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QUOTATION SLIP

Coverage : Total Loss Only

Wording : PSAKBI
The Insured : PT HARAPAN SUKSES PERKASA

Period of insurance : 26 Juni 2022 – 26 Juni 2023

Location of Risk : INDONESIA

Sum Insured : As Per List Attached

Rate : Total Loss Only 0,44 %

Premium Calculation : As Per List Attached

Deductible : Total Loss (pessanger) 5 % of claim Min Rp 1,000,000

Clauses :

COMPLETELY BUILT-UP (CBU) CLAUSE OF MOTOR VEHICLE


TOTAL LOSS ONLY CLAUSE
IMPORTANT NOTICE CLAUSE
KLAUSUL PENGESAMPINGAN
KLAUSUL PERSELISIHAN
SUBJECT TO NO CLAIM UP TO BINDING DATE

Jakarta, 20 May 2022


Signed and on behalf of, Accept By

PT Zurich Asuransi Indonesia PT HARAPAN SUKSES PERKASA

INTERNAL USE ONLY


NO MERK TYPE KODE PL NO POL TAHUN NO RANGKA NO MESIN SUM INSURED TOTAL LOSS ONLY
1 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1964 NZA 2018 MHYESL415JJ600357 G15AID1109782 Rp 126,000,000 Rp 554,400
2 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1958 NZA 2018 MHYESL415JJ600279 G15AID1108132 Rp 126,000,000 Rp 554,400
3 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1751 NZB 2018 MHYESL415JJ600505 G15AID1112354 Rp 126,000,000 Rp 554,400
4 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1934 NZA 2018 MHYESL415JJ600375 G15AID1109717 Rp 126,000,000 Rp 554,400
5 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1984 NZA 2018 MHYESL415JJ600317 G15AID1108627 Rp 126,000,000 Rp 554,400
6 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1033 NZB 2018 MHYESL415JJ601405 G15AID1128820 Rp 126,000,000 Rp 554,400
7 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1960 NZA 2018 MHYESL415JJ600301 G15AID1108522 Rp 126,000,000 Rp 554,400
8 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1027 NBA 2018 MHYESL415JJ600361 G15AID1109633 Rp 126,000,000 Rp 554,400
9 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1940 NZA 2018 MHYESL415JJ600327 G15AID1108722 Rp 126,000,000 Rp 554,400
10 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1962 NZA 2018 MHYESL415JJ600359 G15AID1109395 Rp 126,000,000 Rp 554,400
11 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1956 NZA 2018 MHYESL415JJ600353 G15AID1109422 Rp 126,000,000 Rp 554,400
12 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1737 NZB 2018 MHYESL415JJ600483 G15AID1111810 Rp 126,000,000 Rp 554,400
13 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1747 NZB 2018 MHYESL415JJ600451 G15AID1111213 Rp 126,000,000 Rp 554,400
14 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1584 NZB 2018 MHYESL415JJ600449 G15AID1111683 Rp 126,000,000 Rp 554,400
15 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1592 NZB 2018 MHYESL415JJ600433 G15AID1111422 Rp 126,000,000 Rp 554,400
16 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1588 NZB 2018 MHYESL415JJ600621 G15AID1114219 Rp 126,000,000 Rp 554,400
17 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1025 NZB 2018 MHYESL415JJ600315 G15AID1108807 Rp 126,000,000 Rp 554,400
18 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1061 NZB 2018 MHYESL415JJ600275 G15AID1108029 Rp 126,000,000 Rp 554,400
19 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1753 NZB 2018 MHYESL415JJ600499 G15AID1112539 Rp 126,000,000 Rp 554,400
20 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1590 NZB 2018 MHYESL415JJ600472 G15AID1111639 Rp 126,000,000 Rp 554,400
21 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1037 NZB 2018 MHYESL415JJ600287 G15AID1108696 Rp 126,000,000 Rp 554,400
22 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1739 NZB 2018 MHYESL415JJ600644 G15AID1115269 Rp 126,000,000 Rp 554,400
23 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1594 NZB 2018 MHYESL415JJ600443 G15AID1111079 Rp 126,000,000 Rp 554,400
24 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1976 NZA 2018 MHYESL415JJ601444 G15AID1131265 Rp 126,000,000 Rp 554,400
25 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1986 NZA 2018 MHYESL415JJ600365 G15AID1109722 Rp 126,000,000 Rp 554,400
26 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1017 NZB 2018 MHYESL415JJ600435 G15AID1111453 Rp 126,000,000 Rp 554,400
27 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1978 NZA 2018 MHYESL415JJ600347 G15AID1109372 Rp 126,000,000 Rp 554,400
28 Suzuki Carry Real Van 1.5 GK SUZCAR021 B 1129 NZB 2018 MHYESL415JJ601425 G15AID1129866 Rp 126,000,000 Rp 554,400
PREMIUM Rp 15,523,200
ADMIN Rp 54,000
PREMIUM TOTAL Rp 15,577,200

INTERNAL USE ONLY

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