DRAFT

CERTIFICATE OF INSURANCE
No. 001486

THIS IS TO CERTIFY that Insurance has been effected as per open policy No. 1020305111700001

For account of : KARYAMITRA BUDI SENTOSA QQ PT KARYAMITRA BUDI SENTOSA

Reference No. : CZ190111BA
Address : Jl. Jaksa Agung Suprapto No. 39-41 Kav. 36, Surabaya
Consignee : PT. KARYAMITRA BUDI SENTOSA
JL. JAKSA AGUNG SUPRAPTO 39-41 KAV.36 SURABAYA 60272
INDONESIA
For the sum of : USD 14,146.90
Interest : SYNTHETIC MATERIAL, TEXTILE, BUCKLE, ACCESSORIES, TOP PIECE,
UNIT SOLE,
PLATFORM, PLASTIC SHOE HEEL, MID SOLE, OUTSOLE, SYNTHETIC
UPPER, LINING COUNTER, ELASTIC, RIVET, SKYHOOK, SHOE LACE,
WEBBING, SLIWER, PU SOLE FOR ACCESSORIES, SLIDER, ZIPPER,
EYELET, LABEL FOR SHOES, ZIPPER
Flight Registration : KA
Flight No. : 0781
Invoice No. : CZ190111BA DD: 11.01.2019
Type Of Interest : Others
AWB No. : 043-79986885
At and from : GUANGZHOU to SURABAYA, INDONESIA
Transhipment :
ETD : January 12, 2019
Terms and Conditions : As per 1020305111700001
Rate : - Air Cargo Import 0.03000 %
Premium :
Premium Calculation
( Policy Minimum Premi ) : USD 10.00
Sertifikat : USD 3.00
Biaya Materai : USD 0.45
USD 13.45

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.

CTN0I0307E / NANANG
 DRAFT

Issued at Surabaya, January 12, 2019

For and on behalf of

PT. ASURANSI MEGA PRATAMA

CTN0I0307E / NANANG
 DRAFT
CERTIFICATE OF INSURANCE
No. 001487

THIS IS TO CERTIFY that Insurance has been effected as per open policy No. 1020305111700001

For account of : KARYAMITRA BUDI SENTOSA QQ PT KARYAMITRA BUDI SENTOSA

Reference No. : 2/E
Address : Jl. Jaksa Agung Suprapto No. 39-41 Kav. 36, Surabaya
Consignee : PT. KARYAMITRA BUDI SENTOSA
JL. JAKSA AGUNG SUPRAPTO 39-41 KAV.36 SURABAYA 60272
INDONESIA
For the sum of : EUR 2,017.90
Interest : COW LEATHER, ART GINGER, COL VAR
Flight Registration : CI
Flight No. : 751
Invoice No. : 2/E DD: 10/01/2019
Type Of Interest : Others
AWB No. : 297 77834315
At and from : SINGAPORE - CHANGI to SURABAYA, INDONESIA
Transhipment :
ETD : January 12, 2019
Terms and Conditions : As per 1020305111700001
Rate : - Air Cargo Import 0.03000 %
Premium :
Premium Calculation
( Policy Minimum Premi ) : EUR 10.00
Sertifikat : EUR 2.70
Biaya Materai : EUR 0.40
EUR 13.10

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 Surabaya, January 12, 2019

For and on behalf of

PT. ASURANSI MEGA PRATAMA

CTN0I0307E / NANANG
 DRAFT
CERTIFICATE OF INSURANCE
No. 001488

THIS IS TO CERTIFY that Insurance has been effected as per open policy No. 1020305111700001

For account of : KARYAMITRA BUDI SENTOSA QQ PT KARYAMITRA BUDI SENTOSA

Reference No. : 301283
Address : Jl. Jaksa Agung Suprapto No. 39-41 Kav. 36, Surabaya
Consignee : PT. KARYAMITRA BUDI SENTOSA
JL. JAKSA AGUNG SUPRAPTO 39-41 KAV.36 SURABAYA 60272
INDONESIA
For the sum of : USD 13,432.69
Interest : COW LEATHER, ART VAR
Flight Registration : CI
Flight No. : 751
Invoice No. : 301283 DD: 21.12.2018
Type Of Interest : Others
AWB No. : 297-76741766
At and from : SEGRATE - ITA to SURABAYA, INDONESIA
Transhipment :
ETD : December 27, 2018
Terms and Conditions : As per 1020305111700001
Rate : - Air Cargo Import 0.03000 %
Premium :
Premium Calculation
( Policy Minimum Premi ) : USD 10.00
Sertifikat : USD 3.00
Biaya Materai : USD 0.45
USD 13.45

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 Surabaya, December 27, 2018

For and on behalf of

PT. ASURANSI MEGA PRATAMA

CTN0I0307E / NANANG
 DRAFT
CERTIFICATE OF INSURANCE
No. 001489

THIS IS TO CERTIFY that Insurance has been effected as per open policy No. 1020305111700001

For account of : KARYAMITRA BUDI SENTOSA QQ PT KARYAMITRA BUDI SENTOSA

Reference No. : 19FATVIR/19100151
Address : Jl. Jaksa Agung Suprapto No. 39-41 Kav. 36, Surabaya
Consignee : PT. KARYAMITRA BUDI SENTOSA
JL. JAKSA AGUNG SUPRAPTO 39-41 KAV.36 SURABAYA 60272
INDONESIA
For the sum of : USD 15,657.42
Interest : COW LEATHER, TEXTILE, PLASTIC LAST
Flight Registration : CI
Flight No. : 751
Invoice No. : 19FATVIR/19100151 DD: 10/01/2019
Type Of Interest : Others
AWB No. : 297-76741490
At and from : FLORENCE - ITALIA to SURABAYA, INDONESIA
Transhipment :
ETD : January 11, 2019
Terms and Conditions : As per 1020305111700001
Rate : - Air Cargo Import 0.03000 %
Premium :
Premium Calculation
( Policy Minimum Premi ) : USD 10.00
Sertifikat : USD 3.00
Biaya Materai : USD 0.45
USD 13.45

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 Surabaya, January 11, 2019

For and on behalf of

PT. ASURANSI MEGA PRATAMA

CTN0I0307E / NANANG
 DRAFT
CERTIFICATE OF INSURANCE
No. 001490

THIS IS TO CERTIFY that Insurance has been effected as per open policy No. 1020305111700001

For account of : KARYAMITRA BUDI SENTOSA QQ PT KARYAMITRA BUDI SENTOSA

Reference No. : 786/32/2018
Address : Jl. Jaksa Agung Suprapto No. 39-41 Kav. 36, Surabaya
Consignee : PT. KARYAMITRA BUDI SENTOSA
JL. JAKSA AGUNG SUPRAPTO 39-41 KAV.36 SURABAYA 60272
INDONESIA
For the sum of : USD 4,959.00
Interest : SHEEP LEATHER
Flight Registration : CX
Flight No. : 0781
Invoice No. : 786/32/2018 DD: 07/01/2019
Type Of Interest : Others
AWB No. : 160-4061 1340
At and from : KARACHI AIRPORT, PAKISTAN to SURABAYA, INDONESIA
Transhipment :
ETD : January 07, 2019
Terms and Conditions : As per 1020305111700001
Rate : - Air Cargo Import 0.03000 %
Premium :
Premium Calculation
( Policy Minimum Premi ) : USD 10.00
Sertifikat : USD 3.00
Biaya Materai : USD 0.45
USD 13.45

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 Surabaya, January 07, 2019

For and on behalf of

PT. ASURANSI MEGA PRATAMA

CTN0I0307E / NANANG