Claim

No Description Part Number

Qty Unit Price idr

Sparepart
1 HARNESS;WIRE 4425444 1 Pcs Rp 2,321,828
2 HARNESS;WIRE 4462561 1 Pcs Rp 2,497,373
3 HARNESS;WIRE 4435890 1 Pcs Rp 2,187,750
4 HARNESS;WIRE 4447905 1 Pcs Rp 762,443
5 RELAY 4452159 1 Pcs Rp 1,787,477
6 RELAY;BATTERY 4255762 1 Pcs Rp 1,623,867
7 HARNESS;WIRE YA00014703 1 Pcs Rp 5,680,188
8 HARNESS;WIRE YA00050647 1 Pcs Rp 18,827,458
9 HARNESS;WIRE YA00016870 1 Pcs Rp 2,304,069
10 BUZZER 4297188 1 Pcs Rp 1,607,565
11 MONITOR YA00015000 1 Pcs Rp 28,668,624
12 HARNESS;WIRE YA00024569 1 Pcs Rp 591,701
13 BOX;SWITCH YA00024048 1 Pcs Rp 736,097
14 HARNESS;WIRE 4708537 1 Pcs Rp 2,576,121
15 SWITCH YA00018389 1 Pcs Rp 6,833,751
16 HARNESS;WIRE 4630572 1 Pcs Rp 453,419
17 CONTROLLER YA00022777 1 Pcs Rp 10,761,687
18 CONTROLLER 4452160 1 Pcs Rp 4,126,044
19 SWITCH 4359384 1 Pcs Rp 1,350,069
20 RELAY 4436534 10 Pcs Rp 229,694
21 HARNESS;WIRE YA00025969 1 Pcs Rp 18,827,458
22 HARNESS;WIRE YA0000387 1 Pcs Rp 2,101,013
23 CABLE;CONTROL 4425163 1 Pcs Rp 2,545,844
24 MOTOR 4614911 1 Pcs Rp 12,762,119
25 UNIT;CONTROL YA00008063 1 Pcs Rp 17,719,601
26 SWITCH 4618409 1 Pcs Rp 3,716,001
27 UNIT;CONTROL YA60047785 1 Pcs Rp 24,333,120
28 HARNESS;WIRE YA00017523 1 Pcs Rp 2,547,737
29 CONTROLLER YA60033413 1 Pcs Rp 60,776,103
30 HORN 4719528 1 Pcs Rp 513,536
31 HORN 4719527 1 Pcs Rp 513,245
32 MOTOR 4321872 1 Pcs Rp 1,158,803
33 HARNESS;WIRE XB00000943 1 Pcs Rp 506,694
34 SWITCH 4716973 1 Pcs Rp 3,401,301
35 FEEDER 4321872 1 Pcs Rp 1,044,247
36 RADIO YA00010689 1 Pcs Rp 13,932,712
37 LIGHTER 4653906 1 Pcs Rp 827,363
38 STARTER 8983763920 1 Pcs Rp 34,270,646
39 GENERATOR 8983413950 1 Pcs Rp 31,116,652
40 SWITCH;START 4448303 1 Pcs Rp 2,401,158
41 GASKET KIT 5878170160 1 Pcs Rp 7,378,000
42 LINER 5878146612 4 Pcs Rp 9,677,265
43 METAL 9122716080 1 Pcs Rp 676,272
44 BRG 8070716610 1 Pcs Rp 8,243,791
45 WASHER 8970713580 2 Pcs Rp 373,070
46 ELEMENT;FILTER 4286130 1 Pcs Rp 995,048
47 ELEMENT;FILTER 4286130 1 Pcs Rp 450,363
48 ELEMENT;FILTER 4448401 1 Pcs Rp 1,113,097
49 FUEL;FILTER 4616543 1 Pcs Rp 249,635
50 FUEL;FILTER 4616544 1 Pcs Rp 327,510
51 ELEMENT;FILTER 4630525 1 Pcs Rp 641,920
52 FILTER;OIL 4658521 1 Pcs Rp 406,258
53 HYD 46TP PAIL HTC46TPP 5 Pcs Rp 1,038,571
54 ENG OILDHI PAIL HTCDHIP 1 Pcs Rp 1,313,970
55 GEAR GL490 PAIL HTCGL490P 1 Pcs Rp 1,258,512
56 TURBOCHARGER 8972234281 1 Pcs Rp 19,060,063
Subtotal 1
Labour Cost
1 Mechanic 160 HRS Rp 325,000
2 Mileage 300 KM Rp 7,500
3 Others 1 LS Rp 1,000,000
Subtotal 2

Total
VAT 11%
Total after VAT 11%
Grand total
BI Middle exch
Claim Adjusment

Amount Idr QTY Unit Price idr Amount Idr

Sparepart
Rp 2,321,828 1 Pcs Rp 2,321,828 Rp 1,741,371
Rp 2,497,373 1 Pcs Rp 2,497,373 Rp 1,873,030
Rp 2,187,750 1 Pcs Rp 2,187,750 Rp 2,113,313
Rp 762,443 1 Pcs Rp 762,443 Rp 571,832
Rp 1,787,477 1 Pcs Rp 1,787,477 Rp 1,787,477
Rp 1,623,867 1 Pcs Rp 1,623,867 Rp 1,623,867
Rp 5,680,188 1 Pcs Rp 5,680,188 Rp 4,260,141
Rp 18,827,458 1 Pcs Rp 18,827,458 Rp 14,120,594
Rp 2,304,069 1 Pcs Rp 2,304,069 Rp 1,728,052
Rp 1,607,565 1 Pcs Rp 1,607,565 Rp 1,607,565
Rp 28,668,624 1 Pcs Rp 28,668,624 Rp 28,668,624
Rp 591,701 1 Pcs Rp 591,701 Rp 443,776
Rp 736,097 1 Pcs Rp 736,097 Rp 736,097
Rp 2,576,121 1 Pcs Rp 2,576,121 Rp 1,932,091
Rp 6,833,751 1 Pcs Rp 6,833,751 Rp 6,833,751
Rp 453,419 1 Pcs Rp 453,419 Rp 340,064
Rp 10,761,687 1 Pcs Rp 10,761,687 Rp 10,761,687
Rp 4,126,044 1 Pcs Rp 4,126,044 Rp 4,126,044
Rp 1,350,069 1 Pcs Rp 1,350,069 Rp 1,350,069
Rp 2,296,940 10 Pcs Rp 229,694 Rp 2,296,940
Rp 18,827,458 1 Pcs Rp 18,827,458 Rp 14,120,594
Rp 2,101,013 1 Pcs Rp 2,101,013 Rp 1,575,760
Rp 2,545,844 1 Pcs Rp 2,545,844 Rp 1,909,383
Rp 12,762,119 1 Pcs Rp 12,762,119 Rp 12,762,119
Rp 17,719,601 1 Pcs Rp 17,719,601 Rp 17,719,601
Rp 3,716,001 1 Pcs Rp 3,716,001 Rp 3,716,001
Rp 24,333,120 1 Pcs Rp 24,333,120 Rp 24,333,120
Rp 2,547,737 1 Pcs Rp 2,547,737 Rp 1,910,803
Rp 60,776,103 1 Pcs Rp 60,776,103 Rp 60,776,103
Rp 513,536 1 Pcs Rp 513,536 Rp 513,536
Rp 513,245 1 Pcs Rp 513,245 Rp 513,245
Rp 1,158,803 0 Pcs Rp 1,158,803 -
Rp 506,694 1 Pcs Rp 506,694 Rp 380,021
Rp 3,401,301 1 Pcs Rp 3,401,301 Rp 3,401,301
Rp 1,044,247 1 Pcs Rp 1,044,247 Rp 1,044,247
Rp 13,932,712 1 Pcs Rp 13,932,712 Rp 13,932,712
Rp 827,363 1 Pcs Rp 827,363 Rp 827,363
Rp 34,270,646 35% Pcs Rp 34,270,646 Rp 11,994,726
Rp 31,116,652 35% Pcs Rp 31,116,652 Rp 10,890,828
Rp 2,401,158 1 Pcs Rp 2,401,158 Rp 2,401,158
Rp 7,378,000 1 Pcs Rp 7,378,000 Rp 7,378,000
Rp 38,709,060 0 Pcs Rp 9,677,265 -
Rp 676,272 1 Pcs Rp 676,272 Rp 676,272
Rp 8,243,791 1 Pcs Rp 8,243,791 Rp 8,243,791
Rp 746,140 0 Pcs Rp 373,070 -
Rp 995,048 1 Pcs Rp 995,048 Rp 746,286
Rp 450,363 1 Pcs Rp 450,363 Rp 337,772
Rp 1,113,097 1 Pcs Rp 1,113,097 Rp 834,823
Rp 249,635 1 Pcs Rp 249,635 Rp 187,226
Rp 327,510 1 Pcs Rp 327,510 Rp 245,633
Rp 641,920 1 Pcs Rp 641,920 Rp 481,440
Rp 406,258 1 Pcs Rp 406,258 Rp 304,694
Rp 5,192,855 5 Pcs Rp 1,038,571 Rp 5,192,855
Rp 1,313,970 1 Pcs Rp 1,313,970 Rp 1,313,970
Rp 1,258,512 0 Pcs Rp 1,258,512 -
Rp 19,060,063 0 Pcs Rp 19,060,063 -
Rp 419,772,318 Rp 299,581,768
Labour Cost
Rp 52,000,000 96 HRS Rp 325,000 Rp 31,200,000
Rp 2,250,000 300 Km Rp 7,500 Rp 2,250,000
Rp 1,000,000 1 Ls Rp 500,000 Rp 500,000
Rp 55,250,000 Rp 33,950,000

Rp 475,022,318 Rp 333,531,768
Rp 52,321,755 Rp 36,688,494
Rp 527,344,073 Rp 370,220,262
Rp 527,344,073 Rp 370,220,262

Gross Adjustment Rp 370,220,262

Salvage -
Average -
Dedutible Rp 74,044,052
Net Adjustment Rp 296,176,207

Sum Insured Rp 1,177,000,000

NRV Rp 1,298,700,000
Less betterment Factor -
AVR 75% Rp 974,025,000

Actual Valvue Rp 974,025,000

CTL 75% Rp 730,518,750

Deductible
20% of claim Rp 74,044,052
 Minimum IDR 50.000.000 Rp 50,000,000
BI Middle exchange rates per DOL, US$ 1.00 -
 Remark

Exclusion C; less depr 25%

Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Short circuit
Short circuit
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Short circuit
Short circuit
Exclusion C; less depr 25%
Short circuit
Exclusion C; less depr 25%
Short circuit
Exclusion C; less depr 25%
Short circuit
Short circuit
Short circuit
Short circuit
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Short circuit
Short circuit
Short circuit
Short circuit
Exclusion C; less depr 25%
Short circuit
Short circuit
Short circuit
Not damaged
Exclusion C; less depr 25%
Short circuit
Short circuit
Short circuit
Short circuit
Repair allowance 35%
Repair allowance 35%
Short circuit
Consequence Repair
Reusable
Damaged
Consequence Repair
Reusable
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Exclusion C; less depr 25%
Flushing
Flushing
Not related
Not damaged

Adjusted;2 mechanic
Allowed
Adjusted

Partial Loss

SI Adequate
20% of claim
Subject to salvage

Includes VAT 11%

3 Years, Less depr 25%

Per unit per occurrence