ORIGINAL

Marine Certificate
No. CF201710-000055

Messrs : Tribakti Sarimas, QQ CV.JAYA PERTAMA

Bukit Payung, Desa Pantai Kec. Kuantan Mudik Kab. Kuantan Singingi, Riau

Dear Sir / Madam,

This certificate cover loss of or damage to the insured Cargo, subject to terms/conditions printed on, attached to or written in
Master Policy issued by PT. ASURANSI ASTRA BUANA

Open Cover Policy No : 9021200000053

Interest : CRUDE PALM OIL 499.180 KG
Amount Insured : IDR 4,417,740,504.10
Voyage : From : Lubuk Jambi, Indonesia To : DUMAI, Indonesia
Ship or Vessel : Sailing Date : September 15, 2017
Conveyance : VIA TRUCK, EKSPEDISI PENGANGKUTAN OLEH CV.JAYA PERTAMA
Coverage : Land and Air Transit Clauses Cover "B" DAI

Other T/C As Per Marine Cargo Open Cover No. 9021200000053

Deductible : 0.50% of Total Sum Insured for Shortage Claim anyone accident
10% of Claim, min IDR 5,000,000.00 in respect of Hijacking Claim anyone accident
5% of Actual Value of the stock before claim occurs or 15% of Claim whichever is the higher for
Temporary Storage Claim anyone accident
0.50% of Total Sum Insured, min IDR 5,000,000.00 in respect of all other claims anyone accident
Invoice : 033/TBS-WINA/CPO/VIII/2017

L/C : -

B/L / AWB / DO No. : 156/SO/CPO/IX/2017

Settling Agent : For claims occurs in overseas country, to notify

P T Dharma Nilaitama
Agents of Websters - Singapore

Ciputat Mas Plaza, Blok E, Kav. A-B-C

Jl. Ir Haji Juanda No 5A
Ciputat 15412, Tangerang
JAKARTA
Indonesia

Phone : +62 21 743 2251 | 742 4451 | 749 9428

A/hours : +62 811 863191, +62 811 859941
Fax : +62 21 743 2158 | 742 4452
Email : dnt@cbn.net.id, info@dnt.co.id
Premium Calculation : As Agreed

At Jakarta, September 15, 2017

PT ASURANSI ASTRA BUANA

Authorized Signature

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