TMI Functional Requirement MVP Stage 2

Agent Information
No. Proposal Status Product Customer Type

Agent Code Agent Name Cabang
1 Issued Home Partner 000001 ABC Jakarta Personal - Mr.
2 Issued Home Partner 000001 ABC Jakarta Personal - Ms.
Customer Information - Personal
Insured Name ID Address Line 1 ID Address Line 2 Provinsi Kota
Rae Bryant Jl Tester Customer No 1 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Caine Steadman Jl Tester Customer No 2 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Aneeka Mccullough Jl Tester Customer No 3 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Jamie-Leigh Mccray Jl Tester Customer No 4 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Brett Webster Jl Tester Customer No 5 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Beatrice Frank Jl Tester Customer No 6 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Aditi Draper Jl Tester Customer No 7 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Talhah Barber Jl Tester Customer No 8 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Corrie Oneill Jl Tester Customer No 9 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Terrell Humphries Jl Tester Customer No 10 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Eden Lister Jl Tester Customer No 11 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Lucia Soto Jl Tester Customer No 12 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
mation - Personal Preeliminary Assessment
Kelurahan Kecamatan Kode Pos Email Phone Number I II III IV
PADEMANGAN ANCOL 14430 tester01@gmail.com 08123456789 Yes Yes Yes Yes
Insurance Object Data
Insurance Object Address Line 1 Insurance Object Address Line 2 Provinsi Kota
Jl Tester Customer No 1 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
ance Object Data Commision & Discount
Kelurahan Kecamatan Kode Pos Building Price Content Price Total Sum Insured Commision
PADEMANGAN ANCOL 14430 500,000,000 200,000,000 700,000,000 70,000,000
Commision & Discount
Package Option Chosen Share Quotation No Quotation Date of Share Quotation
Discount
35,000,000 Platinum Yes HP/QT/2021/APR/00001 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00002 4/25/2021
35,000,000 Silver Yes HP/QT/2021/APR/00003 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00002 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00002 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00002 4/25/2021
35,000,000 Bronze Yes HP/QT/2021/APR/00003 4/25/2021
Customer's Decision (in Microsite) Notes for Revision/Cancel (in Microsite) Date of Decision
Approve the quotation N/A 4/25/2021

Living Address
Living Address Line 1 Living Address Line 2 Provinsi Kota Kelurahan
Jl Tester Customer No 1 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA PADEMANGAN
Customer Type
Kecamatan Kode Pos Name ID Number (KTP) Gender Marital Status
ANCOL 14430 Personal - Mr. Rae Bryant 123456789012345 Male Married
ANCOL 14430 Personal - Ms. Caine Steadman 123456789012346 Female Single
ANCOL 14430 Personal - Mr. Aneeka Mccullough 123456789012347 Male Married
ANCOL 14430 Personal - Ms. Jamie-Leigh Mccray 123456789012348 Female Single
ANCOL 14430 Personal - Ms. Brett Webster 123456789012349 Female Married
ANCOL 14430 Personal - Ms. Beatrice Frank 123456789012340 Female Single
ANCOL 14430 Personal - Mr. Aditi Draper 123456789011112 Male Married
ANCOL 14430 Personal - Ms. Talhah Barber 123456789011113 Female Single
ANCOL 14430 Personal - Mr. Corrie Oneill 123456789011114 Male Married
ANCOL 14430 Personal - Ms. Terrell Humphries 123456789011115 Female Single
ANCOL 14430 Personal - Mr. Eden Lister 123456789011116 Male Married
ANCOL 14430 Personal - Ms. Lucia Soto 123456789011117 Female Single
Insured Information - Personal
Nationality Job Date of Birth Place of Birth Email Phone Number
WNI Employee 01/01/1980 Jakarta tester01@gmail.com 08123456789
WNA - England Employee 01/01/1981 Jakarta tester02@gmail.com 081234567810
Indonesia Employee 01/01/1982 Jakarta tester03@gmail.com 081234567811
sonal
ID Address Line 1 ID Address Line 2 Provinsi Kota Kelurahan Kecamatan
Jl Tester Customer No 1 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA PADEMANGAN ANCOL
Insurance Documents - Personal (Camera and/or upload)
Share Cover Note
Kode Pos Insured ID Card (KTP)
14430 *link photo Yes
Payment
No Cover Note Date of Shared Cover Note
Payment Receipt
HP/CN/2021/APR/00001 *link photo 4/25/2021
Agent Information
No. Proposal Status Product Customer Type
Agent Code Agent Name Cabang
1 Issued Home Partner 000001 ABC Jakarta Corporate - PT.
2 Issued Home Partner 000001 ABC Jakarta Corporate - CV.
3 Issued Home Partner 000001 ABC Jakarta Corporate - PO
4 Issued Home Partner 000001 ABC Jakarta Corporate - Kop.
5 Issued Home Partner 000001 ABC Jakarta Corporate - Ysn
6 Issued Home Partner 000001 ABC Jakarta Corporate - Etc (Ltd.)
7 Issued Home Partner 000001 ABC Jakarta Corporate - PT.
8 Issued Home Partner 000001 ABC Jakarta Corporate - CV.
9 Issued Home Partner 000001 ABC Jakarta Corporate - PO
10 Issued Home Partner 000001 ABC Jakarta Corporate - Kop.
11 Issued Home Partner 000001 ABC Jakarta Corporate - Ysn
12 Issued Home Partner 000001 ABC Jakarta Corporate - Etc (Ltd.)
Customer Information - Corporate
Insured Name ID Address Line 1 ID Address Line 2 Provinsi Kota
Rae Bryant Jl Tester Customer No 1 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Caine Steadman Jl Tester Customer No 2 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Aneeka Mccullough Jl Tester Customer No 3 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Jamie-Leigh Mccray Jl Tester Customer No 4 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Brett Webster Jl Tester Customer No 5 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Beatrice Frank Jl Tester Customer No 6 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Aditi Draper Jl Tester Customer No 7 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Talhah Barber Jl Tester Customer No 8 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Corrie Oneill Jl Tester Customer No 9 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Terrell Humphries Jl Tester Customer No 10 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Eden Lister Jl Tester Customer No 11 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
Lucia Soto Jl Tester Customer No 12 RT 001 RW 001 DKI Jakarta KOTA JAKARTA UTARA
ation - Corporate Preeliminary Assessment
Kelurahan Kecamatan Kode Pos Email Phone Number I II III IV
Insurance Object Data
Insurance Object Address Line 1 Insurance Object Address Line 2 Provinsi Kota
rance Object Data Commision & Discount
Kelurahan Kecamatan Kode Pos Building Price Content Price Total Sum Insured Commision
Commision & Discount
Package Option Chosen Share Quotation No Quotation Date of Share Quotation
Discount
35,000,000 Gold Yes HP/QT/2021/APR/00013 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00016 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00019 4/25/2021
35,000,000 Gold Yes HP/QT/2021/APR/00022 4/25/2021
35,000,000 Bronze Yes HP/QT/2021/APR/00023 4/25/2021
Customer's Decision (in Microsite) Notes for Revision/Cancel (in Microsite) Date of Decision

Insured Informa
Customer Type
Company Name Tax Number Business License Number (SIUP)
Corporate - PT. Rae Bryant 123456789012345 123456789012345
Corporate - CV. Caine Steadman 123456789012345 123456789012346
Corporate - PO Aneeka Mccullough 123456789012345 123456789012347
Corporate - Kop. Jamie-Leigh Mccray 123456789012345 123456789012348
Corporate - Ysn Brett Webster 123456789012345 123456789012349
Corporate - Etc (Ltd.) Beatrice Frank 123456789012345 123456789012340
Corporate - PT. Aditi Draper 123456789012345 123456789011112
Corporate - CV. Talhah Barber 123456789012345 123456789011113
Corporate - PO Corrie Oneill 123456789012345 123456789011114
Corporate - Kop. Terrell Humphries 123456789012345 123456789011115
Corporate - Ysn Eden Lister 123456789012345 123456789011116
Corporate - Etc (Ltd.) Lucia Soto 123456789012345 123456789011117
Insured Information - Corporate
Company Origin PIC Name PIC email PIC Phone Number Company Activity Company Establish Year
Indonesia Married Indonesia 08123456789 Trading 1966
Other - Netherland Single Indonesia 081234567810 Trading 1966
Indonesia Single Indonesia 081234567812 Trading 1966
Payment
Share Cover Note No Cover Note Date of Shared Cover Note
Email Payment Receipt
xx01@gmail.com Yes HP/CN/2021/APR/00013 *link photo 4/25/2021

TMI Functional Requirement MVP Stage 2

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TMI Functional Requirement MVP Stage 2

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Agent Information

No. Proposal Status Product Customer Type

Approve the quotation N/A 4/25/2021

Approve the quotation N/A 4/25/2021

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