Lecaten — — 7} Longtude } Lettude ] ‘ity cre |] Postal Code [T oe Em] coy GEE au [mE] em eae iecaten Code = paras =] eiy = Presmes = Postal Coa = Jcone0001 JL Ckini Raye No 99 [Jokerte Puectokorta [11220 Jcone0002 51 Metaram |Yokorta Timur |Jokerta f12220 lpr aac lpr xvz [azo oot [Feed ine = loos Tata = esazase 5645680 Tonaiade hosessss1 josarsiz6Fre Enoretng Ent Sip ined Nine Taio pee Inoeed Fes FO >] [Beach Ted Semen Siang Boe owsre = [*d% trom [Fetcinasnake sore ] 10 FRetcleaminewred ‘outomatic calculation from slip with same insured (coinsurance) Lester Tocca Rao Say 2 Faas = [age ate co0Ko00t [scum Row No Jr Put sorories [rote [easeszsiosezest fo JcooKoo0e [ane ranang bene Stove Tour |itona Tr fisere |-sasewsvocsrser Jo connwnce [Eman oman amenncwnmmnamnemerm | Lise] Number Username Prod Voor uy ‘stetus Curreney ‘create endorement date ‘only show wien msured soved | Entrant sean L-] Lo] [xem] seaman saa dae C8 aa user, luce, Juss Data i transferred! [Gaveney ee OR, USD p>) ffaternree Number cos ‘Sip No [eoa ist F] Koc eNIDN [rocist F] Occupacy Poly No [occ F] Bulding Const Atochment Oiler tps Sip pat Tneroet Inewred Interest ID -Nome ‘Amount ‘Acton 001 -Machinecy 100000000 delate 002 - Butéing 100000000 delete [Ba Conat it gl Tweet YP] =a} Type Currency Percentage Amount Min Claim Amount MR am sate 10000000 delete TPL USD. 001% 100.000 10000000 dele Total Sum insured [ei Ctoal Fem niet nee) | wwe PE] ba% Exo tor iF ex] EE Eee] 001- RSMD Extend Coveroge Perl Code-Nome Nai (permil%) Amount tion ye syste delete 005 -Eorthauoke =O 1000000 alate Pectior & Loyer “or non properional [Erasee aver I r= lnstatent Pane! Instaliment Date Percentage ‘Amount Acton 20/09/2020 50% +100.000.000 datete 20/10/2020 50% 100000000 8 |) bess) Gy otal must be 100% © ro proportional pane! Propertons! CID) Non Pepto reed 20% 60000000 delete 20% 40000000 delete Tomy] Ewa EI Eee]Ship Dota oe Taagenarta cote] ‘country [Bountry cade - nome iat F] she tise [Bip Tipe code none t F Classifcaten [Elosticoion code name at F] ‘construction [Eonenition coda name ft F] @craetew) [LQ Seax [Gade Bip Name = [Owoer = [ORTE TOWIE [RATE [Pome = [County © [type] Cissiicatar® | Conatncton "ET Sp Yee | epor vor® | lanes roorsa4Reience ——frotaHane f19 fo fo fo__|oor-indonaaion- ron ]301- uk Care A0t- American Berecuot Snins|1a4 a4 lasam 500553 }Scouk Nusontara |Gemaindo VK|384 207 Jo Jo _Joot-tndonesifro1-Fibe|B02 -Barse |a01-Germonicher Lys frego——_—|r9a0 Jssnepoe Dota Number Toulemele gonerled trowes —— [Pretnea TOV [>] [Beach oc eumdw Sromesion | [Ewteee Coa Tee] Powe [ee ) PRO F& ouster = [19% trom [Ft nosienae shore i automatic calculation frm slo with same ineured (eo Sh dit Seca Faas caoeooos stance conc san cron cormwence [eden apa a tae hoes wih Sara FOUR “erate enema dt “ey on when iid so nner ndromene sion [—] [] Username ‘automatic record status change Prod ear w sow [Ste Beane Daa wenfened! st Eerement some [Exieg Bia 5 ease F Currency, [Currency eg : JR, USO |v] jee Number sone coo Ream F Cd) i woo SG F piers oscpaey [BOC 5 Sides cont [Bema Interest 1D - Name Amount 036 -Heavy Equpment _100.000000 450 -Bensin 100,000.00 mee] CJ Bee: Tota Sum Inswed [fe (otal om mterest neue) Deductible Font Type Currency Percentage Amount Min Claim Amount Action Mo wR am ste 10000000 delete eL 0.001% 190.000 10000000 delete Jo [-Cendiven Needed Condition Needed Code-Name Information Aeton 028 -RSMO 4 IAVTERRORISM REND A.JAVTERRORIEM alate On. 418A, TERRORISM, SABOTAGE AND CIVIL COMMOTION dete [Gendivon Needed Code Nome Inlormation Uist FE) eons) Leer “ter non proportional [Eheose aver PI pe (oerni 2) [ET soe [1% [etm Bete Promim [raster ‘Groee Prion [= Tram Mer son be Sane Commission [F]9% [Fam sbm es ar Net Pem to NR Installment Panel Instalment Date Percentage Amount ‘tion z0/o9r2020 50% 100,000,000 late 20/10/2020 50%, 100.000.000 late moe80 Sess total must be 100% revo Bockon? [For] ownraterten F]% [== ee ‘outomatic calculation (100%-total retrocession %) Retrocessin Panel Tee FRetrocession Contact Percantope Amount Aeton NM xOL ——zoNmttio 20% 160000000 delete SPL 20K86 20% 40000000 [Genvact et arFence Lines -Enty Sip Po lnswree. Number Toulomatie ganercted Inowed [Preir ea: PT OV [=] [Besci tex Treured w? Suoseaton Sutin es OOo TE ue Share 1% trom [Fexarnannare aha | t Prsarean meee ] *outomatieealeulaton from ap with some inered (coneurane=) Location "Add isk Location Toe Case PRarare =a Frames ¥ [Cattada Longiucs ie Jcooe0001- |31cikni Raya No 99 Jekarta Pusat JFokarta Fuser |Jokorta |-s2seszstosa7zes |e [co0E0002 |s1 Raya Panjang Lebar No 66 Jokorta Timur [Yokarta Timur [Jakarta f-62seres ose77se1 Jo i eee Ld comes ‘crac endorament date ‘only how when inured saved Number [Feutonalis eneraied_] Endorsment /Setsin [—] [7] Username a] seutomatic record status change = State atone 3 Yee = Prodveor = [77] [ Jorer —Jowrereczo oro0a0 |usera w jarane Jovr2cz0 +1500 fused sic frorreczo 12000 [users Stee Dates wonsferred! Source 5 currency [Baeneyee TOR, USD To] Referee Number Sip No cos [costar F] owen koe (RoC Te FI otcy No [ ccupocy [BCE Tat o Butding Const [BE Comte A tachment Oiler ips Slip tpat Tnterest Inewred Interest ID -Nome Amount Acton (001 - Machinery 100000000 delate 002 -Buiding 100000000 delate == —F] CT] ai (etal rom interest neured) we PEE E% bere tor poe Tyee CureneyParcanteea Anoint Hn lam Anoint Aan MO Re wt 10000000 esate TL usd 00m 100000 10000000 eaate Te) EE] E few] pEnend comeoe fet ote-Nane (pad) Ameint —aeton ont. Remo ye sytts— stte 0s Corban Ot 100000 delate Ram} fo) =] ie Insurance Peried einsurnce Period @ ro» proportional pene! Presetenal CD) Non Propertenl Loyer “or non propertenal [Ehoose larer FI Pate erm) [E sre E1% [ee Bost rion recPmicte [=oE=bRFw commesen [21% [Sas "bm Tar] NetPrm ons [Fou DH WOR aw f-lnstenent Pane Installment Bote Percentage mount Aeton zosow2020 50% 100000000 ete zovwree20 50% 4000000000 dete 78 een) Gy ‘otal must be 100% eto Backup ? own Retention [E196 % *eutematie ealeation 100%-otaretocestion 7) -Rewocestion Pre! Type Retrocessien Contract Pereantage ‘Amount ‘tion Ne xOL zone 0% 160.000000 delete SPL zoasc 40000000 delete 20% frets ]>] [Gmwecrit fr] E_]% [=a ber Sovenate generated Prefixes PT, 0V =] [Besa or Trowred w/ Suopenton Eiewaaee trom [Fotalnasionareshare—~+d|*ste [Motaaumraured—SS~*d ith come inured (sinowranes) aitaseTenotude |-szseszss0se774e1 |e saseresnser7se1 lo Consurance Property Type Code - Nome 001- Prone, 005 - Laptop ; ie Is le Is Property type fat fr) [Ae | race enderament data ‘only show when inewed caved now — Fonanaic eect ] tsdoaoct Salen [—] [] seeneme — [anarbon] seutometie record sttue change Soe = asin spa praver [77 ) 3 forer — Jovrer2cz0 020000 users w iene Jovireoz0 sco fuewa © frovoraoe0 n2000 fusws sie souce F Currency [Currency 9 1DR, USD [>] [Reference Number so ( coo [Seam 5 oon [— roc [RE F race [> Cccupsy [BEER 5 uling Cont [Batam] Coverage tachment Oiler ipa Sip tot Intarast Inered Interest ID - Nome ‘Amount ‘Action 001 - Machinery 100000000 delete 002 - Buising 100000000 delete nsterest et wee Currency Percentoge Amount Mn Claim Amount Action MD IDR 1% TL USD 001% 100000 10000000 delete we FOE) % Ee i 10000000 delete eC Nai (peri 2) phere Instalinent Date Percentone Arent Acton 20109/2020 50% 100.000000 delete 20vv0/2020 50% 00.000.000 delete ET! = Terran oT C68 meoreeerwet 78 * Eth © von prpertene vont Propetenal CJD) Nev Proertent (ees) pene consemiona [Fame IC 9 CR oe “otal must be 100% fat Bocie? [Foe ompentin [1% [xe] re) ‘outemticcaleuation (100%-total retrocession Te) [Retrceston ora Wve avoeation Contact Prcentone mcunt etn RKO. zone 20% 160000000 daiste se 2018 20% 40000000 aint» eine] Eamame ) E% fee]Number Tact pneried Insured Pretees PTV Jr] [Sencha Suapmeton Suing Gao Tek ows = [1% trom [Fava to [Ractemrened ] “outomatic calculation rom sip with same neured (coinewance) |-s.256525106877481 4.256105 106677561 Coneuence [Fadl vamata wo separa Way mare Wa oe eohouanoe wih nara tel Det cote Gl fide rarer Even peta 006001 Emme 04 ven oo x 2020 delta D002 Emde 86 Eon Got x 2020 ine Sa Ta ere 5 = = ereateendorament dato ‘only chow when meured caved aber endoement selon [—] [7] Username “outomatic record status change — ws sx sone ; ‘Currency [Currency eg "IDR, USD |v] Re Number sew Eo oom C7 | EE 5 acre ccnwes EE = sia eee [EEF = ‘neers mm citmany enue ue como esc as aa - a TT] we Pe] 1% Ea ane ee Gen) feentgn Anant vant oe ak crm mai ane wre uo semi neey oma ne Te] EE) ET Fes) “cocoa petese-Nome hoe) dene Atn came ye a re soos rae Fl fE_) | as Inewrance Pered a ainevencePoros [7] 8 © 8 Ce @ re proper! pone! Propetenal CD) Nor Frerteral am be wR prlrotelment Pane! Instolinent Date Percentoge Ament Acton 207092020 50% 00.000.000 delete 20vv0/2020 50% 100000000 otal must be 100% ate avo Boeue? [Feo Je] ow etenion []% [see Eo “extent etn (00% retonston ) pirvosenenro Tyee —_—Ratocetson Contact Parcanlone rout Aeton Nexo zone 20% 19000000 delete sp. zonae 20% 40000000 ete Temp) Fame —) E% EasePersonal Accident - Entry Sip Po lnswree. severed Inowed Prefixes PT, 0V =] [Besa or Trowred w/ Suopenton Eiewaaee our Share 1% trom — [Retalnonnare share te [Rademianed ‘outomatic colewlaton from sip with some insured (conewrance) Lecoton “Baa Rak Locator vetoect aa) teens Fama [Rane Brin bate ohn Doo}ovowt9e0 Jone Deefarasm9a) ise Gade = [Raareae =v a Jcone0001 | cikini Raya No 99 Jokorta Pusat [SetertaFusct |Jokarta |-s2seszsiea77es Jo Jcone00ce | Raye Panjang Leber No 66 Jakarta Tims |ickoria Timur |ckarta |.s2sereso5.e77581 | Conevance rhe to weperle Noy Tet ‘only chow when meured caved Number Toutomate Useenome — [isereon] Prod Voor vy ‘Stotue Data is tronaferred currency [Eiareney og TOR, USD >] a cop [copier F] a Koc [ROC Tet F] Policy No Oceupocy [BOC tet F] ‘Butding Conat [Bia Conat ist F] Coverage tachment Oiler ipa Sip tot Intacest Insure Interest ID “Nome ‘Amount ‘Aton 001 - Machinery 100000000 delete 002 - Buiaing 100000000 delete fineteestint >] = Total Sim Ineured [lorcet roninerest newed | ve FOE) % Ea Type Currency Percantoge Amount Min Claim Amount ation MR xm sei 10000000 delete TPL sD (001% 100000 10000000 delete es Extend Coverone Peel Code - Nome, 001- EMD (005 - Earthquake Petter [el © wn prportenl pont Protons CD). Non Pesan LLojer “or non proportional [Bkaaee lever FI pate tomm =) [E—] shee EI% [ee commission [3 ]9G [Fax rb ews at] NetPrmione [Zan =ber wl (WOR em) pplratelment Pane! Instolinent Date Percentoge Ament Acton 0704/2020 50% 100.000.000 delete 20/70/2020 50% +100.000.000 datete ac WI? nat promo to NA otal must be 100% Retro Backup? [res Jo] ‘own Retention [x19 [=* 7% b%= Ee “extomai clean (10% iota evocesson %) Parenter Twe Revocessen Contoct Pacentoe Amount Aeon NOL zone 20% 160000000 eee srt 20186 20% 40000000 eee eet] Eomcrme ]) Eo % EePo lnswree. HE & Motor -Entey Slo Number Toxtamate generated Inowed Prefixes PT,0V =] [Beach to Trowred w/ Suopeaton Saliaeg OOo Tok Our Sore 1% trom ‘outomatieealelation from sip with some inewed (comneuranes) [Fatco Nomar fe 1000 4a 2000 85 on = ise Gade = [Raareos Fy ¥ rovnce = [rattodeLonaiode Jcone0001 | cikin Raya No 9 dokorta Pusat JSckertaPuset |Jckarta 6.286525 106877881 }conE00ce |21 Raye Paniona Leber No 66 Jakarta Timar |ckorta Timur JJokarta _ |-6.286126106.977581 crac enderament date ‘only how when inured saved Number sali gonerat Endoremont /Selsih [] [] secre soutometic record otatus change Pro [Stas = [Datatme Slee = rod Yeor Jower — Jowrarz020 090000 |useca uy faindeg Jowrosz0z0 141500 |useea sic frovtorzoz0 12000 |users Stetue Date ie tronstorred ‘Souree F] Ccurency _ [Eurencyeg IDR USD [x] Peforenee Number ‘Sip No cos, Gang F] enon [— koe [ROC Tat F] Potcy no [ Oceupacy [OCCT F] Balding Const [Bid Corst ist F] Coverone Atochment —oteinst Ta) Slip tpat Interest Inewred Interest ID -Nome Amount Acton (001 - Machinery 100000000 delate 002 -Butcing 100000000 delate ai (etal rom terest neured) w Type Cutroncy Parcantege Amount Min Claim Amount ation Mo OR 1% atti 10000000 delete TPL usd 001% 100000 10000000 delete Te] EE) E ew] 2 Ni (perm) Amount 01% Insurance Pered Reinsuronce Perod © 10 proportional pone! Propet! CID). Non rosa Lover “or non prpertional [Bheove lrer ] Fate ems) [E_] soe E% [== _ oxic Premium GrocePrmiona [Somber —*| commasen [E]9% [=em ER wah] NtPmione [Fou wR wwe SD po lnstenent Pane Inotalinent Date Percantoge ‘Amount even zoyowv2020 50% +00.000000 alate zovwrezo 50% 100000000 delete a Je EQ = wie "net premim to NA EE) ‘otal must be 100% Retro Backup ? OwnRetentin LE ]% [=e bee ‘eutamatic clean (103% otal erocessan 6) [-Retrocesson Pre! Type Retrocession Contract Percentage ‘Amount ‘Acton NoxOL ——zonmattto 0% 160000000 delete sal zonsc 20% 40000000 delete =] ea es =] SoveDate Mostar - Cacing/Excker Cowntey | CO = Becker son [ 31 Anokosa Bick B.8 Kaving No 8 Kemayoron | Jakarta Pusat Indonesia ory FF JRuko Mega Gross Komp Cempoke Mae Bick E No 1415 JL Let Jend Supra Kal Sumur Betu Ke. Kerayen|Brokaeode. ol Fle Date Mostar + Golf Fal Hole Hole Number [__] st Search co [eorres [ioe Nona Jconeoot Jemoroize Hoa Jconeoo2 Jemeraie Jeo }coveo0s Jseoer Royo he