PSAKI (S) INSURANCE PREMIUM CALCULATION

No : B. 174 BDL/UND/11/20

Name of Insured : PT. BRI SYARIAH KCP PRINGSEWU QQ RUDI RIANTO

Address : Jl. Pemuda No. 35A RT/RW 002/001 Kel. Pringsewu Utara Kec. Pringsewu
Kab. Pringsewu

Total Sum Insured : IDR 123.750.000,-

Interest Insured : Atas Bangunan Rumah Toko SHM No. 255 a.n Rudi Rianto
Construction Class : I - One (Satu)

Risk Occupation : 2934 – Chain Sop

Risk Location : Jl. Pemuda No. 35A RT/RW 002/001 Kel. Pringsewu Utara Kec.
Pringsewu Kab. Pringsewu

ZIP Code : 35371-/ Pringsewu Utara -/ Pringsewu

Risk Insured : FLEXAS

Period of Insurance : Awal : 25/11/2020 – 25/11/2021

No telp / Hp : -
Rate : FLEXAS : 0.294 permil
Gross Premi : IDR 188.100,00
Biaya Polis & Materai : IDR 50.000,00
Total Premi IDR 238.100,00
Ujroh : IDR 28.215,00
Net Premi : IDR 209.885,00
Remark : Subject to the terms and conditions of the policy to be issued.

Bandar Lampung, 25 November 2020

BRINS General Insurance
Cabang Lampung

ARIS WISNUADJI
Pemimpin Cabang