NEON SIGN INSURANCE 03M06032200016 PT ADHI KARTIKA JAYA “ALWAYS EXCEED YOUR EXPECTATIONS IN PROVIDING INSURANCE SERVICES” KANTOR CABANG Ruko Grand Ketintang, JI Ketintang Baru | No. 14 A, Surabaya 60231 (3031 82516002 (ax 031 9904 3081 www plninsurance.co.id Mé\RI BerasuransiSI PERISAI LISTRIK NASIONAL PT ASURAN: 7 INU NO § JAKARTA SELATAN 12780 ILAAIA ASA MIGrg0 S008 FAX (21) 794 E422 a ‘es@plninsurance.co.id wwwplninsurance.co.id Neon Sign Insurance Policy Policy No. 03M06032200016 PT. ADHI KARTIKA JAYA in consideration ofthe insured named in the Schedule paying to PT. ASURANSI PERISAI LISTRIK NASIONAL (hereinafter called “the Company’) the premium mentioned in the said schedule. The Company agrees (Subject to the terms conditions and exceptions contained herein or endorsed hereon) to indemnify the insured for all sums which the insured shall be legally liable to pay as set out in the individual sections and schedule to this policy. THE INDEMNITY provided by each section of this Policy is only in respect of claims which are first made in writing againis the insured durin the period of this Poicy and which results from an accident ‘or occurrence which first commences after the inception date of this Policy. Surabaya, March 22, 2022 PT. ASURANS! PERISAI LISTRIK NASIONAL, I Authorized SignaturePT ASURANSI PERISAI LISTRIK NASIONAL wow plninsurance.co id THE SCHEDULE TYPE OF COVER : NEON SIGN INSURANCE POLICY NO. : 03M06032200016 THE INSURED 3 PTADHIKARTIKA JAYA ADDRESS +: Ruko Jemur Raya B17 ~ 18 , Jl. Raya Jemursari No, 203, Surabaya - Jawa Timur PERIOD OF INSURANCE ‘March 17, 2022 up to March 17, 2023 (Both dates inclusive at 12.00 o'clock noon at local time) COVERAGE : Section! : Material Damage Covering for Signboard of the insured against loss or damage by accidental external means by fire, lightning, external explosion or theft, typhoon, hal, huricane or tomado, rot, strike, malicious damage and civ commotion Section ll: Third Party Liability Covering legal ability ofthe Insured for Damage (Including claimant cost and expenses) in respect of bodily injury and/or material property to pay to any third party in connection with the business and occurring within territorial limits during Period of Insurance. INSURED INTEREST 2 Neon Sign Section |: Material Damage Covering for Billboard, Frame work & Advertisement Stanchion Billboard / Megatron / LED / Neon Sign + Konstruksi BB (8m x 2m = 5 tik) Text Advertisement : DJARUM Section Il: Third Party Liability RISK OF LOCATION JJ. Pettaran, Mekessar LIMIT OF LIABILITY / SUM INSURED + Neon Sign Section! : Material Damage Billboard, Frame work & Advertisement Stanchion IDR 600,000.000,00 Section |: Third Party Liability Aggregate Limit for Third Party Liability (Bodily Injury and Property Damage) during the period of Cover 60% of Total Sum Insured. DEDUCTIBLE : = Section |: Material Damage 2.5% of Claim minimum IDR 250.000,00 a.o.a = Section Il: Third Party Liability 2.5% of Claim min IDR 250,000.00 for Property Damage Only _——————— ‘Neon sign Insurance Page?PT ASURANSI PERISAL LISTRIK NASIONAL. anaes sc ITSO ee wwveplninsurance.coid ‘TERM & CONDITIONS {= AsperPT, ASURANSI PERISAI LISTRIK NASIONAL Wording Policy = Claim made basis of Indemnity CLAUSE ATTACHMENT : + Indonesian Jurisdiction Clause - Reinstatement Value Clause - RSMD+CC + Fite Explosion Endorsement ~ Impact by own vehicle clause = Cross Liability Clause - First Aid Clause = Fire Brigade Charge Clause (10% of TS!) - EDRC'A" = Good Maintenance - Nominated Loss Adjuster Clause = PT. Atlas Adjusting Indonesia = PT, Utama Nilai Sentosa + PT. Dharma Nilaitama = Warranty Premium Clause 30 Days - Loss Notification Clause 14 Days = Cancellation Clause 14 Days = Important Notice (BMA) RATE OF PREMIUM 2 0.70% PREMIUM OR 600.000.0000 x 070% = IR 4200.000,00 PolicyCost = IR 30.000,00 ‘Stamp Duty OR 10,000,00 ~* Total Premium = IDR 4240.000,00:.) In witness there of the Undersigned being duly authorized by the insurers and on behalf ofthe insurers has ( have ) hereunto set his (their) hand (s) this day of March 22, 2022 ———— Neon sgn insurance Page 3