Company's Name : KSP GUNA JAYA MANDIRI

Type of Insurance : PERSONAL ACCIDENT

Policy Number : 12.200.0087.41317
Registration Number : 1
Name of Participant : GUNALAN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 2
Name of Participant : ISMAWAN BY
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 3
Name of Participant : NADIANTO
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 4
Name of Participant : DENSI HERAWATI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 5
Name of Participant : ENDE CAHYANA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 6
Name of Participant : DEDI RIYANTO
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 7
Name of Participant : AEP SAEPUDIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 8
Name of Participant : ALDI HALDIANA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 9
Name of Participant : SANDRA GUNAWAN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 10
Name of Participant : TONI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 11
Name of Participant : ADE SOLIHIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 12
Name of Participant : DEWI RANI AMELIA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 13
Name of Participant : BAMBANG ARYANTO
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 14
Name of Participant : JAYANUDIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 15
Name of Participant : EKO SUPRIADI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 16
Name of Participant : CANDA RIA FAMILI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 17
Name of Participant : DEDE RIYAN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 18
Name of Participant : ASEP JALALUDIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 19
Name of Participant : DANDI PRATIWA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 20
Name of Participant : OKTAVIANI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 21
Name of Participant : SAIRIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 22
Name of Participant : MUHAMMAD SYAEFUL
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 23
Name of Participant : DEVITA SARI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 24
Name of Participant : SULAEMAN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 25
Name of Participant : YAHIRIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 26
Name of Participant : ADAM JUNIAR
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 27
Name of Participant : MERI AGUSTINA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 28
Name of Participant : ERIN SRI LESTARI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 29
Name of Participant : ANCE ALMI ANDRIANI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 30
Name of Participant : TEGUH KURNIAWAN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 31
Name of Participant : MELANI PUTRI PUSPITASARI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 32
Name of Participant : ASEP RIANDI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 33
Name of Participant : INDRA WIJAYA
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 34
Name of Participant : ABDUL AZIS
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 35
Name of Participant : ANDI PIYANDI
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022
Company's Name : KSP GUNA JAYA MANDIRI
Type of Insurance : PERSONAL ACCIDENT
Policy Number : 12.200.0087.41317
Registration Number : 36
Name of Participant : ALPIN
Capital Sum Insured : 50.000.000,00
Risk Covered : Resiko A, B, D, MC,
Period of Insurance : 27/12/2022 - 27/12/2023
Effective Date : 27/12/2022