ORIGINAL

1. INTERNASJONALT FORSIKRINGSKORT FOR MOTORVOGNER 2. ISSUED UNDER THE AUTHORITY OF

1. INTERNATIONAL MOTOR INSURANCE CARD TRAFIKKFORSIKRINGSFORENINGEN
1. CARTE INTERNATIONALE D'ASSURANCE AUTOMOBILE

3. VALID 4. Country Code/Insurer’s Code / Number

FROM TO

Day Month Year Day Month Year

10 06 2023 10 09 2023 N / 8000 / 1900081

(Both Dates Inclusive)

5. Registration No. (or if none) Chassis or Engine No. (*)

6. Category of Vehicle 7. Make of Vehicle (merke)

KJ13851 A Audi

8. TERRITORIAL VALIDITY

This card is valid in countries for which the relevant box is not crossed out (for further information, please see www.cobx.org)

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.

For the identification of the relevant bureau, see reverse side.

(I hvert land som blir besøkt og hvor dette kortet er gyldig, vil byrået i vedkommende land, (se kortets bakside), overta forsikringsselskapets ansvar med hensyn til bruken
av motorvognen som er nevnt i dette forsikringskortet, overensstemmende med de lover om obligatorisk forsikring som er gitt i landet.)

A B BG CY (**) 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

AZ (**) BIH BY IL IR MA MD MK MNE RUS SRB (**)

TN TR UA

(**) The cover provided under Green Cards issued for the Republics of Azerbaijan, Cyprus and Serbia is restricted to those geographical parts of these countries which are under the control
of their respective governments. For more information, please consult http://gc-territorial-validity.cobx.org

(For Kypros, Serbia og Aserbajdsjan gjelder grønt kort bare for de geografiske områdene som er under kontroll av republikkenes egne regjeringer.)

9. Name and Address of the Policyholder (or User of the vehicle)

Marija Zarubica (1900081)

Klommesteinveien 7
3303 HOKKSUND

10. This Card has been issued by: 11. Signature of Insurer / (forsikringsselskapets underskrift)

Ibis Forsikring AS
Møllergata 39, 0179 Oslo Nina Charlotte Tiseth
Telephone +47 40 00 42 47 Medeier
www.ibisforsikring.no / [email protected]
Org.nr.: 924 729 562

(*) CATEGORY OF VEHICLE CODE / MOTORVOGNENS KATEGORI KODE:

A CAR (personbil) C LORRY OR TRACTOR (lastebil eller traktor) E BUS (buss) G OTHERS (annet)

B MOTORCYCLE (motorsykkel) D CYCLE FITTED WITH AUXILIARY ENGINE (sykkel med hjelpemotor) F TRAILER (tilhenger)
NOTE TO THE INSURED
Regarding (a) damage to the insured vehicle, however caused; (b) personal injuries not covered by the Compulsory Third Party Insurance Law in force in the country
of accident; (c) renewal of a card the validity of which has expired; the Bureau of the country visited should not be approached but notification should be given (unless otherwise
instructed by the Insurer) direct to the Insurer.

(Byrået i skadelandet skal ikke kontaktes når det gjelder (a) skade, uansett årsak, på det forsikrede kjøretøy, (b) personskade ikke dekket iflg. Trafikkforsikringsloven
skadelandet og (c) fornyelse av et kort der gyldighetstiden er utløpt. I disse tilfellene skal henvendelsen skje til kjøretøyets forsikringsselskap, hvis dette ikke har gitt
annen beskjed.)

NAMES AND ADDRESS OF THE BUREAUX

A AUSTRIA VERBAND DER VERSICHERUNGSUNTERNEHMEN ÖSTERREICHS, Schwarzenbergplatz 7, Postfach 248, A-1030 WIEN,  [43] (1) 711 560
AL ALBANIA BSHS BYROJA SHQIPTARE E SIGURIMIT, Rruga "Gjergj Fishta", Pall. Edil-Al-It, Kati II-te, TIRANA,  [355] (4) 2 254 033
AND ANDORRA OFICINA ANDORRANA D’ENTITATS D’ASSEGURANÇA D’AUTOMÒBIL, c/o Maria Pla., 33, 3r, 3a. AD500, ANDORRA LA VELLA,  [376] 86 00 17
AZ AZERBAIJAN COMPULSORY INSURANCE BUREAU, 8 Hasan Bey Zardabi str., Shokolad Tower, AZ1141 BAKU,  (+99412) 595 00 20
B BELGIUM BUREAU BELGE DES ASSUREURS AUTOMOBILES, Rue de la Charité 33 Bte 2, BE-1210 BRUXELLES,  [32] (2) 287 18 11
BG BULGARIA NATIONAL BUREAU OF BULGARIAN MOTOR INSURERS, 2, Graf Ignatiev Str, floor 2, SOFIA 1000,  [359] (2) 981 11 03
BIH BOSNIA AND HERZEGOVINA BIRO ZELENE KARTE U BOSNI I HERCEGOVINI, Derviša Numića 7, 71000 SARAJEVO,  [387] (33) 610-744
BY BELARUS BELARUSIAN TRANSPORT INSURANCE BUREAU, Pritytskogo str., 29-70, 220092 MINSK,  [375] (17) 209 85 25
CH SWITZERLAND NATIONALES VERSICHERUNGSBÜRO SCHWEIZ (NVB) / SWISS NATIONAL BUREAU OF INSURANCE (NBI), P.O. Box, CH-8085 Zurich,
 [41] (44) 628 65 19: Secretariat / [41] (44) 628 89 30: Claims
CY CYPRUS MOTOR INSURERS’ FUND, 23, Zenon Sozos Str., P.O. Box 22025, 1516 NICOSIA,  [357] (22) 763 913 or 764 907
CZ CZECH REP. ČESKÁ KANCELÁŘ POJISTITELŮ, Milevská 2095/5, 140 00 PRAHA 4,  [420] 221 413 111
D GERMANY DEUTSCHES BÜRO GRÜNE KARTE e.V., Wilhelmstrasse 43/43 G, D-10117 Berlin,  [49] (0)30 2020 5757
DK DENMARK DANSK FORENING FOR INTERNATIONAL MOTORKØRETØJSFORSIKRING, Postboks 111DK-2900 HELLERUP,  [45] 41 91 91 91
E SPAIN OFICINA ESPAÑOLA DE ASEGURADORES DE AUTOMOVILES, Sagasta 18, 28004 MADRID,  [34] (91) 446 03 00
EST ESTONIA EESTI LIIKLUSKINDLUSTUSE FOND, Mustamäe tee 46, 10621 TALLINN,  [372] 667 1800
F FRANCE BUREAU CENTRAL FRANÇAIS, 1, rue Jules Lefebvre, 75431 PARIS, Cedex 09,  [33] (1) 53 21 50 80
FIN FINLAND LIIKENNEVAKUUTUSKESKUS, Itämerenkatu 11-13, FIN-00180 HELSINKI,  (358) (0) 404504520
GR GREECE MOTOR INSURERS' BUREAU-GREECE, 9 Xenophontos Street, ATHENS 105 57,  [30] (210) 32 23 324/32 36 562
H HUNGARY MAGYAR BIZTOSÍTÓK SZÖVETSÉGE (MABISZ), Hungarian Motor Insurance Bureau, Andrássy út 93, H-1062 BUDAPEST / POB 1297, H-1381 BUDAPEST 62,  (36) (1) 802 8400
HR CROATIA HRVATSKI URED ZA OSIGURANJE, Croatian Insurance Bureau, 10000 ZAGREB, Martićeva 71,  [385] (1) 46 96 600
I ITALY UFFICIO CENTRALE ITALIANO, (UCI) Soc. Cons. a r.l, 20145 MILANO, Corso Sempione 39,  [39] (02) 34 96 81
IL ISRAEL ISRAEL INSURANCE ASSOCIATION, THE GREEN CARD BUREAU, Etzel 1 P.O.B. 17160, RISHON-LeZION 75070,  [972] (3) 9424311
IR ISLAMIC REP. OF IRAN GREEN CARD BUREAU OF IRAN c/o BIMEH MARKAZI IRAN, No. 2, corner of Maryam St., Nelson Mandela Ave. 1967764111, TEHRAN, P.O.B. 19395-5588,  [98] (21) 24551000
IRL IRELAND MOTOR INSURERS' BUREAU OF IRELAND, 5 Harbourmaster Place, IFSC, DUBLIN 1,  [353] (1) 676 9944
IS ICELAND ALÞJÓÐLEGAR BIFREIÐATRYGGINGAR Á ÍSLANDI, Borgartúni 35, 105 REYKJAVÍK,  [354] 568 1612
L LUXEMBOURG BUREAU LUXEMBOURGEOIS DES ASSUREURS, 12, rue Erasme, L - 1468 Luxembourg,  [352] 45 73 04
LT LITHUANIA MOTOR INSURERS’ BUREAU OF THE REPUBLIC OF LITHUANIA, Algirdo 38 LT-03606 VILNIUS,  [370] 5 216 28 60
LV LATVIA LATVIJAS TRANSPORTLĪDZEKĻU APDROŠINĀTĀJU BIROJS (Motor Insurers’ Bureau of Latvia), 4 Toma Street LV-1003 RIGA  [371] 67 114 300
M MALTA MALTA GREEN CARD BUREAU, 43A/4 St Paul's Buildings, West Street, VALLETTA VLT 1532,  [356] 21 238 253, (356) 21 232 640
MA MOROCCO BUREAU CENTRAL MAROCAIN DES STÉS D'ASSURANCES, 154, Blvd d'Anfa, 01 - CASABLANCA 20050,  [212] (522) 39 18 57, [212] (522) 39 18 59
MD MOLDOVA NATIONAL BUREAU OF MOTOR INSURERS OF MOLDOVA (NBMIM), 16 Kogalniceanu str., 2001 CHISINAU,  [373] (22) 221 970
MK NORTH MACEDONIA NATIONAL INSURANCE BUREAU, "Mitropolit Trodosij Galaganov" str., no.28/IV SKOPJE,  [389] (2) 3136 172
MNE MONTENEGRO UDRUŽENJE – NACIONALNI BIRO OSIGURAVAČA CRNE GORE, PC Europoint, Svetlane Kane Radević 3/II, 81000 PODGORICA,  [382] 20 243 440
N NORWAY TRAFIKKFORSIKRINGSFORENINGEN, Hansteens Gate 2, Postboks 2551 Solli, 0202 OSLO, www.tff.no, [email protected]
NL NETHERLANDS NEDERLANDS BUREAU DER MOTORRIJTUIGVERZEKERAARS, Handelskade 49 NL-2288 BA RIJSWIJK, ZH,  [31] (70) 3408 280
P PORTUGAL GABINETE PORTUGUÊS DE CARTA VERDE-GPCV, Rua Rodrigo de Fonseca No.41 P - 1250 190 LISBOA,  [351] (21) 384 8101/02
PL POLAND POLISH MOTOR INSURERS’ BUREAU, ul. Swietokrzyska 14 PL 00-050 WARSAW,  [48] (22) 826 46 33
RO ROMANIA BIROUL ASIGURATORILOR DE AUTOVEHICULE DIN ROMANIA (BAAR), 40-40bis Vasile Lascăr Street, 2 BUCHAREST, code 020502,  [40] (21) 319 13 02, [40] (21) 319 13 03
RUS RUSSIA RUSSIAN ASSOCIATION OF MOTOR INSURERS, 27 bld. 3, Lusinovskaya str., 115093, MOSCOW,  Secretariat [7] (495) 771 69 47 - Claims [7] (495) 641 27 87
S SWEDEN TRAFIKFÖRSÄKRINGSFÖRENINGEN, Karlavagen 108, STOCKHOLM / Box 24035, SE-104 50 STOCKHOLM,  [46] (8) 522 782 00
SRB SERBIA UDRUZENJE OSIGURAVACA SRBIJE, Tresnjinog cveta 1g, 11150 BELGRADE,  [381] (11) 2927 950
SK SLOVAK REP. SLOVENSKÁ KANCELÁRIA POIST'OVATEL'OV, Bajkalská 19B, 826 58 BRATISLAVA 29,  [+421] (2) 4445 5452
SLO SLOVENIA SLOVENSKO ZAVAROVALNO ZDRUŽENJE, GIZ, 1000 LJUBLJANA, Železna cesta 14,  [386] (1) 4377 098
TN TUNISIA BUREAU UNIFIÉ AUTOMOBILE TUNISIEN, 85-87 Rue Palestine, 1002 TUNIS Belvédère,  [216] (71) 841 514 or [216] (71) 841 784
TR TURKEY TÜRKIYE MOTORLU TASIT BÜROSU (TURKISH MOTOR INSURERS’ BUREAU), Gulbahar Mahallesi Buyukdere Caddesi No:103, Sarli Is Merkezi A Blok Kat: 4 SISLI ISTANBUL
 [90] (212) 217 5968, 217 5969, 217 5970, 217 5971
UA UKRAINE MOTOR (TRANSPORT) INSURANCE BUREAU OF UKRAINE, P.O.B. No.272, KYIV 2, 02002,  [38] (044) 239 20 27
UK UNITED KINGDOM OF GREAT-BRITAIN AND NORTHERN IRELAND MOTOR INSURERS' BUREAU, Linford Wood House, 6-12 Capital Drive, Linford Wood, MILTON KEYNES, MK14 6XT,  [44] (1908) 830 001

For further information: please see www.cobx.org