Polis + Wording PL Bandara Kertajati

PUBLIC LIABILITY AMANDED TO AIRPORT LIABILITY
INSURANCE
PT Bandar Udara Internasional Jawa Barat QQ PT. Bank

Pembangunan Daerah Jawa Tengah Syariah associated
companies and/or affiliated companies and/or inter-related
companies for their respective rights, interest and liabilities
Policy No. 427.791.110.19.70001
Whereas the Insured named in the Schedule(s) hereto has made to the
PT. Asuransi Jasindo Syariah
(hereinafter called “the Insurer”) a written proposal by completing the Questionnaire(s) which
together with any other statements made in writing by the Insured for the purpose of this policy
is deemed to be incorporated herein.
Now this Policy of Insurance withnesseth that subject to the Insured having paid or agree
to pay to the Insurers the premium mentioned in the Schedule(s) and subject to the terms,
exclusions, provisions and conditions contained herein or endorsed hereon the Insurers will
indemnify the Insured in the manner and to the extent hereinafter provided.
PT ASURANSI JASINDO SYARIAH : Graha MR 21 Lantai 10, Jl. Menteng Raya No. 21 Jakarta Pusat 10340
Telp. 021 3919988 (Hunting), Faks. 021 3912288 Email. asuransi@jasindosyariah.co.id
www.jasindosyariah.co.id
SCHEDULE ATTACHING TO
AIRPORT LIABILITY INSURANCE
POLICY NR. : 427.791.110.19.70001
(A) TYPE OF INSURANCE : PUBLIC LIABILITY AMANDED TO AIRPORT

LIABILITY COVERAGE
(B) THE INSURED : PT Bandar Udara Internasional Jawa Barat QQ PT.

Bank Pembangunan Daerah Jawa Tengah Syariah
associated companies and/or affiliated companies and/or
inter-related companies for their respective rights,
interest and liabilities
(C) ADDRESS : Kecamatan Kertajati, Kabupaten Majalengka, Jawa

Barat
(D) INTEREST : To indemnify the insured to cover the insured’s legal

liability arising out of or in connection with their airport
operations
(E) RISKS LOCATION : Bandar Udara Internasional Jawabarat - Kertajati,

Majalengka Jawa Barat
(F) LIMIT OF LIABILITY : Combined Single Limit (Bodily Injury and Property
damage) USD 5,000,000 (IDR 75,000,000,000 (Kurs Rp.
15.000 / $)) Any One Occurrence and in aggregate in
respect of Products Liability
(G) PERIOD OF INSURANCE : From 31st December 2019 up to 31st December 2020
(both dates inclusive at 12.00 noon o’clock at local time)
(H) DEDUCTIBLE : - Property Damage : IDR 50,000,000 each loss in
relation of Property
- Damage to Aircraft : IDR 150,000,000 each loss
(I) CLAUSES : 1. War, Hi-Jacking And Other Perils Exclusion Clause

(Aviation)
2. Nuclear Risks Exclusion Clause AVN38B
3. Asbestos Exclusion Clause 2488AGM00003
4. Date Recognition Exclusion Clause AVN2000A.
5. Contracts (Rights of Third Parties) ACT 1999
Exclusion Clause
6. Sanctions and Embargo Clause
7. Extended Coverage Endorsement (Aviation
Liabilities)
8. Personal Injury Extension AVN60A Notwithstanding
exclusion 2 of AVN104
9. Unintentional Erors and Omissions Clause
10. Two-Way Cross Liability Clause
11. Tenant’s legal liability extension
12. Primary Liability For Licensed/Unlicensed Vehicles
13. Date Recognition Limited Coverage Clause
14. Contractual agreements
15. Cancellation Clause amended to US Short Rate
Scale NMA45
16. Limitation of Liability Clause (Joint Insured’s) as per
AVN104.
17. Co-insurance clause - Claim Settlement by Leader
PT. Asuransi Jasindo Syariah 70%
(Leader)
Page 2 of 28
POLICY NR. : 202.204.300.14.00004
PT. Asuransi Ramayana Syariah 20%
(Member)
PT. Asuransi ASEI Syariah 10%
(Member)
18. Deferred Premium Clause in 4 installments:
1st payment : 1/4 of Total Premium ~ 1
month after inception date
2nd payment : 1/4 of Total Premium ~ 2
months after inception date
3rd payment : 1/4 of Total Premium ~ 3
4th payment : 1/4 of Total Premium ~4
(J) JURISDICTION : This insurance shall be governed by and construed in

accordance with the law of Indonesia and each party
agrees to submit to the exclusive jurisdiction of the courts
of Indonesia.
(K) PREMIUM : 0.225% x IDR 75,000,000,000 = IDR 168,750,000.00

Discount = IDR. 19,243,819.00
Total Premi = IDR. 149,506,181.00
Jakarta, 26 December 2019

signed and on behalf of
PT. ASURANSI JASINDO SYARIAH
KLAUSULA SYARAT PEMBAYARAN PREMI ANGSURAN
(Melekat Pada Polis No. 427.791.110.19.70001/000/000))
PT Bandar Udara Internasional Jawa Barat

QQ PT. Bank Pembangunan Daerah Jawa Tengah Syariah
DENGAN INI DICATAT DAN DISETUJUI BAHWA MENYIMPANG DARI APAPUN YANG BERTENTANGAN DENGAN SYARAT
INI, PREMI ASURANSI POLIS INI AKAN DIBAYAR DENGAN ANGSURAN SEBAGAI BERIKUT:
ANGSURAN 1: BATAS TANGGAL LUNAS 31 JANUARI 2020 : IDR 37,376,545.25
ANGSURAN 2: BATAS TANGGAL LUNAS 03 MARET 2020 : IDR 37,376,545.25
ANGSURAN 3: BATAS TANGGAL LUNAS 03 APRIL 20 20 : IDR 37,376,545.25
ANGSURAN 4: BATAS TANGGAL LUNAS 03 MEI 2020 : IDR 37,376,545.25
SELANJUTNYA DISETUJUI BAHWA PREMI ASURANSI POLIS INI HARUS DIBAYAR LUNAS SELAMBAT-LAMBATNYA PADA
TANGGAL JATUH TEMPO SETIAP ANGSURAN TERSEBUT DIATAS, APABILA ANGSURAN TIDAK ATAU TERLAMBAT
DIBAYAR, MAKA PENANGGUNG TERBEBAS DARI SEGALA TANGGUNG JAWAB ATAS KLAIM YANG TIMBUL SELAMA
KURUN WAKTU TERLAMBATNYA PEMBAYARAN PREMI TANPA BERPENGARUH TERHADAP HAK PENANGGUNG ATAS
PREMI YANG BELUM DIBAYAR.
DALAM HAL TERJADI KLAIM PARTIAL LOSS DAN/ATAU TOTAL LOSS YANG JUMLAHNYA MELEBIHI PREMI ANGSURAN
YANG SUDAH LUNAS, MAKA SISA KESELURUHAN ANGSURAN PREMI YANG BELUM DIBAYAR WAJIB DIBAYAR LUNAS.
PUBLIC LIABILITY POLICY POLIS PERTANGGUNGAN UMUM
Policy No. 426.791.110.19.00001 No Polis 426.791.110.19.00001
WHEREAS the Insured carrying on the Business BAHWA Tertanggung yang menjalankan Bisnis
described in the Schedule, and no other for the sebagaimana dijelaskan dalam Ikhtisar, dan bukan
purposes of this Indemnity by a proposal which pihak lain, untuk tujuan Pertanggungan
shall be the basis of the Contract and be held as berdasarkan proposal/Surat Pengajuan
incorporated herein has applied to the Company Permohonan Asuransi (SPPA) yang menjadi dasar
for the Indemnity hereinafter expressed. Kontrak dan melekat di dalamnya diberlakukan
pada Perusahaan untuk setiap Pertanggungan
yang dinyatakan kemudian.
IN CONSIDERATION of the payment of the First DENGAN MELAKUKAN pembayaran Premi Awal
Premium or any renewal Premium which the untuk atau Premi perpanjangan yang diterima atas
Company may accept for or on account of such akun Pertanggungan tersebut, maka Perusahaan
Indemnity, the Company agrees subject to the setuju; tunduk pada syarat, pengecualian, batasan
terms, exceptions, limits and conditions contained dan kondisi yang tercantum di dalamnya atau
herein or endorsed hereon to Indemnify the endosemen dalam polis ini; untuk memberikan
Insured against liability arising from accidents Ganti Rugi kepada Tertanggung atas tanggung
occurring during any Period of Indemnify within jawab yang timbul akibat dari kecelakaan yang
the Republic of Indonesia as follows. terjadi selama Periode Pertanggungan dalam
wilayah Negara Republik Indonesia sebagai
berikut:
(A) All sums which the Insured shall become (A) Semua jumlah yang secara hukum menjadi
legally liable to pay for compensation in tanggung jawab Tertanggung untuk membayar
respect of : kompensasi atas:
(1) Accidental bodily injury to any person (1) Cidera badan karena kecelakaan pada
(2) Accidental damage to property Orang
(2) Kerusakan karena kecelakaan pada
properti
happening or caused as described in Schedule yang terjadi atau yang disebabkan

under the heading of Description of Accidents sebagaimana yang dijelaskan dalam Ikhtisar
pada bagian Penjelasan Kecelakaan
(B) All costs and expenses of litigation recovered (B) Seluruh biaya dan pengeluaran proses
by any claimant against the Insured. pemeriksaan pengadilan yang diminta
Penuntut kepada Tertanggung.
(C) All costs and expenses of litigation incurred (C) Seluruh biaya dan pengeluaran; yang timbul
with the written consent of the Company. dari proses pengadilan; dengan ijin tertulis dari
Perusahaan
in respect of a claim against the Insured for Terkait dengan klaim kepada Tertanggung
compensation to which the indemnity untuk kompensasi atas ganti rugi sebagaimana
expressed in this Policy applies. yang dinyatakan dalam Polis ini
In the event of the death of the Insured the Apabila Tertanggung meninggal dunia, Perusahaan
Company will in respect of the liability incurred by akan, sehubungan dengan tanggung jawab yang
the Insured indemnity the Insured’s personal timbul dari Tertanggung, akan memberikan ganti
representatives in the terms of and subject to the rugi kepada perwakilan pribadi Tertanggung sesuai
limitations of this Policy provided that such dengan persyaratan dan tunduk pada batasan Polis
personal representatives shall as though they were ini, dengan ketentuan bahwa perwakilan pribadi
the Insured observe fulfill and be subject to the tersebut harus memenuhi dan tunduk dengan
terms exceptions and conditions of the Policy so persyaratan, pengecualian dan ketentuan Polis
far as they can apply. yang berlaku.
EXCEPTION PENGECUALIAN
The indemnity expressed in this Policy shall not Ganti rugi yang dinyatakan dalam Polis ini tidak
apply to nor include akan diberlakukan atau tidak termasuk
(1) Liability assumed by the Insured by agreement (1) Tanggung Jawab yang dianggap ada pada
unless such liability would have attached to Tertanggung berdasarkan perjanjian kecuali
the Insured notwithstanding such agreement. Tanggung Jawab tersebut telah melekat pada
Tertanggung terlepas dari perjanjian tersebut.
(2) Liability in respect of injury to any person who (2) Tanggung Jawab dalam hal terjadi cidera pada
at the time of sustaining such injury is engaged orang, yang pada saat mengalami cidera
in the service of the Insured or for tersebut sedang menjalankan tugas dari
compensation claimed from the Insured by an Tertanggung, atau kompensasi yang diklaim
injured person or dependant under any kepada Tertanggung oleh orang yang
Workmen’s Compensation Act. mengalami cidera atau kerabatnya
berdasarkan Undang-Undang Kompensasi
Pekerja
(3) Liability in respect of damage to property (3) Tanggung Jawab dalam hal terjadi kerusakan
pada harta benda
(a) belonging to or in the charge or under the a) milik atau yang menjadi tanggung jawab
control of the Insured or of any servant or atau di bawah kendali Tertanggung atau
agent of the Insured. setiap pegawai atau agen Tertanggung.
(b) being that part of any goods or land or b) yang menjadi bagian dari barang atau tanah
building or structure on which the Insured atau bangunan atau struktur yang sedang
or any servant or agent of the Insured is or dikerjakan oleh Tertanggung atau pegawai
has been working. atau agen dari Tertanggung.
(c) caused by or resulting from fire. c) yang disebabkan oleh atau yang diakibatkan
dari kebakaran api.
(4) Liability in respect of (4) Tanggung Jawab sehubungan dengan

(a) damage to any property or land or a) kerusakan pada harta benda atau tanah
structure or building caused by vibration atau struktur atau bangunan yang
or by the removal or weakening of disebabkan oleh getaran atau pemindahan
support. atau melemahnya pondasi.
(b) injury or damage to any person or b) cidera atau kerusakan pada orang atau
property occasioned by or resulting from harta benda yang disebabkan oleh atau
any such damage aforesaid. akibat dari kerusakan sebagaimana tersebut
di atas.
(5) Liability in respect of injury or damage caused (5) Tanggung Jawab sehubungan dengan cidera
by or in connection with or arising from atau kerusakan yang disebabkan oleh atau
a) (i) the ownership or possession or use by sehubungan dengan atau yang timbul dari
or on behalf of the Insured of any a) (i) kepemilikan atau penguasaan atau
vehicle(including any type of machine penggunaan oleh atau atas nama
on wheels or on caterpillar tracks) or Tertanggung dari kendaraan (termasuk
animal or vessel or craft not specified semua jenis mesin beroda atau pada
in the Schedule under the heading of lintasan beroda) atau hewan atau
Plant. kapal atau kendaraan air yang tidak
disebutkan dalam Ikhtisar dengan
judul Peralatan Mesin.
(ii) the loading or unloading of any such (ii) bongkar muat kendaraan atau kapal
vehicle or vessel or craft aforesaid. atau kendaraan air sebagaimana
tersebut di atas.
(iii) The delivery or collection of goods in (iii) pengiriman atau pengumpulan barang
connection with any such vehicle yang berhubungan dengan kendaraan
aforesaid. sebagaimana tersebut di atas.
This Exception (5) (a) (iii) shall not however Pengecualian ini (5) (a) (iii) tidak berlaku
apply to liability in respect of injure or untuk Tanggung Jawab yang berkaitan
damage (to which the indemnity expressed dengan cidera atau kerusakan (yang
in this Policy applies but for this Exception) diberlakukan ganti rugi sebagaimana
caused or arising beyond the limits of any dinyatakan dalam Polis ini tetapi untuk
carriageway or thoroughfare in connection Pengecualian ini) yang disebabkan atau
with. timbul di luar batas jalan atau jalan raya
yang berhubungan dengan.
(a) the bringing of goods to any such (a) membawa barang untuk dimuat
vehicle for loading thereon or diatas kendaraan atau
(b) the taking away of goods from any (b) membawa barang dari kendaraan
such vehicle after unloading therefrom tersebut setelah melakukan
by any person other than the driver or bongkar barang
attendant of any such vehicle. oleh orang lain selain pengemudi atau
petugas dari setiap kendaraan tersebut.
b) any lift elevator, escalator, crane or power b) setiap lift, elevator, eskalator, crane atau
hoisting-machine not specified in the power-hoisting machine yang tidak
Schedule under the heading of Plant. disebutkan dalam Ikhtisar dengan judul
Peralatan Mesin.
c) explosion, flood, fumes or water pollution c) ledakan, banjir, asap atau polusi air
d) accident to any railway rolling stock or any d) kecelakaan dari rel kereta barang, atau
vessel or craft pada kapal atau kendaraan air
e) efective sanitary installation or poisoning e) instalasi sanitasi yang rusak atau yang
of any kind or foreign or deleterious peracunan makanan atau minuman, atau
matter in food or drink. benda asing atau benda yang merusak
makanan atau minuman.
(6) Liability for any consequence whether direct (6) Tanggung Jawab yang diakibatkan baik
or indirect of: langsung maupun tidak langsung oleh:
(a) war, acts of war or any de facto state of a) perang, aksi perang atau perang negara
war, enemy invasion --even if Indonesia is secara de facto, invasi musuh – kendatipun
not one of the belligerent powers-- Indonesia bukan salah satu kekuatan yang
occupation, civil war, interior agresif - pendudukan, perang saudara,
disturbances, revolt, insurrection, mutiny, gangguan internal, revolusi,
riots, civil commotions, reprisals, strike, pemberontakan, penyusupan, kerusuhan,
lock-out of workers, sabotage, acts of huru-hara, pembalasan, pemogokan,
terrorists, disturbance of political or any pemblokiran oleh pekerja, sabotase,
other nature, impact of engines of war, tindakan teroris, gangguan politik atau alam
the performance or omission of any act in lainnya, dampak dari mesin perang,
a correct or incorrect execution of any pelaksanaan atau kelalaian baik yang benar
order, measure, ordinance by any atau tidak atas menjalankan perintah,
Indonesian of foreign military, civil, ketentuan, peraturan kekuatan asing, sipil,
judicial, police or political authority or pengadilan, polisi atau otoritas politik atau
organization, nationalization, confiscation, organisasi di Indonesia, nasionalisasi,
requisition or demand for military pengahpusan, pengambilalihan atau
purposes. In case of loss or damage perintah untuk keperluan militer. Apabila
covered by this insurance the Insured shall terjadi kerugian atau kerusakan yang
have to prove that such loss or damage ditanggung oleh asuransi ini maka
has not been caused by -- not is directly or Tertanggung harus dapat membuktikan
indirectly connected with-- any exclusions bahwa kerugian atau kerusakan tidak
mentioned in this paragraph. disebabkan oleh - tidak secara langsung
atau tidak langsung berhubungan dengan -
setiap pengecualian yang disebutkan dalam
ayat ini.
(b) any nuclear reaction of the atom, b) reaksi atom nuklir, terlepas seperti apa
irrespective as to how the reaction has pengaruh dari reaksi tersebut.
been affected.
In these exceptions the expression “vessel or craft” Dalam pengecualian ini, istilah "kapal atau
shall include any vessel, craft or thing made or kendaraan air " termasuk setiap kapal, kendaraan
intended to float on or in or travel on or through air, atau sesuatu yang dibuat atau yang
water or air. dimaksudkan mengapung di atas atau dalam atau
berjalan pada atau di atas air atau udara.
THE LIMITS OF INDEMNITY BATAS GANTI RUGI
The liability of the Company under this Policy for Tanggung Jawab Perusahaan menurut Polis ini
all compensation payable. untuk semua kompensasi yang harus dibayar.
a) To any claimant or any number of claimants in a) kepada penuntut atau sejumlah penuntut
respect of or arising out of any one occurrence sehubungan dengan atau yang timbul dari satu
or in respect of or arising out of all kejadian atau sehubungan dengan atau yang
occurrences of a series consequent on or timbul dari semua kejadian atas serangkaian
attributable to one source or original cause konsekuensi atau yang disebabkan satu
shall not exceed the Limit of Indemnity sumber atau penyebab awal tidak akan
specified in the Schedule for any one Accident. melebihi Batas Pertanggungan yang ditetapkan
dalam Ikhtisar untuk setiap satu kejadian
Kecelakaan.
b) In respect of all injury and damage sustained b) Sehubungan dengan seluruh cidera dan
during any one Period of Indemnity shall not kerusakan yang dialami selama satu Periode
exceed the Limit of Indemnity specified in the Pertanggungan, tidak akan melebihi Batas
Schedule for any one Period of Indemnity. Pertanggungan yang ditetapkan dalam Ikhtisar
untuk satu Periode Pertanggungan.
CONDITIONS KETENTUAN
The Policy and the schedule shall be read together Polis dan ikhtisar harus dibaca sebagai satu
as one contract and any word expressions to which kesatuan kontrak dan kata - kata, yang memiliki
specific meaning has been attached in any part of pengertian spesifik sebagaimana telah melekat di
this Policy or of the Schedule shall bear such setiap bagian Polis ini atau Ikhtisar akan diartikan
specific meaning wherever it may appear. sebagaimana pengertian spesifik tersebut
dimanapun muncul dalam polis ini.
(1) The Insured shall give written notice to the (1) Tertanggung harus memberikan
Head Office or Branch Office of the Company pemberitahuan tertulis kepada Kantor Pusat
of any accident or claim or proceeding atau Kantor Cabang Perusahaan atas setiap
immediately the same shall have come to the kecelakaan atau klaim atau pemeriksaan,
knowledge of the Insured or his segera setelah diketahui Tertanggung atau
representative. perwakilannya.
(2) The Insured shall not without the consent in (2) Tertanggung, tanpa memperoleh persetujuan
writing of the Company repudiate liability tertulis dari Perusahaan, tidak akan menolak
negotiate or make any admission offer Tanggung Jawab, bernegosiasi atau membuat,
promise or payment in connection with any janji atau melakukan pembayaran
accident or claim and the Company shall be sehubungan dengan kecelakaan atau klaim,
entitled if is so desires to take over and dan Perusahaan berhak jika berkeinginan
conduct in the name of the Insured the untuk mengambil alih dan melakukan atas
defence of any claim or to prosecute in the nama Tertanggung, upaya untuk
name of the Insured at its own expense and mempertahankan klaim atau menuntut atas
for its own benefit any claim for indemnity or nama Tertanggung dengan biaya sendiri dan
damages or otherwise against any persons untuk kepentingannya sendiri, setiap klaim
and shall have full discretion in the conduct of ganti rugi atau pembayaran ganti rugi atau
any proceedings and in the settlement of any kerusakan atau lainnya kepada setiap orang
claim and the Insured shall give all such dan memiliki wewenang penuh dalam
information and assistance at the Company melakukan setiap proses dan dalam
may require. menyelesaikan setiap klaim dan Tertanggung
harus memberikan semua informasi dan
bantuan kepada Perusahaan bilamana
diperlukan.
(3) The Company may in the case of any accident (3) Perusahaan dapat, bila terjadi kecelakaan,
pay to the Insured the Limit of Indemnity for membayar kepada Tertanggung sampai Batas
any one Accident (but deducting thereform in Pertanggungan untuk satu kejadian
such case any sum or sums already paid as Kecelakaan (tetapi dipotong dengan jumlah
compensation in respect thereof) or any atau jumlah-jumlah yang telah dibayar
lesser sum for which the claim or claims sebagai kompensasi sehubungan dengan hal
arising from such accident can be settled and tersebut) atau jumlah yang lebih kecil dimana
the Company shall thereafter be under no klaim atau klaim-klaim yang timbul dari
further liability in respect of such accident kecelakaan tersebut dapat diselesaikan, dan
except for the payment of costs and expenses Perusahaan selanjutnya tidak
of litigation under clauses (B) and/or (C) on bertanggungjawab sehubungan dengan
the first page of this Policy incurred prior to kecelakaan tersebut, kecuali untuk
the date of the payment of such Limit of pembayaran biaya dan pengeluaran untuk
Indemnity or such lesser sum. proses pengadilan menurut klausula (B)
dan/atau (C) pada halaman pertama Polis ini
yang telah dikeluarkan sebelum tanggal
pembayaran tersebut di atas.
(4) If the premium for this Policy has been (4) Jika premi untuk Polis ini telah dihitung
calculated on any estimates furnished by the berdasarkan perkiraan yang diberikan oleh
Insured, the Insured shall keep an accurate Tertanggung maka Tertanggung harus
record containing all particulars relative menyimpan catatan yang akurat yang berisi
thereto and shall at all times allow the semua keterangan yang terkait dan setiap
Company to inspect such record. The Insured saat memberikan ijin kepada Perusahaan
shall within one month from the expiry of untuk memeriksa catatan tersebut.
each Period of Indemnity furnish to the Tertanggung, dalam waktu satu bulan sejak
Company such particulars and information as berakhirnya masing-masing Periode
the Company may require. The premium for Pertanggungan, harus memberikan
such period shall thereupon be adjusted and keterangan yang terkait dan informasi
the difference paid by or allowed to the tersebut sebagaimana yang diminta
Insured as the case may be. Perusahaan. Premi untuk periode tersebut
kemudian akan disesuaikan dan selisihnya
dibayar oleh atau dikembalikan kepada
Tertanggung, sebagaimana mestinya.
(5) If at the time of any claim arising under this (5) Jika pada waktu terjadi klaim yang timbul
Indemnity there shall be any other insurance berdasarkan Pertanggungan ini terdapat
covering the same risk or any part thereof the asuransi lain yang menjamin resiko yang sama
Company shall not be liable for more than its atau sebagian, maka Perusahaan tidak
rateable proportion thereof. bertanggungjawab melebihi dari bagiannya
sesuai proporsinya.
(6) If at any time or from time to time any (6) Jika pada waktu atau dari waktu ke waktu
change shall occur materially varying any of terdapat perubahan secara materiil yang
the facts existing at the date of the proposal merubah salah satu fakta yang telah ada pada
the Insured shall within seven days give tanggal proposal, maka Tertanggung dalam
notice in writing to the Company and shall waktu tujuh hari harus memberikan
pay such additional premium as the Company pemberitahuan secara tertulis kepada
may require. Perusahaan dan harus membayar premi
tambahan seperti yang diminta oleh
Perusahaan.
(7) This Policy may be cancelled at any time by (7) Polis ini dapat dibatalkan setiap saat dengan
seven days notice by registered letter from menyampaikan pemberitahuan tujuh hari
the Company to the Insured’s last known sebelumnya melalui surat tercatat dari
address and in such even the Company will Perusahaan ke alamat terakhir Tertanggung
return a pro rata portion of premium for the dan dalam hal itu Perusahaan akan
unespired part of the Period of Indemnity mengembalikan bagian premi secara pro-
rata untuk bagian dari Periode
Pertanggungan yang belum dijalankan.
(8) The Insured shall exercise reasonable care (8) Tertanggung harus melaksanakan
than only steady sober and competent pemeliharaan yang wajar yang dilakukan oleh
employees are employed and that buildings karyawan yang sehat dan kompeten dan
ways, works, plant machinery, furniture and gedung, jalan, pekerjaan, peralatan mesin,
fittings are substantial and sound and in mesin, furnitur dan perlengkapannya secara
proper order and fit for the purposes for substansial dan wajar dan dengan cara yang
which they are used and that all Acts of tepat sesuai dengan kegunaannya dan
Parliament and all by-laws and directions mematuhi seluruh perUndang-Undangan
made by statutory or local authority are duly hukum dan petunjuk yang dibuat menurut
observed and complied with. Upon any defect undang-undang atau pihak berwenang
being brought to his notice the Insured shall setempat. Terhadap setiap kerusakan yang
forthwith proceed to make good the same diketahui Tertanggung, Tertanggung akan
and shall take such temporary precautions to menjaga dan mengambil tindakan
prevent accident as the circumstances may pencegahan sementara untuk menghindari
require but so far as practicable no alteration kecelakaan, sesuai kondisi yang dibutuhkan,
or repair shall without the consent of the tetapi tidak ada perubahan atau perbaikan
Company be made after any occurrence yang dapat dilakukan tanpa memperoleh
covered by this Policy until the Company shall persetujuan dari Perusahaan setelah kejadian
have had an opportunity of inspecting. The yang dijamin dalam Polis ini, sebelum
Company shall at all reasonable times have Perusahaan melakukan pemeriksaan.
free access to inspect any property. In the Perusahaan dapat, dalam waktu yang wajar,
event of any defect or danger being apparent memiliki akses untuk melakukan pemeriksaan
to the Company’s inspector the Company pada harta benda tersebut. Apabila terdapat
may give notice in writing to the Insured and kerusakan atau bahaya yang nyata bagi
thereupon all liability of the Company in petugas pemeriksa Perusahaan, maka
respect thereof or arising thereform shall be Perusahaan dapat memberikan
PT ASURANSI JASINDO SYARIAH : Graha MR 21 Lantai 10, Jl. Menteng Raya No. 21 Jakarta Pusat 10340 ( )
suspended until the same be cured or pemberitahuan tertulis kepada Tertanggung
removed to the satisfaction of the Company. dan seluruh tanggung jawab Perusahaan
sehubungan dengan hal tersebut atau yang
mungkin timbul akan ditangguhkan sampai
diperbaiki atau diganti yang sesuai dengan
keinginan Perusahaan.
(9) All disputes resulting from the interpretation (9) Semua perselisihan yang diakibatkan oleh
of this Policy, both parties are free to choose penafsiran atas Polis ini, kedua belah pihak
any legal remedy to resolve them. bebas memilih setiap upaya hukum untuk
menyelesaikannya.
All disputes regarding the amount of loss or Semua perselisihan mengenai jumlah
damage (liability being otherwise admitted) kerugian atau kerusakan (selain tanggung
shall be submitted to arbitration with jawab yang diakui) akan diserahkan kepada
stipulation as follows: arbitrase dengan ketentuan sebagai berikut:
(a) The party desiring to submit a case to (a) pihak yang ingin membawa suatu kasus
arbitration, hereinafter called the ke badan arbitrase, selanjutnya disebut
Initiating Party, must give notice of Pihak Penggugat, harus memberikan
intention to arbitrate, hereinafter called pemberitahuan mengenai keinginannya
the Notice, to the other party, untuk melakukan arbitrase, selanjutnya
hereinafter called the Responding Party, disebut Pemberitahuan, ke pihak lain,
and by a mutual agreement a single selanjutnya disebut Pihak Tergugat, dan
arbitrator shall be appointed by both dengan kesepakatan bersama kedua
parties. belah pihak dapat menunjuk arbitrator
tunggal.
(b) If within 15 days after the Responding (b) Jika dalam waktu 15 hari setelah Pihak
Party receives such Notice, both parties Tergugat menerima Pemberitahuan
fail to agree on the single arbitrator as tersebut, kedua belah pihak gagal
provided in item a. above, each party menyetujui arbitrator tunggal
shall appoint an arbitrator and the two sebagaimana dimaksud dalam butir a.
appointed arbitrators then appoint the diatas, masing-masing pihak akan
third arbitrator to act as an umpire. menunjuk seorang arbitrator dan kedua
arbitrator yang ditunjuk kemudian
menunjuk arbitrator ketiga untuk
bertindak sebagai penengah.
(c) If within 60 days after the Responding (c) Jika dalam waktu 60 hari setelah Pihak
Party receives such Notice the selection Tergugat menerima pemberitahuan
of the arbitrator as provided in item b. tersebut, pemilihan arbitrator
above fails, the Initiating Party may sebagaimana dimaksud dalam butir b di
appoint a single arbitrator. If within 75 atas gagal, maka Pihak Penggugat dapat
days after the Responding Party receives menunjuk arbitrator tunggal. Jika dalam
such Notice, the Responding Party waktu 75 hari setelah Pihak Tergugat
submit an objection to such single menerima Pemberitahuan tersebut, Pihak
arbitrator, then the Initiating Party may Tergugat menyampaikan keberatan atas
request the President of the competent arbitrator tunggal tersebut, maka Pihak
district court in Indonesia to appoint a Penggugat dapat meminta Ketua
single arbitrator. pengadilan negeri yang berkompeten di
Indonesia untuk menunjuk arbitrator
tunggal.
(d) The death of any party shall not cancel (d) Kematian dari salah pihak tidak akan
or have any effect on the power or membatalkan atau memiliki efek pada
authority granted to the arbitrator. In kekuasaan atau wewenang yang diberikan
the event that an arbitrator(s) kepada arbitrator. Dalam hal seorang
withdraws from the panel or is unable to arbitrator menarik diri dari panel atau
discharge his or her duties by reason of tidak dapat melaksanakan tugasnya
death, illness or incompetence or dengan alasan meninggal dunia,
otherwise, a replacement shall be menderita penyakit atau tidak mampu
appointed by the one who appoints such atau lainnya, seorang pengganti harus
arbitrator. ditunjuk oleh orang yang menunjuk
arbitrator tersebut.
(e) Right, duties and responsibility as well as (e) Hak, tugas dan tanggung jawab serta
the procedures of the arbitration shall prosedur arbitrase harus ditentukan oleh
be determined by the arbitrator(s) and arbitrator dan harus berdasarkan
shall be based on the Law of the Undang-Undang Republik Indonesia No.
Republic of Indonesia no. 30 year 1999 30 tahun 1999 tentang Arbitrase dan
on Arbitration and Alternative Disputes Alternatif Keputusan Perselisihan dan
Resolutions and or its changes and atau perubahan dan penggantiannya.
replacement.
(f) The arbitration award shall be final and (f) Putusan arbitrase bersifat final dan
binding on the parties to arbitration. mengikat para pihak dalam arbitrase.
(10) The due observance and fulfillment of the (10) Dengan memperhatikan dan memenuhi
terms provisions conditions and syarat, ketentuan, kondisi dan endorsemen
endorsements of this Policy by the Insured in dalam Polis ini oleh Tertanggung sejauh yang
so far they relate to anything to be done or berhubungan dengan segala sesuatu yang
complied with by him and the truth of the dilakukan atau dipenuhi olehnya dan
statements and answers in the said proposal kebenaran dari pernyataan dan jawaban
shall be conditions precedent to any liability dalam proposal tersebut merupakan
of the Company to make any payment under ketentuan awal terhadap tanggung jawab
this Policy. Perusahaan untuk melakukan pembayaran
Polis ini.
AIRPORT LIABILITY INSURANCE
The Insurers agree to pay on behalf of the Insured all sums, less any applicable deductible, which the Insured shall
become legally liable to pay as damages for Bodily Injury and/or Property Damage caused by an Occurrence arising
out of the Insured's business as owner and/or operator of the Airport(s) specified in Item 5 of the Schedule and
subject to the Geographical Limits stated in Item 6 of the Schedule
EXCLUSIONS
This Policy does not cover
1. Bodily Injury to any person who at the time of sustaining such Bodily Injury is engaged in the service of the
Insured, or liability for which the Insured or their insurer may be held liable under any employer’s liability,
workers’ compensation, unemployment compensation or disability benefits law or any similar law.
2. Liability assumed by the Insured by agreement under any contract unless such liability would have attached to
the Insured even in the absence of such agreement.
3. Property Damage to property owned, rented, leased or occupied by or in the care, custody or control of the
Insured other than Property Damage to:
(a) aircraft not owned, rented or leased by the Insured, while such aircraft are on the ground and in the care,
custody or control of the Insured for the purpose of storage, servicing, handling or maintenance
(b) vehicles not owned, rented or leased by the Insured, while such vehicles are at the Airport(s) specified in
Item 5 of the Schedule
(c) baggage and/or cargo not owned by the Insured while such baggage and/or cargo is in the care, custody or
control of the Insured.
4. Bodily Injury or Property Damage caused by any ships, vessels, craft or aircraft owned, chartered, used or
5. operated by or on account of the Insured.
This exclusion does not apply to Bodily Injury or Property Damage caused by aircraft not owned, rented or
leased by the Insured, while such aircraft are on the ground and in the care, custody or control of the Insured for
the purpose of storage, servicing, handling or maintenance.
6. Liability arising out of the possession, use, consumption or handling of any goods or products manufactured,
constructed, altered, repaired, serviced, treated, sold, supplied or distributed by the Insured, after such goods
or products have ceased to be in the possession or under the control of the Insured.
This exclusion does not apply to
(a) goods or products which form part of or are used in conjunction with aircraft
(b) the supply, by the Insured, of food and drink at the Airport(s) specified in Item 5 of the Schedule.
7 The cost of repairing or replacing any defective goods or products manufactured, constructed, altered,
repaired, serviced, treated, sold, supplied or distributed by the Insured or any defective part or parts thereof.
8 Loss arising out of improper or inadequate performance, design or specification but this exclusion shall be
deemed not to apply to Bodily Injury or Property Damage insured hereby resulting therefrom.
9 The cost of making good any faulty workmanship but this exclusion shall not apply to Bodily Injury or Property
Damage arising out of such faulty workmanship.
10 Bodily Injury or Property Damage caused by the use of any vehicle on the road in such a manner as to require
insurance or security under any domestic or international law governing road traffic or, in the absence of any
applicable law, to liability arising from the use of any vehicle on the public highway.
This exclusion does not apply in respect of any such liability arising from Occurrences within the confines of the
Airport(s) specified in Item 5 of the Schedule
a) if there is no such applicable law
b) to the liability of the Insured to pay any amount which is in excess of
i) any prescribed limit that is required to be insured where insurance may be effected to comply with the
law whether the Insured effects an insurance policy in respect of such liability or not
ii) the limit of liability of the insurance policy effected by the Insured in respect of such liability whichever
is the greater.
11 Bodily Injury or Property Damage arising out of construction of, demolition of or alterations to buildings,
runways or installations (other than normal maintenance operations).
12 Liability arising out of the operation of an airfield control tower or the provision of air traffic control services.
13 Bodily Injury or Property Damage arising out of any airmeet, air race, or air show or any stand used for the
accommodation of spectators in connection therewith.
14 Claims excluded by the attached
a) War, Hi-Jacking and Other Perils Exclusion Clause (Aviation) AVN48B
b) Noise and Pollution and Other Perils Exclusion Clause AVN46B
c) Paragraph 1(b) of the above Clause AVN46B shall not apply to pollution or contamination of goods or
products sold or supplied by the Insured.
d) Nuclear Risks Exclusion Clause AVN38B
e) Date Recognition Exclusion Clause AVN2000A
f) Asbestos Exclusion Clause 2488AGM00003
g) Contracts (Rights of Third Parties) Act 1999 Exclusion Clause AVN72.
II. DEFENSE, SETTLEMENT AND SUPPLEMENTARY PAYMENTS
With respect to such coverage as is afforded under this Policy the Insurers shall
1. Have the right and obligation to defend at their cost and expense in the name of and on behalf of the Insured
any suit or other proceedings, even if groundless, false or fraudulent, brought against the Insured. However,
the Insurers shall have the right to make such investigation, negotiation and settlement of any claim or suit as
they deem expedient. Furthermore, the Insurers shall pay all expenses incurred by the Insured with the
Insurers' approval (other than the salaries of the Insured's employees and the Insured's normal office
expenses) in respect of any such suit or other proceedings brought against the Insured.
2. Pay all premiums on bonds to release attachments for an amount not in excess of the applicable limit of liability
of this Policy and all premiums on appeal bonds required in any such defended suit, but without any obligation
to apply for or furnish any such bonds.
3. Pay all costs taxed against the Insured in any such suit or proceedings and all interest accruing after entry of
judgement until the Insurers have paid, tendered or deposited in court, such part of such judgement as does
not exceed the applicable limit of the Insurers' liability. The Insurers shall only be liable to pay for that
proportion of the said costs and interest which the applicable limit of the Insurers' liability bears to the amount
of such judgement.
The amounts incurred under this clause, except settlements of claims and suits, are payable by the Insurers in
addition to the limit of the Insurers' liability stated in the Schedule. However with respect to any coverage
which is subject to an aggregate limit hereunder the Insurers shall not be obligated to defend any suit nor to
pay any costs or expenses after the aggregate limit of liability under this Policy has been exhausted and in this
event the Insured shall have the right to take over control of proceedings from the Insurers.
DEFINITIONS
BODILY INJURY
The term “Bodily Injury” means bodily injury, sickness or disease, including death at any time resulting therefrom.
PROPERTY DAMAGE
The term “Property Damage” means physical loss of or damage to or destruction of tangible property, including the
resultant loss of use of such property.
OCCURRENCE
The term “Occurrence” means an accident or a continued or repeated exposure to conditions occurring during the
Period of Insurance which results in Bodily Injury and/or Property Damage neither expected nor intended from the
standpoint of the Insured.
All liability arising out of such exposure to substantially the same general conditions shall be deemed to arise from one
Occurrence.
PRODUCTS LIABILITY
The term “Products Liability” means Bodily Injury and/or Property Damage arising out of the possession, use,
consumption or handling of any goods or products manufactured, constructed, altered, repaired, serviced, treated,
sold, supplied or distributed by the Insured, after such goods or products have ceased to be in the possession or
under the control of the Insured. However, liability arising out of the supply by the Insured of food or drink at the
Airport(s) specified in Item 5 of the Schedule shall not be considered Products Liability.
INSURED
The term “Insured” means the Insured specified in Item 1 of the Schedule and shall include directors, officers and
employees of the Insured whilst acting within the scope of their duties on behalf of the Insured.
CONDITIONS PRECEDENT
It is necessary that the Insured observes and fulfils the following conditions precedent before the Insurers have any
liability to make any payments under this Policy.
1 No liability shall be admitted and no admission, arrangement, offer, promise or payment shall be made by
the Insured without the written consent of Insurers who shall be entitled, if they so desire, to prosecute in
the name of the Insured for their own benefit any claim for indemnity or damages or otherwise against any
third party, and shall have full discretion in the conduct of any negotiations or proceedings, and the Insured
shall give all such information and assistance as Insurers may require.
2 Pay all costs taxed against the Insured in any such suit or proceedings and all interest accruing after entry
of judgement until the Insurers have paid, tendered or deposited in court, such part of such judgement as
does not exceed the applicable limit of the Insurers' liability. The Insurers shall only be liable to pay for that
proportion of the said costs and interest which the applicable limit of the Insurers' liability bears to the
amount of such judgement.
3 The amounts incurred under this clause, except settlements of claims and suits, are payable by the Insurers
in addition to the limit of the Insurers' liability stated in the Schedule. However with respect to any coverage
which is subject to an aggregate limit hereunder the Insurers shall not be obligated to defend any suit nor
to pay any costs or expenses after the aggregate limit of liability under this Policy has been exhausted and
in this event the Insured shall have the right to take over control of proceedings from the Insurers.
GENERAL CONDITIONS
1. Upon the happening of any event likely to give rise to a claim under this Policy or upon receipt by the Insured
of notice of any claim or of any other subsequent proceedings, notice in writing with full particulars shall be
given to the Insurers as soon as possible after same shall come to the knowledge of the Insured or the Insured’s
representative. Every letter, claim, writ, summons or process shall be forwarded to Insurers immediately on
receipt by the Insured.
1
2. All notices as specified above shall be given by the Insured to the firm named for the purpose in Item 8 of the
Schedule.
3. If the I nsured has other insurance against loss covered by this Policy , the I nsurers shall not be liable for a
greater proportion of such loss than the Limit of Liability stated in the Schedule bears to the limit of indemnity
of all valid and collectible insurance against such loss.
4. This Policy may be cancelled at any time at the written request of the Insured or may be cancelled by or on
behalf of the Insurers provided 30 days notice in writing be given. (Where 30 days notice is contrary to law or
statute then the minimum period that is permitted shall be substituted therefor).
If the Policy shall be cancelled by the Insured, the Insurers shall retain the proportion of the premium
calculated in accordance with the following scale.
1 month on risk... ....... ... . 20% annual premium

2 months on risk ... ..... .... .30% annual premium
3 months on risk ... ..... .... .40% annual premium
4 months on risk ... ..... ... .50% annual premium
5 months on risk... ...... .... .60% annual premium
6 months on risk... ... .. ... 70% annual premium
7 months on risk ... ... .. .... 75% annual premium
8 months on risk ... ... .. .....80% annual premium
9 months on risk... ... ... . ...85% annual premium
Over 9 months equivalent to Annual.
If the Policy shall be cancelled by I nsurers, they shall retain the premium for the period that this Policy has
been in force, calculated pro-rata. Notice of cancellation by the Insurers shall be effective even though the
Insurers make no payment or tender of return premium.
5. Should there be any material change in the circumstances or nature of the risks which are the basis of this
contract the Insured shall give immediate notice thereof to the Insurers and no claim arising subsequent to
such change shall be recoverable hereunder unless such change has been accepted by the Insurers.
6. An Insured shall not in the presentation and furtherance of any claim:
(a) deliberately or recklessly conceal from Insurers any information which such Insured knows or ought to know
might be material to their consideration of any claim;
(b) provide to Insurers information, which such Insured knows to be false, with respect either to any event relied
upon as a cause of loss or as to the amount claimed; nor
(c) otherwise use fraudulent means or devices, including suppressing a known defence to Insurers’ liability.
In any such event the Insurers shall have the option to refuse to pay the whole or any part of the claim to such
Insured.
In the circumstances set out in sub-paragraph (b) above, Insurers shall also have the option to:
(i) terminate the cover provided by the Policy to such Insured with effect from the date of the event relied
upon for the claim;
(ii) recover any sums paid to such Insured in respect of losses occurring on or after the date of the event
relied upon for the claim; and
(iii) retain any and all premium paid by such Insured.
If any provision of this condition is in conflict with the law governing the Policy it shall be of no effect to the
extent of such conflict.
7. Notwithstanding the inclusion herein of more than one Insured, whether by endorsement or otherwise, the total
2
liability of the Insurers in respect of any or all Insureds shall not exceed the limit of liability stated in the Schedule.
8. This Insurance shall be governed by and construed in accordance with the law of …………….and each party agrees to
submit to the exclusive jurisdiction of the Courts of ………………… in any dispute arising hereunder.
9. The coverage provided by this Policy shall not be invalidated by any reasonable act by or on behalf of the Insured for
the purpose of protecting persons or property.
AVN 104 22.1.09
WAR HI-JACKING AND OTHER PERILS EXCLUSION CLAUSE (AVIATION)
This Policy does not cover claims caused by :
(a) War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion,
revolution, insurrection, martial law, military or usurped power or attempts at usurpation of power.
(b) Any
- hostile detonation of any device employing atomic or nuclear fission and/or fusion or other like reaction,
- hostile use of radioactive contamination or matter,
- hostile use of an electromagnetic pulse,
- use of chemical or biological material that are poisonous or pathogenic arising from war, invasion, acts of
foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection,
martial law, military or usurped power or attempts at usurpation of power, or for political or terrorist
purpose and whether the loss or damage resulting therefrom is accidental or intentional.
(c) Strikes, riots, civil commotions or labour disturbances.
(d) Any act of one or more persons, whether or not agents of a sovereign Power, for political or terrorist purposes
and whether the loss or damage resulting therefrom is accidental or intentional.
(e) Any malicious act or act of sabotage.
(f) Confiscation, nationalisation, seizure, restraint, detention, appropriation, requisition for title or use by or under
the order of any Government (whether civil military or de facto) or public or local authority.
(g) Hi-jacking or any unlawful seizure or wrongful exercise of control of the Aircraft or crew in Flight (including any
attempt at such seizure or control) made by any person or persons on board the Aircraft acting without the
consent of the Insured. For the purpose of this exclusion (g) only, an aircraft is considered to be in flight at any
time from the moment when all its external doors are closed following embarkation until the moment when any
such door is opened for disembarkation or when the aircraft is in motion. A rotor-wing aircraft shall be deemed
to be in flight when the rotors are in motion as a result of engine power, the momentum generated therefrom,
or autorotation.
Furthermore this Policy does not cover claims arising whilst the Aircraft is outside the control of the Insured by
reason of any of the above perils. The Aircraft shall be deemed to have been restored to the control of the Insured
on the safe return of the Aircraft to the Insured at an airfield not excluded by the geographical limits of this Policy,
and entirely suitable for the operation of the Aircraft (such safe return shall require that the Aircraft be parked with
engines shut down and under no duress).
AVN 48C
NUCLEAR RISKS EXCLUSION CLAUSE
(1) This Policy does not cover:

(i) loss of or destruction of or damage to any property whatsoever or any loss or expense whatsoever
resulting or arising therefrom or any consequential loss
(ii) any legal liability of whatsoever nature
directly or indirectly caused by or contributed to by or arising from:
(a) the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or
nuclear component thereof;
(b) the radioactive properties of, or a combination of radioactive properties with toxic, explosive or other
hazardous properties of, any other radioactive material in the course of carriage as cargo, including
storage or handling incidental thereto;
(c) ionizing radiations or contamination by radioactivity from, or the toxic, explosive or other hazardous
properties of, any other radioactive source whatsoever.
(2) It is understood and agreed that such radioactive material or other radioactive source in paragraph (1) (b) and
(c) above shall not include:
(i) depleted uranium and natural uranium in any form;
(ii) radioisotopes which have reached the final stage of fabrication so as to be usable for any scientific,
medical, agricultural, commercial, educational or industrial purpose.
(3) This Policy, however, does not cover loss of or destruction of or damage to any property or any consequential
loss or any legal liability of whatsoever nature with respect to which:
(i) the Insured under this Policy is also an insured or an additional insured under any other insurance policy,
including any nuclear energy liability policy, or
(ii) any person or organization is required to maintain financial protection pursuant to legislation in any
country; or
(iii) the Insured under this Policy is, or had this Policy not been issued would be, entitled to indemnification
from any government or agency thereof.
(4) Loss, destruction, damage, expense or legal liability in respect of the nuclear risks not excluded by reason of
paragraph (2) shall (subject to all other terms, conditions, limitations, warranties and exclusions of this Policy)
be covered, provided that:
(i) in the case of any claim in respect of radioactive material in the course of carriage as cargo, including
storage or handling incidental thereto, such carriage shall in all respects have complied with the full
International Civil Aviation Organization “Technical Instructions for the Safe Transport of Dangerous Goods
by Air”, unless the carriage shall have been subject to any more restrictive legislation, when it shall in all
respects have complied with such legislation;
(ii) this Policy shall only apply to an incident happening during the period of this Policy and where any claim
by the Insured against the Insurers or by any claimant against the Insured arising out of such incident
shall have been made within three years after the date thereof;
(iii) in the case of any claim for the loss of or destruction of or damage to or loss of use of an aircraft caused
by or contributed to by radioactive contamination, the level of such contamination shall have exceeded the
maximum permissible level set out in the following scale:
Emitter Maximum permissible level of non-

fixed radioactive surface
contamination
(IAEA Health and Safety
Regulations) (Averaged over 300cm²)
Beta, gamma and low toxicity Not exceeding 4 Becquerels/cm²

alpha emitters (10-4 microcuries/cm²)
All other emitters Not exceeding 0.4 Becquerels/cm²
(10-5 microcuries/cm²)
(iv) the cover afforded hereby may be cancelled at any time by the Insurers giving seven days’ notice of
cancellation.
AVN 38B
22.7.96
ASBESTOS EXCLUSION CLAUSE

This policy does not cover any claims of any kind whatsoever directly or indirectly relating to, arising out of or in
consequence of:
1. the actual, alleged or threatened presence of asbestos in any form whatsoever, or any material or product
containing, or alleged to contain, asbestos; or
2. any obligation, request, demand, order, or statutory or regulatory requirement that any Insured or others test
for, monitor, clean up, remove, contain, treat, neutralize, protect against or in any other way respond to the
actual, alleged or threatened presence of asbestos or any material or product containing, or alleged to contain,
asbestos.
However, this exclusion shall not apply to any claim caused by or resulting in a crash fire explosion or collision or a
recorded in-flight emergency causing abnormal aircraft operation.
Notwithstanding any other provisions of this Policy, Insurers will have no duty to investigate, defend or pay defence
costs in respect of any claim excluded in whole or in part under paragraphs (1) or (2) hereof.
All other terms and conditions of the Policy remain unchanged.

2488 AGM00003
DATE RECOGNITION EXCLUSION CLAUSE
This Policy does not cover any claim, damage, injury, loss, cost, expense or liability (whether in contract,
tort, negligence, product liability, misrepresentation, fraud or otherwise) of any nature whatsoever arising from or
occasioned by or in consequence of (whether directly or indirectly and whether wholly or partly):
1. the failure or inability of any computer hardware, software, integrated circuit, chip or information technology
equipment or system (whether in the possession of the Insured or of any third party) accurately or
completely to process, exchange or transfer year, date or time data or information in connection with any
change of year, date or time; whether on or before or after such change of year, date or time;
2. any implemented or attempted change or modification of any computer hardware, software, integrated
circuit, chip or information technology equipment or system (whether in the possession of the Insured or of
any third party) in anticipation of or in response to any such change of year, date or time, or any advice
given or services performed in connection with any such change or modification;
3. any non-use or unavailability for use of any property or equipment of any kind whatsoever resulting from
any act, failure to act or decision of the Insured or of any third party related to any such change of year,
date or time;
and any provision in this Policy concerning any duty of Insurer to investigate or defend claims shall not apply to any
claims so excluded.
AVN.2000A
SANCTIONS AND EMBARGO CLAUSE

Notwithstanding anything to the contrary in the Policy the following shall apply:
1. If, by virtue of any law or regulation which is applicable to an Insurer at the inception of this Policy or becomes
applicable at any time thereafter, providing coverage to the Insured is or would be unlawful because it breaches
an embargo or sanction, that Insurer shall provide no coverage and have no liability whatsoever nor provide any
defence to the Insured or make any payment of defence costs or provide any form of security on behalf of the
Insured, to the extent that it would be in breach of such law or regulation.
2. In circumstances where it is lawful for an Insurer to provide coverage under the Policy, but the payment of a
valid and otherwise collectable claim may breach an embargo or sanction, then the Insurer will take all
reasonable measures to obtain the necessary authorisation to make such payment.
3. In the event of any law or regulation becoming applicable during the Policy period which will restrict the ability of
an Insurer to provide coverage as specified in paragraph 1, then both the Insured and the Insurer shall have the
right to cancel its participation on this Policy in accordance with the laws and regulations applicable to the Policy
provided that in respect of cancellation by the Insurer a minimum of 30 days notice in writing be given.
In the event of cancellation by either the Insured or the Insurer, the Insurer shall retain the pro rata proportion of
the premium for the period that the Policy has been in force. However, in the event that the incurred claims at the
effective date of cancellation exceed the earned or pro rata premium (as applicable) due to the Insurer, and in the
absence of a more specific provision in the Policy relating to the return of premium, any return premium shall be
subject to mutual agreement. Notice of cancellation by the Insurer shall be effective even though the Insurer makes
no payment or tender of return premium.
AVN 111 01.10.10
EXTENDED COVERAGE ENDORSEMENT (AVIATION LIABILITIES)
1. WHEREAS the Policy of which this Endorsement forms part includes the War, Hi-Jacking and Other Perils
Exclusion Clause (Clause AVN 48B), IN CONSIDERATION of an Additional Premium of ..........., it is hereby
understood and agreed that with effect from ......... , all sub-paragraphs other than ............. of Clause AVN 48B
forming part of this Policy are deleted SUBJECT TO all terms and conditions of this Endorsement.
2. EXCLUSION applicable only to any cover extended in respect of the deletion of sub-paragraph (a) of Clause AVN
48B.
Cover shall not include liability for damage to any form of property on the ground situated outside Canada and
the United States of America unless caused by or arising out of the use of aircraft.
3. LIMITATION OF LIABILITY
The limit of Insurers’ liability in respect of the coverage provided by this Endorsement shall be a sub-limit of
USD 5,000,000.00 or the applicable Policy limit whichever the lesser any one Occurrence and in the annual
aggregate. This sub-limit shall apply within the full Policy limit and not in addition thereto.
4. AUTOMATIC TERMINATION
To the extent provided below, cover extended by this Endorsement shall TERMINATE AUTOMATICALLY in the
following circumstances:
(i) All cover
upon the outbreak of war (whether there be a declaration of war or not) between any two or more of the
following States, namely, France, the People’s Republic of China, the Russian Federation, the United
Kingdom, the United States of America
(ii) Any cover extended in respect of the deletion of sub-paragraph (a) of Clause AVN 48B
upon the hostile detonation of any weapon of war employing atomic or nuclear fission and/or fusion or
other like reaction or radioactive force or matter wheresoever or whensoever such detonation may occur
and whether or not the Insured Aircraft may be involved
(iii) All cover in respect of any of the Insured Aircraft requisitioned for either title or use
upon such requisition
PROVIDED THAT if an Insured Aircraft is in the air when (i), (ii) or (iii) occurs, then the cover provided by this
Endorsement (unless otherwise cancelled, terminated or suspended) shall continue in respect of such an
Aircraft until completion of its first landing thereafter and any passengers have disembarked.
5. REVIEW AND CANCELLATION

(a) Review of Premium and/or Geographical Limits (7 days)
Insurers may give notice to review premium and/or geographical limits - such notice to become effective on the
expiry of seven days from 23.59 hours GMT on the day on which notice is given.
(b) Limited Cancellation (48 hours)
Following a hostile detonation as specified in 4 (ii) above, Insurers may give notice of cancellation of one or
more parts of the cover provided by paragraph 1 of this Endorsement by reference to sub-paragraphs (c), (d),
(e), (f) and/ or (g) of Clause AVN 48B - such notice to become effective on the expiry of forty-eight hours from
23.59 hours GMT on the day on which notice is given.
(c) Cancellation (7 days)
The cover provided by this Endorsement may be cancelled by either Insurers or the Insured giving notice to
become effective on the expiry of seven days from 23.59 hours GMT on the day on which such notice is given.
(d) Notices
All notices referred to herein shall be in writing.
AVN 52G 17.10.01
PERSONAL INJURY EXTENSION
The insurance provided by this policy extends to indemnify the insured for legal liability for damages awarded to any
person arising out of one or more of the following offences committed during the policy period but only where such
offences are committed in connection with that part of the insured’s aviation operations or interests for which other
coverage is granted by the policy:-
1. false arrest, restraint, detention or imprisonment.
2. malicious prosecution.
3. wrongful entry, eviction or other invasion of the right of private occupancy.
4. inadvertent discrimination with respect to withholding or refusal of transportation except with respect to
overbooking.
5. the publication or utterance of a libel or slander or of other defamatory or disparaging material in violation of
an individual's right of privacy except publication or utterance in the course of or related to advertising,
broadcasting or telecasting activities conducted by or on behalf of the named insured.
6. incidental medical malpractice error or mistake by a physician, surgeon, nurse, medical technician or other
person performing medical services but only for or on behalf of the insured in the provision of emergency
medical relief.
The following additional exclusions shall apply to the insurance provided by this extension:-
(a) liability assumed by the named insured under any contract or agreement
(b) personal injury arising out of the wilful violation of penal statute or ordinance committed by or with the
knowledge or consent of the named insured
(c) personal injury arising out of offence 5 above
(i) if the first injurious publication or utterance of the same or similar material was made prior to the
effective date of this insurance
(ii) if such publication or utterance was made by or at the direction of the insured with the knowledge of
the false nature thereof
(d) liability for personal injury sustained by any person directly or indirectly related to the past, present or
potential employment of such person by the insured.
The limit of liability applicable to this extension shall be (as per Schedule) in the aggregate during the policy period
being within the overall policy limit and not in addition thereto.
All other terms and conditions of this policy remain unchanged.
AVN 60А 24.12.2004
UNINTENTIONAL ERROR OR OMISSION IN REPORTING CLAUSE
1. Neither this section (s), nor any claims made by the Insured under this section (s) shall be prejudiced or
invalidated by any Unintentional Error Or Omission In Reporting by the Insured, provided always that the
Insured notifies Underwriters of such error or omission as soon as practicable upon its discovery by the
employee of the Insured who is responsible for managing the Insured’s insurance programme and always
subject to the provisions of paragraph 3 below.
2. As used in this clause, the phrase “Unintentional Error Or Omission In Reporting” shall mean:
a. an inadvertent failure to report exposures intended to be covered by this section (s), or
b. an inadvertent failure to report exposures promptly as required by reporting provisions of this section
(s) (other than those included within paragraph 3 below), if any,
but solely where the failure results directly from information concerning these exposures not being advised to
the employee of the Insured who is responsible for compiling and reporting such information to Underwriters
under the Insured’s insurance programme.
3. For the purposes of this section (s), an “Unintentional Error Or Omission In Reporting” shall in no circumstances
include the failure to report any change in existing exposures within sixty (60) days (where the Insured acts as
operator) or one hundred and eighty (180) days (where the Insured is a non-operator) following the initial
existence of such changes or new exposures, regardless of whether or not any employee of the Insured has
been advised of such changes or exposures.
4. Nothing contained in this Clause shall operate to override any specific provisions contained elsewhere in this
section (s) or the general provisions of this policy relating to the notification of losses, occurrences, accidents,
incidents or claims (including, but not by way of limitation, any time-limitation or discovery, notification or
reporting) which shall always be paramount to the provisions of this Clause.
Notwithstanding anything to the contrary contained in this Clause, the amount for which Underwriters will be liable in
respect of any claim that is payable under this section (s) solely by virtue of the concessions allowed to the Insured
under this Clause shall not exceed - any one Occurrence and in the aggregate for the period of this section (s).
TWO WAY CROSS LIABILITY CLAUSE
It is agreed that the inclusion of more than one Insured in this Policy shall not affect the rights of any Insured as
respects any claim or suit by any other Insured, or by any employee of such other Insured. The Policy shall insure
each Insured in the same manner as though a separate policy had been issued to each and the Underwriters hereby
agree to waive all rights of subrogation which they may have or acquire against any party insured hereon arising out
of an accident or occurrence in respect of which any claim is made hereunder. PROVIDED NEVERTHELESS that
nothing contained herein shall operate to increase the Underwriters liability as set forth elsewhere in the Policy
beyond the amount or amounts for which the Underwriters would have been liable if only one Insured had been
named.
LSW715 (12/93)
TENANT'S LIABILITY CLAUSE
It is agreed and understood that subject to the Insured having paid the agreed additional premium, this Policy shall
be extended to cover the Insured's legal liability for the claims made against the Insured for accidental bodily injury
of and/ or accidental property damage to any third party caused by fire to the buildings leased.
This Clause is subject otherwise to the terms, conditions and exceptions of this Policy.
DATE RECOGNITION LIMITED COVERAGE CLAUSE

WHEREAS the Policy of which this Endorsement forms part includes the Date Recognition Exclusion Clause (Clause
AVN 2000A), it is hereby understood and agreed that, subject to all terms and provisions of this Endorsement, Clause
AVN 2000A shall not apply to any sums which the Insured shall become legally liable to pay, and (if so required by
the Policy) shall pay (including costs awarded against the Insured) in respect of:
(1) accidental bodily injury, fatal or otherwise, or loss of or damage to property caused by an aircraft accident
occurring during the Policy period and arising out of a risk insured under the Policy; and/or
(2) accidental bodily injury, fatal or otherwise, or loss of or damage to property caused by an accident, other than
an aircraft accident, occurring during the Policy period and arising out of a risk insured under the Policy. For
the avoidance of doubt, solely for the purposes of this paragraph (2) and without prejudice to the meaning of
the words in any other context, “bodily injury” shall mean only physical corporeal injury and unless arising
directly therefrom shall not include mental or psychological injury.
PROVIDED THAT:
1. Coverage provided pursuant to this Endorsement shall be subject to all terms, conditions, limitations,
warranties, exclusions and cancellation provisions of the Policy (except as specifically provided herein), and
nothing in this Endorsement extends coverage beyond that which is provided by the Policy.
2. Nothing in this Endorsement shall provide any coverage:
(a) applying in excess of any scheduled underlying insurance and/or in respect of any non aviation risks;
and/or
(b) in respect of grounding of any aircraft; and/or
(c) in respect of loss of use of any property unless it arises out of physical damage to or destruction of
property in the accident giving rise to a claim under the Policy.
3. The Insured agrees that it has an obligation to disclose in writing to the Insurers during the Policy period any
material facts relating to the Date Recognition Conformity of the Insured’s operations, equipment and
products.
AVN 2002A 21.3.01

(Applicable to non Aircraft Liability only)
CANCELLATION CLAUSE AMENDED TO US SHORT RATE SCALE NMA45
Notwithsanding anything to the contrary contained herein an in consideration of the premium for which this
insurance is written it is agreed that in the event of cancellation thereof by the assured and earned premium shall be
computed according US Short Rate Scale NMA45
LIMITATION OF LIABILITY CLAUSE (JOINT INSUREDS)
Notwithstanding the inclusion herein of more than one Insured, whether by endorsement or otherwise, the total
liability of the Insurers in respect of any or all Insureds shall not exceed the limit(s) of liability stated in this Policy.
AVN 14 1.10.96

Polis + Wording PL Bandara Kertajati

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PUBLIC LIABILITY AMANDED TO AIRPORT LIABILITY

PT Bandar Udara Internasional Jawa Barat QQ PT. Bank

Policy No. 427.791.110.19.70001

PT. Asuransi Jasindo Syariah

(A) TYPE OF INSURANCE : PUBLIC LIABILITY AMANDED TO AIRPORT

(B) THE INSURED : PT Bandar Udara Internasional Jawa Barat QQ PT.

(C) ADDRESS : Kecamatan Kertajati, Kabupaten Majalengka, Jawa

(D) INTEREST : To indemnify the insured to cover the insured’s legal

(E) RISKS LOCATION : Bandar Udara Internasional Jawabarat - Kertajati,

(I) CLAUSES : 1. War, Hi-Jacking And Other Perils Exclusion Clause

(J) JURISDICTION : This insurance shall be governed by and construed in

(K) PREMIUM : 0.225% x IDR 75,000,000,000 = IDR 168,750,000.00

Jakarta, 26 December 2019

PT Bandar Udara Internasional Jawa Barat

ANGSURAN 1: BATAS TANGGAL LUNAS 31 JANUARI 2020 : IDR 37,376,545.25

ANGSURAN 2: BATAS TANGGAL LUNAS 03 MARET 2020 : IDR 37,376,545.25

ANGSURAN 3: BATAS TANGGAL LUNAS 03 APRIL 20 20 : IDR 37,376,545.25

ANGSURAN 4: BATAS TANGGAL LUNAS 03 MEI 2020 : IDR 37,376,545.25

happening or caused as described in Schedule yang terjadi atau yang disebabkan

(4) Liability in respect of (4) Tanggung Jawab sehubungan dengan

This Policy does not cover

5. operated by or on account of the Insured.

This exclusion does not apply to

a) if there is no such applicable law

b) to the liability of the Insured to pay any amount which is in excess of

14 Claims excluded by the attached

a) War, Hi-Jacking and Other Perils Exclusion Clause (Aviation) AVN48B

b) Noise and Pollution and Other Perils Exclusion Clause AVN46B

d) Nuclear Risks Exclusion Clause AVN38B

e) Date Recognition Exclusion Clause AVN2000A

f) Asbestos Exclusion Clause 2488AGM00003

g) Contracts (Rights of Third Parties) Act 1999 Exclusion Clause AVN72.

II. DEFENSE, SETTLEMENT AND SUPPLEMENTARY PAYMENTS

1 month on risk... ....... ... . 20% annual premium

Over 9 months equivalent to Annual.

6. An Insured shall not in the presentation and furtherance of any claim:

(iii) retain any and all premium paid by such Insured.

WAR HI-JACKING AND OTHER PERILS EXCLUSION CLAUSE (AVIATION)

This Policy does not cover claims caused by :

NUCLEAR RISKS EXCLUSION CLAUSE

(1) This Policy does not cover:

Emitter Maximum permissible level of non-

Beta, gamma and low toxicity Not exceeding 4 Becquerels/cm²

ASBESTOS EXCLUSION CLAUSE

All other terms and conditions of the Policy remain unchanged.

SANCTIONS AND EMBARGO CLAUSE

EXTENDED COVERAGE ENDORSEMENT (AVIATION LIABILITIES)

5. REVIEW AND CANCELLATION

PERSONAL INJURY EXTENSION

UNINTENTIONAL ERROR OR OMISSION IN REPORTING CLAUSE

TWO WAY CROSS LIABILITY CLAUSE

DATE RECOGNITION LIMITED COVERAGE CLAUSE

2. Nothing in this Endorsement shall provide any coverage:

(b) in respect of grounding of any aircraft; and/or

AVN 2002A 21.3.01

CANCELLATION CLAUSE AMENDED TO US SHORT RATE SCALE NMA45

LIMITATION OF LIABILITY CLAUSE (JOINT INSUREDS)

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