MARINE CARGO POLICY

THE SCHEDULLE
NO.POLIS : 09.02.15.000681

Nama Tertanggung : Tn. CHARLIE QUEENATA

Alamat : Jl. Rama Kasih VI, No.1572, Rt.015/004, 5 Ilir, Ilir Timur I, Palembang

Periode of insurance : 03 November 2015 s/d 07 November 2015

Alat Angkut : By : Kapal Tongkang & Tugboat

Nama Kapal : Salam Berkat Abadi I./ Salam Berkat Abadi V
Tahun : 2008/ 2008

Objek Pertanggungan : SUMITOMO Hydraulic Excavator SH210-5

S/N :STN210F5E00BH11612; Tahun 2013 ; IDR. 1,200,000,000.00

Harga Pertanggungan/ TSI : IDR. 1,200,000,000.00

Term and Condition :- ICC C (TLO) Following The Vessel

- Port to Port
- Seaworthiness warranty
- No Overload cargo or Passanger During Periods of insurance
- Radioactive Contamination exclusion clause
- Standard packaging / safety lassing

Suku Premi : 0.20 %

Perhitungan Premi = (TSI x Rate) + Biaya Polis dan Materai

= (IDR. 1.200,000,000.00 x 0.20%) + IDR. 37,000.00
= IDR. 2,400,000.00 + IDR. 37,000.00
= IDR. 2,437,000.00

Tempat Keberangkatan : Dermaga PT. Salam Berkat Abadi, Jl. Syahyakirti, No.30, Musi II, Palembang

Tempat Tujuan : Desa Karang Agung, Kecamatan Lalan, Kab. Musi Banyuasin,
Sumatera Selatan

We, PT. Asuransi Bringin Sejahtera Artamakmur, herby agree, in consideration of the payment to us by on or
behalf of the assured of the premium as arranged, to insure aginst loss damage liability or expence to the
extent and in the manner herein provided.
In withness whereof, this policy has been signed by duty authorized representative of this company.

Sign at : Palembang, 03/11/2015

The Insurer,
PT. Asuransi Bringin Sejahtera Arta Makmur
Cabang Palembang