AHEEEHAPBFPNHPAHEEEHA

BNFFFNBPFOJKAPBNFFFNB
EOIHDFFAGEOODELIGPCEA
MFNFNNEHANMPIKEHBPINO
APBBBPAPDOGFFBOCMOMEM
HHHHHHHPHHPHHHHHPHHPP

PLACING SLIP
MARINE HULL INSURANCE

POLICY NO. : (RENEWAL)

NOMOR POLIS
THE INSURED : PT BRI CABANG SIBOLGA QQ Bi Guat
NAMA TERTANGGUNG
ADDRESS : Jl. M.T. Haryono No. 3 C, Kel. Simare-Mare, Kec. Sibolga Utara, Kota Sibolga
ALAMAT

- DETAILS OF THE SUBJECT MATTER INSURED -

- DETAIL OBJEK PERTANGGUNGAN -

PERIOD OF INSURANCE : commencing from April 27, 2023 to April 27, 2024 both days at 12 o'clock noon,
JANGKA WAKTU local time at the location of the insured property.
PERTANGGUNGAN
VESSEL NAME : KM. Elisabet
NAMA KAPAL
VESSEL CLASS : UNCLASSED
KELAS KAPAL
VESSEL CONSTRUCTION : Wood (Kayu)
KONSTRUKSI KAPAL
GROSS TONNAGE : 98
BERAT KAPAL
YEAR OF BUILT : 2003
TAHUN PEMBUATAN
VESSEL CLASSIFICATION : Non BKI
KLASIFIKASI KAPAL
VESSEL FLAG : Indonesia
BENDERA KAPAL
TRADING WARRANTY : INDONESIAN TERRITORIAL
TRADING WARRANTY
VESSEL TYPE : Tugboat
JENIS KAPAL
SUM INSURED : - Hull - Marine K.M. Elisabet IDR 1,000,000,000.00
NILAI PERTANGGUNGAN

- DEDUCTIBLES & THE CLAUSES -

- RISIKO SENDIRI DAN KLAUSUL -

DEDUCTIBLE : - ITC 289 : 10 % of TSI

RISIKO SENDIRI

CLAUSES : As per attached

KLAUSULA

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.
Clean Loss Record for the existing : Clean Loss Record for the existing period
period

Sailing permit from port authority : Sailing permit from port authority
Warranted all regulation and : Warranted all regulation and recommendation by port/sea authorities must be
recommendation by port/sea fulfilled except for ISM code
authorities must be fulfilled except for
ISM code

WARRANTED AVAILABILITY OF : WARRANTED AVAILABILITY OF SHIP`S VALID DOCUMENT AND/OR

SHIP`S VALID DOCUMENT AND/OR STATUTORY CERTIFICATES
STATUTORY CERTIFICATES

Warranted Hull and Machinery : Warranted Hull and Machinery maintained during periode of insurance
maintained during periode of
insurance

Warranted L/R for the last 3 years : Warranted L/R for the last 3 years must be NIL
must be NIL

Warranted no Over load passenger : Warranted no Over load passenger and/or cargo during operation
and/or cargo during operation

Warranted seaworthy condition : Warranted seaworthy condition

Warranted vessel not sailing when : Warranted vessel not sailing when the red flag (in harbor) and blue signal are
the red flag (in harbor) and blue hoisted
signal are hoisted

When a vessel missing for 6 (six) : When a vessel missing for 6 (six) Consecutive months from the date of sailing her
Consecutive months from the date of last port, shall be preasumed to be an " Actual Total Loss"
sailing her last port, shall be
preasumed to be an " Actual Total
Loss"

Exclude Flag of Ship of Liberia, : Exclude Flag of Ship of Liberia, Panama and Honduras
Panama and Honduras

Exclusion Liner Negligence : Exclusion Liner Negligence

- THE PREMIUM -
- PREMI -

PREMIUM RATE : Institute Time Clauses (Hulls) - 1/10/83 (Cl. 289) Total
SUKU PREMI Loss incl. Salvage, Salvage Charge, Sue, and Labour
(1.50000 %)

PSNSI0401E / MANANDA Page 2 of 2

 PREMIUM CALCULATION :
PERHITUNGAN PREMI
- Institute Time Clauses (Hulls) - 1/10/83IDR 1,000,000,000.00 x 1.5% IDR 15,000,000.00
(Cl. 289) Total Loss incl. Salvage, 27/Apr/23 - 27/Apr/24
Salvage Charge, Sue, and Labour

TOTAL PREMIUM IDR 15,000,000.00

Policy Cost / Biaya Polis IDR 30,000.00
Stamp Duty / Biaya Meterai IDR 20,000.00
TOTAL IDR 15,050,000.00

CoInsurance Information : Leader : PT. BRI ASURANSI INDONESIA (60.00 %)

Informasi Ko-Asuransi Member : Asuransi Bosowa Periskop Cabang Medan (20.00 %)
Member : JASINDO SYARIAH CABANG MEDAN (20.00 %)

In witness whereof the Undersigned being duly authorized by the Insurers and on behalf of the Insurers has (have) hereunto
set his (their) hand(s).

MEDAN, Mei 16, 2023

PT. BRI ASURANSI INDONESIA

Eko Wibowo

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.

Clause(s) : - Banker`s Clause BRI Sibolga

- Co-Insurance Clause
- Extra - Contractual Obligation Exclusion
- ELECTRONIC DATE RECOGNITION ENDORSEMENT - C (XLEDRC)
- Information Technology Hazard Clarification Clause (NMA 2912)
- Institute Extende Radioactive Contamination Exclusion Clause - 01/11/02
- Institute Radioactive Contamination Exclusion Clause - 1/8/97
- Jurisdiction Clause (Indonesian)
- Joint Excess of Loss Committee Terrorism Exclusion Clause ( XL - 2002/002)
- KL. SUBJECT TO NO CLAIM as at 15 Mei 2023
- Klausula Perselisihan
- Klausula Pengesampingan
- No Lay Up Return Premium
- Nuclear Energy Risks Exclusion Clause
- Political Risk, Financial Guarantee and Credit Exclusion Clause 1995
- Exclusion Paramount Clause - 5/10/77
- SEEPAGE AND POLLUTION EXCLUSION CLAUSE (01/01/89)
- Terrorism Exclusion Clause
- Warranty Payment Clause ( 60 days )
- Coronavirus Exclusion LMA 5395

PSNSI0401E / MANANDA Page 2 of 2

 PLACING SLIP
MARINE HULL INSURANCE

POLICY NO. : (RENEWAL)

NOMOR POLIS
THE INSURED : PT BRI SIBOLGA QQ Bi Guat
NAMA TERTANGGUNG
ADDRESS : Jl. M.T. Haryono No. 3 C, Kel. Simare-Mare, Kec. Sibolga Utara, Kota Sibolga
ALAMAT

- DETAILS OF THE SUBJECT MATTER INSURED -

- DETAIL OBJEK PERTANGGUNGAN -

PERIOD OF INSURANCE : commencing from April 27, 2023 to April 27, 2024 both days at 12 o'clock noon,
JANGKA WAKTU local time at the location of the insured property.
PERTANGGUNGAN
VESSEL NAME : KM. BAHAGIA
NAMA KAPAL
VESSEL CLASS : UNCLASSED
KELAS KAPAL
VESSEL CONSTRUCTION : Wood (Kayu)
KONSTRUKSI KAPAL
GROSS TONNAGE : 58
BERAT KAPAL
YEAR OF BUILT : 2003
TAHUN PEMBUATAN
VESSEL CLASSIFICATION : Non BKI
KLASIFIKASI KAPAL
VESSEL FLAG : Indonesia
BENDERA KAPAL
TRADING WARRANTY : INDONESIAN TERRITORIAL
TRADING WARRANTY
SUM INSURED : - Hull - Marine K.M. Bahagia IDR 500,000,000.00
NILAI PERTANGGUNGAN

- DEDUCTIBLES & THE CLAUSES -

- RISIKO SENDIRI DAN KLAUSUL -

DEDUCTIBLE : - ITC 289 : 10 % of TSI

RISIKO SENDIRI

CLAUSES : As per attached

KLAUSULA

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.
Clean Loss Record for the existing : Clean Loss Record for the existing period
period

Sailing permit from port authority : Sailing permit from port authority
Warranted all regulation and : Warranted all regulation and recommendation by port/sea authorities must be
recommendation by port/sea fulfilled except for ISM code
authorities must be fulfilled except for
ISM code

WARRANTED AVAILABILITY OF : WARRANTED AVAILABILITY OF SHIP`S VALID DOCUMENT AND/OR

SHIP`S VALID DOCUMENT AND/OR STATUTORY CERTIFICATES
STATUTORY CERTIFICATES

Warranted Hull and Machinery : Warranted Hull and Machinery maintained during periode of insurance
maintained during periode of
insurance

Warranted L/R for the last 3 years : Warranted L/R for the last 3 years must be NIL
must be NIL

Warranted no Over load passenger : Warranted no Over load passenger and/or cargo during operation
and/or cargo during operation

Warranted seaworthy condition : Warranted seaworthy condition

Warranted vessel not sailing when : Warranted vessel not sailing when the red flag (in harbor) and blue signal are
the red flag (in harbor) and blue hoisted
signal are hoisted

When a vessel missing for 6 (six) : When a vessel missing for 6 (six) Consecutive months from the date of sailing her
Consecutive months from the date of last port, shall be preasumed to be an " Actual Total Loss"
sailing her last port, shall be
preasumed to be an " Actual Total
Loss"

Exclude Flag of Ship of Liberia, : Exclude Flag of Ship of Liberia, Panama and Honduras
Panama and Honduras

Exclusion Liner Negligence : Exclusion Liner Negligence

- THE PREMIUM -
- PREMI -

PREMIUM RATE : Institute Time Clauses (Hulls) - 1/10/83 (Cl. 289) Total
SUKU PREMI Loss incl. Salvage, Salvage Charge, Sue, and Labour
(1.50000 %)

PSNSI0401E / MANANDA Page 2 of 2

 PREMIUM CALCULATION :
PERHITUNGAN PREMI
- Institute Time Clauses (Hulls) - 1/10/83IDR 500,000,000.00 x 1.5% IDR 7,500,000.00
(Cl. 289) Total Loss incl. Salvage, 27/Apr/23 - 27/Apr/24
Salvage Charge, Sue, and Labour

TOTAL PREMIUM IDR 7,500,000.00

Policy Cost / Biaya Polis IDR 30,000.00
Stamp Duty / Biaya Materai IDR 20,000.00
TOTAL IDR 7,550,000.00

CoInsurance Information : Leader : PT. BRI ASURANSI INDONESIA (60.00 %)

Informasi Ko-Asuransi Member : Asuransi Bosowa Periskop Cabang Medan (20.00 %)
Member : JASINDO SYARIAH CABANG MEDAN (20.00 %)

In witness whereof the Undersigned being duly authorized by the Insurers and on behalf of the Insurers has (have) hereunto
set his (their) hand(s).

MEDAN, Mei 16, 2023

PT. BRI ASURANSI INDONESIA

Eko Wibowo

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.

Clause(s) : - Banker`s Clause BRI Sibolga

- Co-Insurance Clause
- Extra - Contractual Obligation Exclusion
- ELECTRONIC DATE RECOGNITION ENDORSEMENT - C (XLEDRC)
- Information Technology Hazard Clarification Clause (NMA 2912)
- Institute Extende Radioactive Contamination Exclusion Clause - 01/11/02
- Institute Radioactive Contamination Exclusion Clause - 1/8/97
- Jurisdiction Clause (Indonesian)
- Joint Excess of Loss Committee Terrorism Exclusion Clause ( XL - 2002/002)
- KL. SUBJECT TO NO CLAIM as at 15 Mei 2023
- Klausula Perselisihan
- Klausula Pengesampingan
- No Lay Up Return Premium
- Nuclear Energy Risks Exclusion Clause
- Political Risk, Financial Guarantee and Credit Exclusion Clause 1995
- Exclusion Paramount Clause - 5/10/77
- SEEPAGE AND POLLUTION EXCLUSION CLAUSE (01/01/89)
- Terrorism Exclusion Clause
- Warranty Payment Clause ( 60 days )
- Coronavirus Exclusion LMA 5395

PSNSI0401E / MANANDA Page 2 of 2

 PLACING SLIP
MARINE HULL INSURANCE

POLICY NO. : (RENEWAL)

NOMOR POLIS
THE INSURED : PT BRI SIBOLGA QQ Bi Guat
NAMA TERTANGGUNG
ADDRESS : Jl. M.T. Haryono No. 3 C, Kel. Simare-Mare, Kec. Sibolga Utara, Kota Sibolga
ALAMAT

- DETAILS OF THE SUBJECT MATTER INSURED -

- DETAIL OBJEK PERTANGGUNGAN -

PERIOD OF INSURANCE : commencing from April 27, 2023 to April 27, 2024 both days at 12 o'clock noon,
JANGKA WAKTU local time at the location of the insured property.
PERTANGGUNGAN
VESSEL NAME : KM. NDH-II
NAMA KAPAL
VESSEL CLASS : UNCLASSED
KELAS KAPAL
VESSEL CONSTRUCTION : Wood (Kayu)
KONSTRUKSI KAPAL
GROSS TONNAGE : 96
BERAT KAPAL
YEAR OF BUILT : 1996
TAHUN PEMBUATAN
VESSEL CLASSIFICATION : Non BKI
KLASIFIKASI KAPAL
VESSEL FLAG : Indonesia
BENDERA KAPAL
TRADING WARRANTY : INDONESIAN TERRITORIAL
TRADING WARRANTY
SUM INSURED : - Hull - Marine K.M. NDH-II IDR 1,000,000,000.00
NILAI PERTANGGUNGAN

- DEDUCTIBLES & THE CLAUSES -

- RISIKO SENDIRI DAN KLAUSUL -

DEDUCTIBLE : - ITC 289 : 10 % of TSI

RISIKO SENDIRI

CLAUSES : As per attached

KLAUSULA

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.
Clean Loss Record for the existing : Clean Loss Record for the existing period
period

Sailing permit from port authority : Sailing permit from port authority
Warranted all regulation and : Warranted all regulation and recommendation by port/sea authorities must be
recommendation by port/sea fulfilled except for ISM code
authorities must be fulfilled except for
ISM code

WARRANTED AVAILABILITY OF : WARRANTED AVAILABILITY OF SHIP`S VALID DOCUMENT AND/OR

SHIP`S VALID DOCUMENT AND/OR STATUTORY CERTIFICATES
STATUTORY CERTIFICATES

Warranted Hull and Machinery : Warranted Hull and Machinery maintained during periode of insurance
maintained during periode of
insurance

Warranted L/R for the last 3 years : Warranted L/R for the last 3 years must be NIL
must be NIL

Warranted no Over load passenger : Warranted no Over load passenger and/or cargo during operation
and/or cargo during operation

Warranted seaworthy condition : Warranted seaworthy condition

Warranted vessel not sailing when : Warranted vessel not sailing when the red flag (in harbor) and blue signal are
the red flag (in harbor) and blue hoisted
signal are hoisted

When a vessel missing for 6 (six) : When a vessel missing for 6 (six) Consecutive months from the date of sailing her
Consecutive months from the date of last port, shall be preasumed to be an " Actual Total Loss"
sailing her last port, shall be
preasumed to be an " Actual Total
Loss"

Exclude Flag of Ship of Liberia, : Exclude Flag of Ship of Liberia, Panama and Honduras
Panama and Honduras

Exclusion Liner Negligence : Exclusion Liner Negligence

- THE PREMIUM -
- PREMI -

PREMIUM RATE : Institute Time Clauses (Hulls) - 1/10/83 (Cl. 289) Total
SUKU PREMI Loss incl. Salvage, Salvage Charge, Sue, and Labour
(1.50000 %)

PSNSI0401E / MANANDA Page 2 of 2

 PREMIUM CALCULATION :
PERHITUNGAN PREMI
- Institute Time Clauses (Hulls) - 1/10/83IDR 1,000,000,000.00 x 1.5% IDR 15,000,000.00
(Cl. 289) Total Loss incl. Salvage, 27/Apr/23 - 27/Apr/24
Salvage Charge, Sue, and Labour

TOTAL PREMIUM IDR 15,000,000.00

Policy Cost / Biaya Polis IDR 30,000.00
Stamp Duty / Biaya Meterai IDR 20,000.00
TOTAL IDR 15,050,000.00

CoInsurance Information : Leader : PT. BRI ASURANSI INDONESIA (60.00 %)

Informasi Ko-Asuransi Member : Asuransi Bosowa Periskop Cabang Medan (20.00 %)
Member : JASINDO SYARIAH CABANG MEDAN (20.00 %)

In witness whereof the Undersigned being duly authorized by the Insurers and on behalf of the Insurers has (have) hereunto
set his (their) hand(s).

MEDAN, Mei 16, 2023

PT. BRI ASURANSI INDONESIA

Eko Wibowo

PSNSI0401E / MANANDA Page 1 of 2

This page is a forming part of Policy No.
Halaman ini adalah bagian dari Polis No.

Clause(s) : - Banker`s Clause BRI Sibolga

- Co-Insurance Clause
- Extra - Contractual Obligation Exclusion
- ELECTRONIC DATE RECOGNITION ENDORSEMENT - C (XLEDRC)
- Information Technology Hazard Clarification Clause (NMA 2912)
- Institute Extende Radioactive Contamination Exclusion Clause - 01/11/02
- Institute Radioactive Contamination Exclusion Clause - 1/8/97
- Jurisdiction Clause (Indonesian)
- Joint Excess of Loss Committee Terrorism Exclusion Clause ( XL - 2002/002)
- KL. SUBJECT TO NO CLAIM as at 15 Mei 2023
- Klausula Perselisihan
- Klausula Pengesampingan
- No Lay Up Return Premium
- Nuclear Energy Risks Exclusion Clause
- Political Risk, Financial Guarantee and Credit Exclusion Clause 1995
- Exclusion Paramount Clause - 5/10/77
- SEEPAGE AND POLLUTION EXCLUSION CLAUSE (01/01/89)
- Terrorism Exclusion Clause
- Warranty Payment Clause ( 60 days )
- Coronavirus Exclusion LMA 5395

PSNSI0401E / MANANDA Page 2 of 2