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    This document is a claim report from a workshop dated March 14, 2016. It lists 9 car insurance claims that were accepted between December 1, 2015 and March 14, 2016. For each claim, it provides the reference number, name of the insured, date of the incident, amount of the net claim, amount of the claim accepted, tax on services, and total amount to be paid. The total net amount of claims was Rp. 6,820,000,000 with Rp. 2,700,000,000 accepted and a total of Rp. 3,983,500,000 to be paid.

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    This document is a claim report from a workshop dated March 14, 2016. It lists 9 car insurance claims that were accepted between December 1, 2015 and March 14, 2016. For each claim, it provides the reference number, name of the insured, date of the incident, amount of the net claim, amount of the claim accepted, tax on services, and total amount to be paid. The total net amount of claims was Rp. 6,820,000,000 with Rp. 2,700,000,000 accepted and a total of Rp. 3,983,500,000 to be paid.

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    12 views1 page

    Img 20160314 0002 PDF

    Uploaded by

    part rafflesia
    This document is a claim report from a workshop dated March 14, 2016. It lists 9 car insurance claims that were accepted between December 1, 2015 and March 14, 2016. For each claim, it provides the reference number, name of the insured, date of the incident, amount of the net claim, amount of the claim accepted, tax on services, and total amount to be paid. The total net amount of claims was Rp. 6,820,000,000 with Rp. 2,700,000,000 accepted and a total of Rp. 3,983,500,000 to be paid.

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    Page I of 1

    LAPORAN KLAIM BERDASARKAN BENGKEL


    Penode Tanggal Aksep . 1,12016 sld 14/3/2016

    No. Referensi: C0066110010002945I0312016/MBU No. FIPWP ; 148C28913311000 Tanggal 14lA3AUa


    llarna : SPEED BODY REPAIR ijama NPIArP IENDRO Waktu : i0:03:04
    Bengkel iB=NGKULUI
    Alamat ] JL. RAFLESIA SIMPANG EfulPAT Aiamat : JL. WIJAYA KiJSUh,IA NO.25
    Bengkel PANTI BEIIGKUI-U NPWP RT12 RWC4 BENGKUi-LI
    Kepada : HENDRO
    Nomor 0032851 169 - BANK SIIIARMAS
    Account

    No No. Akseptasi Nama Tertanggung Klaim Dlaksep : Keterangan -Ja sa Pph Jasa Ju mlah
    No. Poli$ Tgl ltejadian -Own Da&age -Sparepart Klaim
    No. WO Tgl. Pelunasan Premi .T.P,L -Material Dibayar
    No. K,rYitansi No. Plat -PPn iNET)
    1 A0204620 1 60201 1025C fuI. ARIEF S:t PUTRA QQ YURNALIS NET 75 000 UX JUU UUU 7q tnn '1 500 -.226.500
    IErUOllU l f, 0
    02046201 500653 c?i07 Qa15 3
    046 1 506493 BD i 475C4 IHL U
    c

    ? A02040201 63201 r027C PT BCA FINANCE QQ BCA OA [ttrT cR 3C0 000 470.000 I 4CC 160.500
    AKMALUDIN QQ AKMALUDIN
    02046?01 500382 01lrl3/20 J 6 0
    046154051 3 72{06i2015 IiL U
    gD1 120PA c

    3 402046?01 6010 iC28C PT BCA F]NANCE AA BCA OA NOVI


    1
    ilET a?4 nnn oR 300.000 57.500
    ADITYA SATIVA. OO NOVI ADiWA 0
    02046201 500290 SATJVA 0 0
    0461640503 a2ta3t?a1s TPL O
    25105/20i 5 0
    BD 1 C81 K.B

    AC2046201 6OZ0'1 I029C PT BCA TiNAI.]CE OO 8'A OO ERYVjN NET 1.360 $t0 0R 200 003 1 360 000 27 200 I tJl ouu
    CANDRA Qa ERYviln CAIIDRA
    0204620130155? ?9tazi?a1a 0
    046 1 6AC487 1Et1?t?ti3 TPL O
    BD 1 478NA 0
    A022292C't BCZ0.r t045C CTC RO EENGKULU QQ HARIY}NTO. NEr 1 185 000 cR 300 000 1 185.C00 23 704 E61 300
    S KO[,l.Mftl QO DliMAl'i Sr..JPRAftulAN
    0222S21r',i 400878 20IC21201 6 0
    046 1 5A0439 06ri 01201 4 TPL O
    D8850S 0
    hUrU4OlUlGUIUilU{/L PT 8CA FINAI.ICE QO BCA QQ TAUFJK NET 1.515.000 0R 30c c00 30 30c 1 r 84.700
    QURRAHIIIAN QQ TAUFIK 0
    OURRAHMAN 0 0
    c461 6A0528 06i 03J20_16 TPL O
    29i45i2A15 0
    BD1 523CE

    A020402016020.4 t04BC NURAINA OO HSNDRI wlRMAN OQ NfT 550 000 oR 30c.000 550.tc0 11 0c0 239.000
    AYU DiAH WiSMARINI 0
    02c46201 5B i C28 08103i?0 16 0 0
    046_j 6AC5$'l 28r1 0120 1 5 TPL C
    0
    8. A02C46201 6C201 i050C PT BCA FINANCE QO BCA OA tl Er 805.0c0 cR 300 000 605.000 t? lnn 292.9r3
    .3
    YOHANES LE OE HILDA MULYAI']I
    02046201 60C206 c5r03i20 1 6 c 0
    046 i 6A0550 TPL O
    trU:JJ- I 0

    9. 40204620-1SOZ01 t052C BCA FINANCE, PT OQ BCA QO WELD1 NET 685 000 oR 400.c00 685.00C 1 3.70! 271 .304
    iul )t\u 0
    02046201 300051 a7ia1t7a16 0 0
    c46 1 6A0563 1 1t43fi413 i rL u
    BD1677AR 0
    Totai 6.82C 00C 2.700 0c0 3.983 500
    0 0
    0

    A*i

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