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PREMIUM NOTE

NO : 924463/2126086/KARY INDOMAS ELOK, PT


REF : 1126192 Issue Date: 24 July 2018
THIS PREMIUM NOTE IS NOT A RECEIPT NOR PROOF OF PAYMENT
Policy Number : 01-C-00636-000-07-2018

The Insured : KARY INDOMAS ELOK, PT

Address : KAWASAN INDUSTRI MITRAKARAWANG JL. MITRA SELATAN II, KAV. 89


KARAWANG

Class of : MCM
Business

Description : VESSEL : KMTC PENANG 1802N


182 ROLLS = 9,089.0 YARDS OF PE150D/144F + PE75D/36F SHEEP BOA
58 INCH X 10MM X 350G/YD
01 WHITE (58/60" X 10MM X 350G/Y) = 9,089.0 YARDS

Insurer : RAKSA PRATIKARA INSURANCE


Policy Periode : 18-Jul-2018 to TBA Payment Due : 7 ( SEVEN ) DAYS

Kindly make payment in the amount PREMIUM AMOUNT : USD 28,19


shown in this Premium Note imediately
to finalize the transaction. Payment may POLICY COST : USD 1,48
be made with a crossed cheque in the DUTY COST : USD 0,00
name of PT Salvus Inti or transferred to
our current account: OTHER COST : USD 0,00
TOTAL : USD 29,67
BANK NAME : BANK CENTRAL ASIA

ACCOUNT NO : 6040.80.8840

ACCOUNT HOLDER : PT SALVUS INTI

If premium is made through bank transfer, please


indicate Policy Number or Premium Note Number or
Reference in the message column of the transfer slip.