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DRAFT

CERTIFICATE OF INSURANCE
No. 001603
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq Bapak Budiman - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI each Container, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 2 Container Kawat @IDR 250,000,000.00 / Cnt


No. Container / No. Seal :
TAKU2360932 / F063354 - 028405;
TAKU2302978 / F063396 - 028113

From / To

: Belawan Deli, Medan to Pontianak

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

500,000,000.00

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

500,000,000.00 x 0.10000%

: IDR

500,000.00

: IDR
: IDR

15,000.00
9,000.00

IDR

524,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

CTN0I0307E / JESSICA-UW

DRAFT
It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001604
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq PT Multi Prima Mandiri - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI each Container, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 3 Container Biskuit @IDR 150,000,000.00 / Cnt


No. Container / No. Seal :
TAKU6021855 / F063446 - 028497;
TAKU6021217 / F063336 - 028120;
TAKU6015750 / F063499 - 028014

700,000,000.00

1 Container Biskuit @IDR 250,000,000.00


No. Container : TAKU6034641 No. Seal : F064443 / 028410
From / To

: Belawan Deli, Medan to Pontianak

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

700,000,000.00 x 0.10000%

: IDR

700,000.00

: IDR
: IDR

15,000.00
9,000.00

IDR

724,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

CTN0I0307E / JESSICA-UW

DRAFT
It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001605
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq PT Industri Karet Nusantara - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI each Container, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 1 Container : 445 Box R. Thread A-Grade @IDR 459,000,000.00


No. Container : TAKU2431717 No. Seal : F063356 / 028415;

1,242,000,000.00

1 Container : 872 Box R. Thread A-Grade @IDR 783,000,000.00


No. Container : TAKU6021006 No. Seal : F063522 / 030383 - 0002173
From / To

: Belawan Deli, Medan to Tg. Priok, Jakarta

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

1,242,000,000.00 x 0.10000%

: IDR

1,242,000.00

: IDR
: IDR

15,000.00
12,000.00

IDR

1,269,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

CTN0I0307E / JESSICA-UW

DRAFT
It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001606
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq Bp. Alui - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI each Container, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 2 Container Besi Tua @IDR 100,000,000.00 / Cnt


No. Container / No. Seal :
CLHU2939026 / F063135 - 028473;
TAKU2327873 / F064434 - 028426

From / To

: Belawan Deli, Medan to Tg. Priok, Jakarta

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

200,000,000.00

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

200,000,000.00 x 0.10000%

: IDR

200,000.00

: IDR
: IDR

15,000.00
6,000.00

IDR

221,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

CTN0I0307E / JESSICA-UW

DRAFT
It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001607
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq Sinar Matahari - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 1 Container Kacang Tanah


No. Container : TAKU2381093 No. Seal : F063379 / 028116

From / To

: Belawan Deli, Medan to Tg. Priok, Jakarta

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

400,000,000.00

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

400,000,000.00 x 0.10000%

: IDR

400,000.00

: IDR
: IDR

15,000.00
9,000.00

IDR

424,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001608
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq Ibu Fei - Fei - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 1 Container Mesin
No. Container : TAKU2469538 No. Seal : F063861 / 029825 / 0001807

From / To

: Belawan Deli, Medan to Tg. Priok, Jakarta

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

500,000,000.00

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

500,000,000.00 x 0.10000%

: IDR

500,000.00

: IDR
: IDR

15,000.00
9,000.00

IDR

524,000.00

6/10/16-8/9/16

Biaya Polis
Biaya Materai

It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW

DRAFT
CERTIFICATE OF INSURANCE
No. 001609
THIS IS TO CERTIFY that Insurance has been effected as per open policy No . 10030311140700015
For account of

: EMKL PT Bandar Jaya qq PT Canang Indah Industri Particle Board - Medan

Address

: JL. KEDIRI NO. 7 - 9 , MEDAN

Reference No.

: OPC.0351/2011-00001

Sum Insured

: IDR

Interest

: Cargo

Deductible

: - Institute Cargo Clauses "A" : 1 % of TSI each Container, minimum : IDR 2,500,000.00

Voyage Number

: 153

Vessel Registration 1

: TANTO BERSATU

Vessel Registration 2

: KM

Type Of Interest

: 31 Container : MDF(A)(Carb)+PB(A)(B)
No. Container / No. Seal :
TAKU2361420 / F063148; TAKU2428591 / F063392; CLHU3130669 / F063393;
TAKU2459191 / F063338; TAKU2422720 / F063337; TAKU2388689 / F063340;
TAKU2401498 / F063150; TAKU2334050 / F063367; TAKU2361414 / F063368;
TAKU2420862 / F063385; TAKU2340216 / F063386; TAKU2406925 / F063388;
TAKU2410632 / F063387; TAKU2353492 / F063381; TAKU2429432 / F063382;
TAKU2387580 / F063141; TAKU2435625 / F063142; TAKU2419455 / F063466;
TAKU2378295 / F063138; DRYU2322499 / F063469; TAKU2434845 / F063139;
TAKU2433432 / F063390; TAKU2401862 / F063391; TAKU2356043 / F063149;
TAKU2341228 / F063468; TAKU2307650 / F063339; TAKU2400357 / F063130;
TAKU2387039 / F063467; TAKU2307624 / F063131; TAKU2346370 / F063147;
TAKU2370524 / F064243

From / To

: Belawan Deli, Medan to Tg. Priok, Jakarta

Transhipment

: Conveyance/Vessel

ETD

: June 10, 2016

Terms and Conditions

: As per 10030311140700015

Rate

: - Institute Cargo Clause "A"

Premium

1,635,585,200.00

From

To

ETD/TransDate

0.10000 %

Premium Calculation
Main
- Institute Cargo Clause "A"

: IDR

1,635,585,200.00 x 0.10000%

: IDR

1,635,585.20

: IDR
: IDR

15,000.00
12,000.00

IDR

1,662,585.20

6/10/16-8/9/16

Biaya Polis
Biaya Materai

CTN0I0307E / JESSICA-UW

DRAFT
It is understood and agreed that this certificate represents and replaces the Original Stamped Policy and conveys all
the rights of the Original Policy - Holder (for the purpose of collecting any loss or claim) as fully as if the Interest
Insured was covered by a Special Policy direct to the holder of this certificate and free of any liability for unpaid
Premiums.
Issued at Medan, June 10, 2016
For and on behalf of
PT. ASURANSI HIMALAYA PELINDUNG

CTN0I0307E / JESSICA-UW