QUOTATION SLIP

NO.301/CAR-BGUARI/III/2023
RIC : 25%

SHARE OFFERED : OPEN

Note : i. Subject to no claim as at binding date from the insured

ii. Clause no.19 – Deferred Premium Clause - each due date of each installment plus 14 days of payment
to reinsurer

Regards,
PT. Asuransi Reliance Indonesia

_________________
Authorized Signature