POLICY SCHEDULE

MOTOR VEHICLE INSURANCE

Policy Refference No. : IPFS020124005703

Name of Insured : ASEP BUDI SATRIA QQ IRMA RANI WIDODO

Address of Insured : JL. SATURNUS TIMUR IX NO 10 RT.005 / RW.014,MANJAHLEGA

(CISARANTENKIDUL),RANCASARI,KOTA BANDUNG,JAWA BARAT
Sum Insured
- Motor Vehicle : IDR 201,000,000.00
- Third Party Liability : IDR 10,000,000.00

Deductibles : Comprehensive : IDR 300.000,00 Per Kejadian

: Third Party Liability : -

Period of Insurance : 12 months from 29 Jan 2024 to 29 Jan 2025

both days at 12 o'clock noon, local time at the location of the insured property
Object Information

Brand/Type License Number Colour Function

HONDA/ALL NEW CR-V/2.4 L 4X2 A/T D-1342 MH PUTIH MUTIARA PRIBADI/DINAS

Chassis Number Machine Number Year Seat Capacity

MHRRE3850CJ1000851 K24Z15826435 2012 0

Additional Accessories :

Jakarta, 31 Jan 2024

PT. ASURANSI INTRA ASIA
This page is a forming part of Policy Refference No. IPFS020124005703

Additional Clauses
- 85% condition of Average Relief Clause
- Automatic Addition and Deletion Clause (30 days) Limit IDR 500,000,000 per unit
- Broad Pair and Set Clause (exclude wheel & tire)
- Constructive Total Loss Clause (75%)
- Loss Notification Clause (30 days)
- Claim Fast Track Clause
- Error & Omissions
- Lock & Keys Clause (Limit IDR 2,000,000.00 a.o.a.)
- New for Old Clause (6 months from the date of purchase)
- Prorate Return Premium Clause - (Subject to no claim)
- Sister Car Clause
- Genuine Parts Guarantee (Klausula Garansi Cat dan Suku Cadang)
- No Kaditserse letter required for loss
- Transit Extension Clause (Inter Island / Ferry crossing anywhere Indonesian) as per PSAKB
- Towing Fee 1% of Sum Insured
- Taxi allowance Limit IDR 300,000.00/day with no additional premium. (Maximum 5 days & waiting period: 3 days)
- Non-Standard Accessories (Maximum 10% of Sum Insured) - Without declaration
- Premium Payment Warranty 90 days
- Wheel and Tire Clause
- Ambulance Fee (max IDR 1,000,000.00 per anyone accident)
- Notice of Cancellation Clause
- Klausula Kerugian Total Saja
- Klausula Tanggung Jawab Hukum Terhadap Pihak Ketiga (KL.KBM-03)
This page is a forming part of Policy Refference No. IPFS020124005703

Premium Calculation
- Comprehensive IDR 201,000,000.00 x 2.8080% IDR 5,644,080.00
- Third Party Liability IDR 10,000,000.00 x 1.0000% IDR 100,000.00
Biaya Polis IDR 35,000.00
Biaya Materai IDR 10,000.00

TOTAL IDR 5,789,080.00