DUPLIKÁT
ϭ͘D/EZKE1hdKDK/>KsWK:/aeKs1<Zd
1. INTERNATIONAL MOTOR INSURANCE CARD
1. CARTE INTERNATIONALE D'ASSURANCE AUTOMOBILE
3.
PLATNÁ
Ϯ͘szEWKs \E1^<<E>\WK:/^d/d>p͕WZ,
Ϯ͘/^^hhEZd,hd,KZ/dzK&^<<E>\WK:/^d/d>p͕
PRAHA
4͘<ſĚnjĞŵĢͬ<ſĚƉŽũŝƐƚŝƚĞůĞͬşƐůŽ
4. Country Code / Insurer's Code / Number
VALID
Den
Day
OD
FROM
DĢƐşĐ
Month
Rok
Year
Den
Day
DO
TO
DĢƐşĐ
Month
Rok
Year
9. Jméno a adresa pojistníka (nebo provozovatele vozidla)
9. Name and Address of the Policyholder (or User of the Vehicle)
10. Tato karta byla vydána:
10. This Card has been issued by:
CZ/0040/
11. Podpis za pojistitele
11. Signature of insurer
;KďĢĚĂƚĂǀēĞƚŶĢͿ
(Both Dates Inclusive)
5͘ZĞŐŝƐƚƌĂēŶşnjŶĂēŬĂ;ŶĞŶşͲůŝ͕ƵǀĞĚĞƐĞs/EŶĞďŽēşƐůŽƉŽĚǀŽnjŬƵŶĞďŽŵŽƚŽƌƵͿ
5. Registration No. (or if none) Chassis or Engine No.
6. Druh vozidla
6. Category of Vehicle*
7͘ŶĂēŬĂǀŽnjŝĚůĂ
7. Make of Vehicle
8. ÚZEMNÍ PLATNOST
8. TERRITORIAL VALIDITY
dĂƚŽŬĂƌƚĂŶĞŶşƉůĂƚŶĄǀnjĞŵşĐŚ͕ũĞũŝĐŚǎƌƵďƌŝŬĂũĞƉƎĞƓŬƌƚŶƵƚĂ;ďůŝǎƓşŝŶĨŽƌŵĂĐĞŶĂũĚĞƚĞŶĂǁǁǁ͘ĐŽďdž͘ŽƌŐͿ͘
This card is valid in Countries for which the relevant box is not crossed out (for further information, please see www.cobx.org).
sŬĂǎĚĠŶĂǀƓƚşǀĞŶĠnjĞŵŝƌƵēş<ĂŶĐĞůĄƎƚĠƚŽnjĞŵĢnjĂnjĄǀĂnjŬLJƉŽũŝƐƚŝƚĞůĞǀnjƚĂŚƵũşĐşƐĞŬƉŽƵǎŝƚşnjŵşŶĢŶĠŚŽǀŽnjŝĚůĂ͕ĂƚŽǀƐŽƵůĂĚƵƐĞnjĄŬŽŶLJǀnjƚĂŚƵũşĐşŵŝ
ƐĞŬƉŽǀŝŶŶĠŵƵƉŽũŝƓƚĢŶşǀƚĠƚŽnjĞŵŝ͘
In each country visited, the Bureau of that country guarantees, in respect of the use of the vehicle referred to herein, the insurance cover in
accordance with the laws relating to compulsory insurance in that country.
/ŶĨŽƌŵĂĐĞƚljŬĂũşĐşƐĞďůŝǎƓşŝĚĞŶƚŝĨŝŬĂĐĞũĞĚŶŽƚůŝǀljĐŚ<ĂŶĐĞůĄƎşŶĂůĞnjŶĞƚĞŶĂnjĂĚŶşƐƚƌĂŶĢƚĠƚŽŬĂƌƚLJ͘
For the identification of the relevant Bureau, see reverse side.
A
B
BG
CY(1)
CZ
D
DK
E
EST
F
FIN
GB
GR
H
HR
I
IRL
IS
L
LT
LV
M
N
NL
P
PL
RO
S
SK
SLO
CH
AL
AND
BIH
BY
IL
IR
MA
MD
MK
MNE
RUS
SRB(2)
TN
TR
UA
(1ͿWŽũŝƐƚŶĠŬƌLJƚşƉŽƐŬLJƚŽǀĂŶĠnjĞůĞŶŽƵŬĂƌƚŽƵǀLJĚĂŶŽƵƉƌŽ<LJƉƌũĞŽŵĞnjĞŶŽŶĂƚLJnjĞŵĢƉŝƐŶĠēĄƐƚŝ<LJƉƌƵ͕ũĞǎũƐŽƵƉŽĚŬŽŶƚƌŽůŽƵǀůĄĚLJ<LJƉĞƌƐŬĠ
republiky.
The cover provided under Green Cards issued for Cyprus is restricted to those geographical parts of Cyprus which are under the control of the
Government of the Republic of Cyprus.
(2ͿWŽũŝƐƚŶĠŬƌLJƚşƉŽƐŬLJƚŽǀĂŶĠnjĞůĞŶŽƵŬĂƌƚŽƵǀLJĚĂŶŽƵƉƌŽ^ƌďƐŬŽũĞŽŵĞnjĞŶŽŶĂƚLJnjĞŵĢƉŝƐŶĠēĄƐƚŝ^ƌďƐŬĂ͕ŬƚĞƌĠũƐŽƵƉŽĚŬŽŶƚƌŽůŽƵǀůĄĚLJ^ƌďƐŬĂ͘
The cover provided under Green Cards issued for Serbia is restricted to those geographical parts of Serbia which are under control of the Government of
the Republic of Serbia.
ŶĂēŬĂǀŽnjŝĚůĂͬŵŽĚĞů
Make of vehicle / model
* DRUH VOZIDLA (KÓD) / CATEGORY OF VEHICLES CODE:
A OSOBNÍ AUTO C NÁKLADNÍ AUTO NEBO TRAKTOR
B MOTOCYKL
D KOLO S POMOCNÝM MOTORKEM / MOPED
E AUTOBUS
&W\1s ^ͬEs ^
G OSTATNÍ
ORIGINÁL
ϭ͘D/EZKE1hdKDK/>KsWK:/aeKs1<Zd
1. INTERNATIONAL MOTOR INSURANCE CARD
1. CARTE INTERNATIONALE D'ASSURANCE AUTOMOBILE
3.
PLATNÁ
Ϯ͘szEWKs \E1^<<E>\WK:/^d/d>p͕WZ,
Ϯ͘/^^hhEZd,hd,KZ/dzK&^<<E>\WK:/^d/d>p͕
PRAHA
4͘<ſĚnjĞŵĢͬ<ſĚƉŽũŝƐƚŝƚĞůĞͬşƐůŽ
4. Country Code / Insurer's Code / Number
VALID
Den
Day
OD
FROM
DĢƐşĐ
Month
Rok
Year
Den
Day
DO
TO
DĢƐşĐ
Month
Rok
Year
9. Jméno a adresa pojistníka (nebo provozovatele vozidla)
9. Name and Address of the Policyholder (or User of the Vehicle)
10. Tato karta byla vydána:
10. This Card has been issued by:
CZ/0040/
11. Podpis za pojistitele
11. Signature of insurer
;KďĢĚĂƚĂǀēĞƚŶĢͿ
(Both Dates Inclusive)
5͘ZĞŐŝƐƚƌĂēŶşnjŶĂēŬĂ;ŶĞŶşͲůŝ͕ƵǀĞĚĞƐĞs/EŶĞďŽēşƐůŽƉŽĚǀŽnjŬƵŶĞďŽŵŽƚŽƌƵͿ
5. Registration No. (or if none) Chassis or Engine No.
6. Druh vozidla
6. Category of Vehicle*
7͘ŶĂēŬĂǀŽnjŝĚůĂ
7. Make of Vehicle
8. ÚZEMNÍ PLATNOST
8. TERRITORIAL VALIDITY
dĂƚŽŬĂƌƚĂŶĞŶşƉůĂƚŶĄǀnjĞŵşĐŚ͕ũĞũŝĐŚǎƌƵďƌŝŬĂũĞƉƎĞƓŬƌƚŶƵƚĂ;ďůŝǎƓşŝŶĨŽƌŵĂĐĞŶĂũĚĞƚĞŶĂǁǁǁ͘ĐŽďdž͘ŽƌŐͿ͘
This card is valid in Countries for which the relevant box is not crossed out (for further information, please see www.cobx.org).
sŬĂǎĚĠŶĂǀƓƚşǀĞŶĠnjĞŵŝƌƵēş<ĂŶĐĞůĄƎƚĠƚŽnjĞŵĢnjĂnjĄǀĂnjŬLJƉŽũŝƐƚŝƚĞůĞǀnjƚĂŚƵũşĐşƐĞŬƉŽƵǎŝƚşnjŵşŶĢŶĠŚŽǀŽnjŝĚůĂ͕ĂƚŽǀƐŽƵůĂĚƵƐĞnjĄŬŽŶLJǀnjƚĂŚƵũşĐşŵŝ
ƐĞŬƉŽǀŝŶŶĠŵƵƉŽũŝƓƚĢŶşǀƚĠƚŽnjĞŵŝ͘
In each country visited, the Bureau of that country guarantees, in respect of the use of the vehicle referred to herein, the insurance cover in
accordance with the laws relating to compulsory insurance in that country.
/ŶĨŽƌŵĂĐĞƚljŬĂũşĐşƐĞďůŝǎƓşŝĚĞŶƚŝĨŝŬĂĐĞũĞĚŶŽƚůŝǀljĐŚ<ĂŶĐĞůĄƎşŶĂůĞnjŶĞƚĞŶĂnjĂĚŶşƐƚƌĂŶĢƚĠƚŽŬĂƌƚLJ͘
For the identification of the relevant Bureau, see reverse side.
A
B
BG
CY(1)
CZ
D
DK
E
EST
F
FIN
GB
GR
H
HR
I
IRL
IS
L
LT
LV
M
N
NL
P
PL
RO
S
SK
SLO
CH
AL
AND
BIH
BY
IL
IR
MA
MD
MK
MNE
RUS
SRB(2)
TN
TR
UA
(1ͿWŽũŝƐƚŶĠŬƌLJƚşƉŽƐŬLJƚŽǀĂŶĠnjĞůĞŶŽƵŬĂƌƚŽƵǀLJĚĂŶŽƵƉƌŽ<LJƉƌũĞŽŵĞnjĞŶŽŶĂƚLJnjĞŵĢƉŝƐŶĠēĄƐƚŝ<LJƉƌƵ͕ũĞǎũƐŽƵƉŽĚŬŽŶƚƌŽůŽƵǀůĄĚLJ<LJƉĞƌƐŬĠ
republiky.
The cover provided under Green Cards issued for Cyprus is restricted to those geographical parts of Cyprus which are under the control of the
Government of the Republic of Cyprus.
(2ͿWŽũŝƐƚŶĠŬƌLJƚşƉŽƐŬLJƚŽǀĂŶĠnjĞůĞŶŽƵŬĂƌƚŽƵǀLJĚĂŶŽƵƉƌŽ^ƌďƐŬŽũĞŽŵĞnjĞŶŽŶĂƚLJnjĞŵĢƉŝƐŶĠēĄƐƚŝ^ƌďƐŬĂ͕ŬƚĞƌĠũƐŽƵƉŽĚŬŽŶƚƌŽůŽƵǀůĄĚLJ^ƌďƐŬĂ͘
The cover provided under Green Cards issued for Serbia is restricted to those geographical parts of Serbia which are under control of the Government of
the Republic of Serbia.
ŶĂēŬĂǀŽnjŝĚůĂͬŵŽĚĞů
Make of vehicle / model
* DRUH VOZIDLA (KÓD) / CATEGORY OF VEHICLES CODE:
A OSOBNÍ AUTO C NÁKLADNÍ AUTO NEBO TRAKTOR
B MOTOCYKL
D KOLO S POMOCNÝM MOTORKEM / MOPED
E AUTOBUS
&W\1s ^ͬEs ^
G OSTATNÍ
hWKKZE E1WZKWK:/^dE1<
sĞǀnjƚĂŚƵŬ͗;ĂͿƓŬŽĚĢŶĂǀŽnjŝĚůĞƉŽũŝƐƚŶşŬĂũĂŬŬŽůŝǀnjƉƽƐŽďĞŶĠ͖;ďͿƷũŵĢŶĂnjĚƌĂǀş͕ŬƚĞƌĄŶĞŶşŬƌLJƚĂnjĄŬŽŶĞŵŽƉŽǀŝŶŶĠŵƉŽũŝƓƚĢŶşŽĚƉŽǀĢĚŶŽƐƚŝnjĂƓŬŽĚLJnjƉƽƐŽďĞŶĠƉƌŽǀŽnjĞŵǀŽnjŝĚůĂƉůĂƚŶljŵǀnjĞŵŝŶĞŚŽĚLJ͖
;ĐͿŽďŶŽǀĞŶşŬĂƌƚLJ͕ũĞũşǎƉůĂƚŶŽƐƚǀLJƉƌƓĞůĂ͕ŶĞďƵĚĞŬŽŶƚĂŬƚŽǀĄŶĂ<ĂŶĐĞůĄƎŶĂǀƓƚşǀĞŶĠnjĞŵĢ͕ĂůĞŽnjŶĄŵĞŶşƐĞƉŽĚĄǀĄƉƎşŵŽƉŽũŝƐƚŝƚĞůŝ;ƉŽŬƵĚƉŽũŝƐƚŝƚĞůĞŵŶĞŶşƐƚĂŶŽǀĞŶŽũŝŶĂŬͿ͘
Esz<E>\1
NAMES OF THE BUREAUX
A
RAKOUSKO
VERBAND DER VERSICHERUNGSUNTERNEHMEN ÖSTERREICHS
IRL
IRSKO
MOTOR INSURERS' BUREAU OF IRELAND
AL ALBÁNIE
BSHS BYROJA SHQIPTARE E SIGURIMIT
IS
ISLAND
ALÞJÓ-DLEGAR BIFREI-DATRYGGINGAR Á ÍSLANDI
AND ANDORRA
OFICINA ANDORRANA D’ENTITATS D’ASSEGURANÇA D’AUTOMÒBIL
L
LUCEMBURSKO
BUREAU LUXEMBOURGEOIS DES ASSUREURS
B
BELGIE
BUREAU BELGE DES ASSUREURS AUTOMOBILES
LT
LITVA
MOTOR INSURERS´ BUREAU OF THE REPUBLIC OF LITHUANIA
BG BULHARSKO
NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS
LV
LOTYŠSKO
BIH BOSNA A HERZEGOVINA BIRO ZELENE KARTE U BOSNI I HERCEGOVINI
M
MALTA
BY >KZh^<K
BELARUSIAN TRANSPORT INSURANCE BUREAU
MA
MAROKO
NATIONALES VERSICHERUNGSBÜRO SCHWEIZ (NVB) SWISS NATIONAL BUREAU
CH ŠVÝCARSKO
MD
MOLDAVSKO
OF INSURANCE (NBI)
CY KYPR
MOTOR INSURERS’ FUND
MK
MAKEDONIE
CZ ^<ZWh>/<
^<<E>\WK:/^d/d>p
MNE ZE,KZ
D
E D<K
DEUTSCHES BÜRO GRÜNE KARTE e.V
N
NORSKO
DK DÁNSKO
DANSK FORENING FOR INTERNATIONAL MOTORKØRETØJSFORSIKRING
NL
NIZOZEMSKO
E
aWE >^<K
OFICINA ESPAÑOLA DE ASEGURADORES DE AUTOMOVILES
P
PORTUGALSKO
EST ESTONSKO
EESTI LIIKLUSKINDLUSTUSE FOND
PL
POLSKO
F
FRANCIE
BUREAU CENTRAL FRANÇAIS
RO
RUMUNSKO
FIN FINSKO
LIIKENNEVAKUUTUSKESKUS
RUS RUSKO
GB VELKÁ BRITÁNIE
MOTOR INSURERS' BUREAU
S
ŠVÉDSKO
GR \<K
MOTOR INSURERS' BUREAU-GREECE
SRB
SRBSKO
H
DZ^<K
HUNGARIAN MOTOR INSURANCE BUREAU
SK
SLOVENSKO
HR CHORVATSKO
HRVATSKI URED ZA OSIGURANJE
SLO
SLOVINSKO
I
ITÁLIE
UFFICIO CENTRALE ITALIANO, (UCI)
TN
TUNISKO
IL
IZRAEL
ISRAEL INSURANCE ASSOCIATION, THE GREEN CARD BUREAU
TR
TURECKO
IR
ÍRÁN
GREEN CARD BUREAU OF IRAN, c/o Bimeh Markazi Iran
UA
UKRAJINA
Další informace naleznete na www.cobx.org
For further information: please see www.cobx.org
>ds/:^dZE^WKZd>5<AhWZKa/E
d
:h/ZK:^
MALTA GREEN CARD BUREAU
BUREAU CENTRAL MAROCAIN DES STÉS D'ASSURANCES
NATIONAL BUREAU OF MOTOR INSURERS OF MOLDOVA
NATIONAL INSURANCE BUREAU
hZhE:ʹE/KE>E//ZKK^/'hZsZE'KZ
TRAFIKKFORSIKRINGSFORENINGEN
NEDERLANDS BUREAU DER MOTORRIJTUIGVERZEKERAARS
GABINETE PORTUGUÊS DE CARTA VERDE-GPCV
POLISH MOTOR INSURERS’ BUREAU
BAAR - BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA
RUSSIAN ASSOCIATION OF MOTOR INSURERS
TRAFIKFÖRSÄKRINGSFÖRENINGEN
UDRUZENJE OSIGURAVAJUCIH ORGANIZACIJA SRBIJE
^>KsE^<<E>Z/WK/^eKsd?Ks
SLOVENSKO ZAVAROVALNO ZDRUŽENJE, GIZ
BUREAU UNIFIE AUTOMOBILE TUNISIEN
TÜRKIYE MOTORLU TASIT BÜROSU (TURKISH MOTOR INSURANCE BUREAU)
MOTOR (TRANSPORT) INSURANCE BUREAU OF UKRAINE
hWKKZE E1WZKWK:/^dE1<
sĞǀnjƚĂŚƵŬ͗;ĂͿƓŬŽĚĢŶĂǀŽnjŝĚůĞƉŽũŝƐƚŶşŬĂũĂŬŬŽůŝǀnjƉƽƐŽďĞŶĠ͖;ďͿƷũŵĢŶĂnjĚƌĂǀş͕ŬƚĞƌĄŶĞŶşŬƌLJƚĂnjĄŬŽŶĞŵŽƉŽǀŝŶŶĠŵƉŽũŝƓƚĢŶşŽĚƉŽǀĢĚŶŽƐƚŝnjĂƓŬŽĚLJnjƉƽƐŽďĞŶĠƉƌŽǀŽnjĞŵǀŽnjŝĚůĂƉůĂƚŶljŵǀnjĞŵŝŶĞŚŽĚLJ͖
;ĐͿŽďŶŽǀĞŶşŬĂƌƚLJ͕ũĞũşǎƉůĂƚŶŽƐƚǀLJƉƌƓĞůĂ͕ŶĞďƵĚĞŬŽŶƚĂŬƚŽǀĄŶĂ<ĂŶĐĞůĄƎŶĂǀƓƚşǀĞŶĠnjĞŵĢ͕ĂůĞŽnjŶĄŵĞŶşƐĞƉŽĚĄǀĄƉƎşŵŽƉŽũŝƐƚŝƚĞůŝ;ƉŽŬƵĚƉŽũŝƐƚŝƚĞůĞŵŶĞŶşƐƚĂŶŽǀĞŶŽũŝŶĂŬͿ͘
Esz<E>\1
NAMES OF THE BUREAUX
A
RAKOUSKO
VERBAND DER VERSICHERUNGSUNTERNEHMEN ÖSTERREICHS
IRL
IRSKO
MOTOR INSURERS' BUREAU OF IRELAND
AL ALBÁNIE
BSHS BYROJA SHQIPTARE E SIGURIMIT
IS
ISLAND
ALÞJÓ-DLEGAR BIFREI-DATRYGGINGAR Á ÍSLANDI
AND ANDORRA
OFICINA ANDORRANA D’ENTITATS D’ASSEGURANÇA D’AUTOMÒBIL
L
LUCEMBURSKO
BUREAU LUXEMBOURGEOIS DES ASSUREURS
B
BELGIE
BUREAU BELGE DES ASSUREURS AUTOMOBILES
LT
LITVA
MOTOR INSURERS´ BUREAU OF THE REPUBLIC OF LITHUANIA
BG BULHARSKO
NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS
LV
LOTYŠSKO
BIH BOSNA A HERZEGOVINA BIRO ZELENE KARTE U BOSNI I HERCEGOVINI
M
MALTA
BY >KZh^<K
BELARUSIAN TRANSPORT INSURANCE BUREAU
MA
MAROKO
NATIONALES VERSICHERUNGSBÜRO SCHWEIZ (NVB) SWISS NATIONAL BUREAU
CH ŠVÝCARSKO
MD
MOLDAVSKO
OF INSURANCE (NBI)
CY KYPR
MOTOR INSURERS’ FUND
MK
MAKEDONIE
CZ ^<ZWh>/<
^<<E>\WK:/^d/d>p
MNE ZE,KZ
D
E D<K
DEUTSCHES BÜRO GRÜNE KARTE e.V
N
NORSKO
DK DÁNSKO
DANSK FORENING FOR INTERNATIONAL MOTORKØRETØJSFORSIKRING
NL
NIZOZEMSKO
E
aWE >^<K
OFICINA ESPAÑOLA DE ASEGURADORES DE AUTOMOVILES
P
PORTUGALSKO
EST ESTONSKO
EESTI LIIKLUSKINDLUSTUSE FOND
PL
POLSKO
F
FRANCIE
BUREAU CENTRAL FRANÇAIS
RO
RUMUNSKO
FIN FINSKO
LIIKENNEVAKUUTUSKESKUS
RUS RUSKO
GB VELKÁ BRITÁNIE
MOTOR INSURERS' BUREAU
S
ŠVÉDSKO
GR \<K
MOTOR INSURERS' BUREAU-GREECE
SRB
SRBSKO
H
DZ^<K
HUNGARIAN MOTOR INSURANCE BUREAU
SK
SLOVENSKO
HR CHORVATSKO
HRVATSKI URED ZA OSIGURANJE
SLO
SLOVINSKO
I
ITÁLIE
UFFICIO CENTRALE ITALIANO, (UCI)
TN
TUNISKO
IL
IZRAEL
ISRAEL INSURANCE ASSOCIATION, THE GREEN CARD BUREAU
TR
TURECKO
IR
ÍRÁN
GREEN CARD BUREAU OF IRAN, c/o Bimeh Markazi Iran
UA
UKRAJINA
Další informace naleznete na www.cobx.org
For further information: please see www.cobx.org
>ds/:^dZE^WKZd>5<AhWZKa/E
d
:h/ZK:^
MALTA GREEN CARD BUREAU
BUREAU CENTRAL MAROCAIN DES STÉS D'ASSURANCES
NATIONAL BUREAU OF MOTOR INSURERS OF MOLDOVA
NATIONAL INSURANCE BUREAU
hZhE:ʹE/KE>E//ZKK^/'hZsZE'KZ
TRAFIKKFORSIKRINGSFORENINGEN
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POLISH MOTOR INSURERS’ BUREAU
BAAR - BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA
RUSSIAN ASSOCIATION OF MOTOR INSURERS
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BUREAU UNIFIE AUTOMOBILE TUNISIEN
TÜRKIYE MOTORLU TASIT BÜROSU (TURKISH MOTOR INSURANCE BUREAU)
MOTOR (TRANSPORT) INSURANCE BUREAU OF UKRAINE
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