="radio"
name="rbl_Pagubit_Vinovat_Omniasig" value="Vinovat" checked="checked"><label for="rbl_Pagubit_Vinovat_Omniasig_1"> Vinovat</label></span></span>
</div>
</div>
<div class="col-sm-5">
<label>Localitatea in care se va efectua reparatia: </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-key-25"></i>
</div>
</div>
<input name="txtLocalitateReparatie_Omniasig" type="text" id="txtLocalitateReparatie_Omniasig" class="form-control" placeholder="Localitate reparatie">
</div>
<label>Telefon: </label>
<div class="input-group">
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-mobile"></i>
</div>
</div>
<input name="txtTelefon_Omniasig" type="text" id="txtTelefon_Omniasig" class="form-control" placeholder="Telefon">
</div>
</div>
</div>
<div class="col-sm-10">
<label>Adresa de e-mail: </label>
<div class="input-group">
<div class="input-group-prepend">
<div class="input-group-text">
<i class="tim-icons icon-email-85"></i>
</div>
</div>
<input name="txtEmail_Omniasig" type="text" id="txtEmail_Omniasig" class="form-control" placeholder="Address">
</div>
</div>
<div class="col-sm-10"><br></div>
<div class="col-sm-10">
<div class="form-group">
<label>Denumirea elementelor avariate (exemplu: bara fata, proiector de ceata dreapta, usa stanga fata etc.)</label>
<textarea name="txtElementeAvariate_Omniasig" id="txtElementeAvariate_Omniasig" rows="6" class="auto_height" oninput="auto_height(this)" style="height:100px;" placeholder="Elemente avariate"></textarea>
</div>
</div>
</div>
</div>
<div id="PasFinalOmniasig" class="tab-pane">
<h3 class="info-text"> Va multumim! </h3>
<div class="row justify-content-center mt-5">
<img src="Images/Checkmark_64_64.png">
<div class="col-sm-10">
<h4>Am primit notificarea dumneavoastra si urmeaza sa fiti contactat de catre un inspector de daune in cel mai scurt timp. Va multumim!</h4>
</div>
</div>
</div>
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</form>Text Content
NOTIFICARE ONLINE * Pas 1 * Pas 2 * Pas 3 * Pas 4 * Pas 5 PENTRU NOTIFICAREA DAUNEI ONLINE VA RUGAM SA PREGATITI URMATOARELE DOCUMENTE: * Carte de identitate sofer/utilizator * Permis de conducere sofer/utilizator * Certificat de inmatriculare autoturism * Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista) * Documente vinovat (in cazul in care raspunzator de producerea evenimentului este o terta persoana identificata): Carte de identitate, Permis de conducere, Certificat de inmatriculare, Polita RCA (daca exista) * LA DOCUMENTELE MENTIONATE ANTERIOR SE VOR EFECTUA FOTOGRAFII CARE VOR FI SOLICITATE SI INCARCATE INTR-UN PAS ULTERIOR FOTOGRAFII NECESARE: PENTRU A PUTEA IDENTIFICA BUNUL ASIGURAT SI PREJUDICIUL PRODUS IN URMA UNUI EVENIMENT, VOR FI NECESARE URMATOARELE FOTOGRAFII (SE VOR SELECTA DIN MEMORIA DISPOZITIVULUI SAU SE VOR EFECTUA SI INCARCA INTR-UN PAS ULTERIOR): * Colt stanga fata * Colt dreapta fata * Colt dreapta spate * Colt stanga spate * Numar kilometri totali (fotografie bord) * Serie de sasiu (parbriz, stalp stanga fata etc.) * Avarii (poza de ansamblu urmata de cateva fotografii in detaliu pentru fiecare element avariat) INFORMATII NECESARE DESPRE VEHICUL SI EVENIMENT Numar de inmatriculare vehicul (format B01AAA): Data evenimentului (format AAAA-LL-ZZ): << Tuesday, July 23, 2024 >> Ora evenimentului (format hh:mm): Confirm ca am citit si imi exprim acordul privind prelucrarea datelor cu caracter personal conform Notei de informare privind prelucrarea datelor cu caracter personal. INFORMATII DESPRE CONDUCATOR/UTILIZATOR Subsemnatul (nume, prenume) Permis de conducere (numarul) Cod numeric personal: Telefon: Adresa de e-mail: INFORMATII DESPRE EVENIMENT Starea autovehicului la momentul evenimentului PARCAT CONDUS Vinovat de producerea evenimentului este un tert identificat? DA NU Tipul evenimentului: Alege Optiunea... * Alege Optiunea... * In mers – parbriz avariat * Culpa Asigurat/utilizator – avariat in parcare (stalp, gard, bordura) * Culpa Asigurat/utilizator – a lovit un alt auto * Coliziune cu animale * Altele Alege Optiunea... In mers – parbriz avariat Culpa Asigurat/utilizator – avariat in parcare (stalp, gard, bordura) Culpa Asigurat/utilizator – a lovit un alt auto Coliziune cu animale Altele Localitate eveniment: Judet/Sector: Bucuresti * Bucuresti * Alba * Arad * Arges * Bacau * Bihor * Bistrita-Nasaud * Botosani * Brasov * Braila * Buzau * Caras-Severin * Calarasi * Cluj * Constanta * Covasna * Dâmbovita * Dolj * Galati * Giurgiu * Gorj * Harghita * Hunedoara * Ialomita * Iasi * Ilfov * Maramures * Mehedinti * Mures * Neamt * Olt * Prahova * Satu Mare * Salaj * Sibiu * Suceava * Teleorman * Timis * Tulcea * Vâlcea * Vaslui * Vrancea Bucuresti Alba Arad Arges Bacau Bihor Bistrita-Nasaud Botosani Brasov Braila Buzau Caras-Severin Calarasi Cluj Constanta Covasna Dâmbovita Dolj Galati Giurgiu Gorj Harghita Hunedoara Ialomita Iasi Ilfov Maramures Mehedinti Mures Neamt Olt Prahova Satu Mare Salaj Sibiu Suceava Teleorman Timis Tulcea Vâlcea Vaslui Vrancea Strada/Soseaua: In dreptul imobilului cu numarul / kilometrul Din directia Catre Descrierea evenimentului: Localitate reparatie: Declar pe proprie răspundere că, în urma evenimentului rutier, au rezultat / nu au rezultat decesul sau rănirea vreunei persoane ori producerea de pagube altor persoane, respectiv Evenimentul rutier nu a făcut / a făcut obiectul cercetării organelor de poliţie şi nu este emis / este emis proces verbal de contravenţie şi autorizaţie de reparaţie. SCHITA PRODUCERII EVENIMENTULUI Schita evenimentului (se deseneaza in chenarul de mai jos) In cazul in care nu se realizeaza schita in chenarul de mai jos, aceasta poate fi desenata manual si incarcata sub forma unei fotografii intr-un pas ulterior sau poate fi preluata din constatul amiabil (daca exista) prin fotografiere si incarcata intr-un pas ulterior. Fata Stanga Spate Dreapta Plafon Denumirea elementelor avariate (exemplu: bara fata, proiector de ceata dreapta, usa stanga fata etc.) Prin semnatura de mai jos declar pe propria raspundere veridicitatea informatiilor si a datelor furnizate INCARCARE FOTOGRAFII SI DOCUMENTE Carte de identitate sofer/utilizator Modifica Document obligatoriu! Invalid file type. Permis de conducere sofer/utilizator Modifica Document obligatoriu! Invalid file type. Certificat de inmatriculare autoturism Modifica Document obligatoriu! Invalid file type. Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista) Modifica Invalid file type. Documente vinovat (in cazul in care raspunzator de producerea evenimentului este o terta persoana identificata): Carte de identitate, Permis de conducere, Certificat de inmatriculare, Polita RCA Modifica Invalid file type. Schita eveniment (daca nu a fost desenata anterior) Modifica Invalid file type. Alte documente Modifica Invalid file type. Colt stanga fata Modifica Invalid file type. Colt dreapta fata Modifica Invalid file type. Colt dreapta spate Modifica Invalid file type. Colt stanga spate Modifica Invalid file type. Numar kilometri totali (fotografie bord) Modifica Invalid file type. Serie de sasiu (parbriz, stalp stanga fata etc.) Modifica Invalid file type. Avarii (poza de ansamblu urmata de cateva fotografii in detaliu pentru fiecare element avariat) Modifica Invalid file type. Avarii 1 Modifica Invalid file type. Avarii 2 Modifica Invalid file type. Avarii 3 Modifica Invalid file type. Avarii 4 Modifica Invalid file type. Avarii 5 Modifica Invalid file type. Avarii 6 Modifica Invalid file type. Avarii 7 Modifica Invalid file type. Avarii 8 Modifica Invalid file type. Avarii 9 Modifica Invalid file type. Avarii 10 Modifica Invalid file type. Carte de identitate sofer/utilizator Modifica Invalid file type. Sterge Permis de conducere sofer/utilizator Modifica Invalid file type. Sterge Certificat de inmatriculare autoturism Modifica Invalid file type. Sterge Constat amiabil / Proces Verbal Politie / Autorizatie de reparatii (daca exista) Modifica Invalid file type. Sterge VA MULTUMIM! AM PRIMIT NOTIFICAREA DUMNEAVOASTRA SI URMEAZA SA FITI CONTACTAT DE CATRE UN INSPECTOR DE DAUNE IN CEL MAI SCURT TIMP. VA MULTUMIM! INFORMATII DESPRE CONDUCATOR/UTILIZATOR Subsemnatul (nume, prenume) Vinovat / Pagubit Pagubit Vinovat Localitatea in care se va efectua reparatia: Telefon: Adresa de e-mail: Denumirea elementelor avariate (exemplu: bara fata, proiector de ceata dreapta, usa stanga fata etc.) VA MULTUMIM! AM PRIMIT NOTIFICAREA DUMNEAVOASTRA SI URMEAZA SA FITI CONTACTAT DE CATRE UN INSPECTOR DE DAUNE IN CEL MAI SCURT TIMP. VA MULTUMIM! * AMS Claims * Despre noi © 2024 Lease Plan Romania