COVER NOTE

NO. 028589/CV/IAR/999.S16-KBRU/10/2023
Type of Cover : INDUSTRIAL ALL RISK INSURANCE
 Amended with riot, strike, Malicious Damage + CC (RSMDCC
4.1B/2007)
 Extended to include Boiler Explosion (as per PSKI)
 Subject to War & Terrorism Exclusion Endorsement (NMA
2920)

EARTHQUAKE INSURANCE

Wording / Form :  Munich-Re Standard Wording (Amended) extended with RSMD +

CC 4.1B Endorsement / AAUI 2007
 Indonesian Standard Earthquake Policy Wording - (Latest
Version)

The Insured : KAHATEX, PT and/or subsidiary and/or affiliated and/or associated

and/or for their respective rights and interests.

Risk Location : As per list attached

Period of Insurance : September 30, 2023 up to September 30, 2024

(Both dates inclusive at 12.00 o’clock at noon standard local time).

Occupation : As per list attached and/or sales activities and/or operation activities
and/or others related to the insured business.

Extension All kind of Mechanical, Electrical, Electronic Breakdown and/or

(Munich Re Wording)
(As Per OJK) - For
Lokasi Rancaekek
(Synthetic Fiber)
Derangement (hereinafter called Machinery Breakdown) whatsoever
caused
Loss limit: USD 1,500,000.00 anyone accident and in the aggregate
for the annual period

The loss limit of USD 1,500,000.00 is only in respect of the particular

machine, apparatus or equipment in which such breakdown or
derangement originates ngga kas

Note: The boiler(s) if any, is/are deemed to be specifically listed under

the schedule at this policy &/or extension thereof

Basis of valuation: reinstatement value

Spesification of Interest : Buildings of every description, including sub-stations and/or stations,

Insured adjoining car park, foundations, underground construction, material on
the ground and all structural appurtenances therein and thereon,
fixtures, fittings attaching and belonging thereto, gates, fences, walls,
outbuildings, tanks, metal frameworks, extensions, annexes, awnings,
blinds, signs, gangways, roadways, paths, landscape, and other
permanent and/or semi-permanent structures, all kind of cables
including underground cables supplying services, instruments, pipes,
meters and the like and their accessories

Machineries, plants, equipments and/or spare parts of every

description (including installation cost, testing cost, supporting and
Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 1 of 7
KAHATEX, PT
 protective structure), including property whilst on platform, in alleys,
yards and in the open within the boundaries of the premises

Content of all description, including but not limited to furniture,

machineries and equipments, stationeries, drawings, designs, plans,
business books including cost of rewriting, employees effects and
tools (other than the effects of employees permanently in residence),
money, negotiable documents, stamps, models, moulds.

Stock of raw materials, work in progress, finished goods and utensils

of trade of every description including but not limited to packaging,
helping materials, stocks on consignment and stocks sold but not
delivered

The property in care or in custody of the Insured or held by him in

trust or on commission for which he is liable and not otherwise
insured

Deductibles : Any one loss or series of losses arising out of any one event:
 Fire, Lightning, Explosion, Impact of Falling Aircraft and Smoke:
5% of claim or 0.1% of TSI whichever is higher
 Impact of Vehicle: USD 100.00
 Special Self Combustion: 5% of claim or 0.1% of Limit
 Riots, Strikes, Malicious Damage and Civil Commotion:
5% of claim, minimum USD 500.00
 Typhoon, Storm, Flood, Water Damage, Landslide, Landslip &
Subsidence: 10% of claim
 Others: USD 1,000.00
 Machinery Breakdown: 10% of Claim, Minimum USD 2,500.00 -
For Lokasi Rancaekek (Synthetic Fiber)
 Earthquake, Volcanic Eruption, Tsunami and fire following
Earthquake, Volcanic Eruption & Tsunami: USD 3,000,000.00

Sum Insured : As Per List Attached

Additional Clauses : 1. Alterations Clause (30 days)

2. Alteration and Repairs Clause
3. All Other Contents Clause (Limit IDR 100,000,000.00 / item and
in aggregate)
4. Appraisement Clause (5% of Total Sum Insured)
5. Automatic Reinstatement of Sum Insured (For PSAGBI – if any)
With additional premium
6. Average Relief Clause (85%)
7. Brand and Label Clause
8. Breach of Warranty Clause
9. Broad Pair & Set Clause (Applicable to Furniture and/or Office
Equipments Only)
“it is hereby noted and agreed that in case of loss destruction or
damage to part of a pair or set, the insurer will pay the full amount
of the pair or set provided the insured agree to surrender the
remaining articles of the pair or set to the insurer”
10. Capital Additions Clause (10% of Total Sum Insured)
11. Civil Authorities Clause
12. Computer Record Clause (Limit USD 1,000.00 / item and in
aggregate)
13. Cost of Re-erection Clause
14. Customer Goods Clause
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KAHATEX, PT
 15. Designation Clause
16. Deterioration Of Stock Clause
17. Dispute Clause (AAUI 2021)
18. Escalation Clause (10%)
19. Expediting Expenses Clause (10% of claim)
20. Fire Brigade Charges Clause (Reasonable Cost, maximum Limit
USD 10,000.00)
21. Fire Extinguishing Cost Clause (Reasonable Cost, maximum
Limit USD 10,000.00)
22. General Interest Clause
23. Indonesia Jurisdiction Clause
24. Impact by Own Vehicle Clause
25. Internal Removal Clause
26. Interpretation Clause
27. Leased Property Clause
28. Lessor’s Interest Clause (If any)
29. Loading and Unloading Clause
30. Loss of Damaged Goods Clause
31. Landslide, Landslip and Subsidence Clause
It is hereby noted and agreed that, this policy shall also cover the
peril of subsidence, landslip or landslide.
32. Misdescription Clause
33. Minor Alterations & Repairs Clause
34. Notification Clause (30 days)
35. Non-Invalidation Clause
36. Outbuilding Clause
37. Onsite Storage Clause
38. Premises Clause
39. Preventive Measure Clause
40. Prorate Return Premium Clause (Subject to no claim)
41. Public Authorities Clause
42. Removal of Debris Clause (Limit USD 250,000.00)
43. Removal Permit Clause
44. Riot, Strikes, Malicious Damage plus Civil Commotion (RSMD
CC) 4.1B Endorsement / AAUI 2007
45. Reinstatement Value Clause (For PSAGBI – if any) – As Per
Munich Re Wording
46. Salvage and Recoveries Clause
47. Selling Price Clause
48. Electrical Short Circuit (Limit IDR 250,000,000.00 anyone loss
and in aggregate, applicable to items other than Machineries) –
As Per PSAKI Wording
49. Structural Alteration Clause
50. Sprinkler Leakage Clause
51. Sue and Labor Clause
52. Service Clause
53. Special Self Combustion Clause (limit USD 1,500,000.00 any one
accident and in aggregate)

Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 3 of 7

KAHATEX, PT
 54. Single Deductible Clause
It is hereby noted and agreed that the objects insured by this
policy are in accumulation with the object insured under Policy
Number (to be advised) and for the purpose of applying the
deductibles shall he considered to be running in conjunction with
each other and that only a single deductibles shall be applied in
the aggregate for any one claim where more than one policy is
involved at the location
55. Temporary Removal Clause (Exclude Aceh, Papua and Maluku)
56. Undamaged Stock Clause
57. Vehicle Load Clause
58. Workmen’s Clause
59. 72 Hours Clause (including TSFWDLLS & RSMDCC)
60. Banker’s Clause
Noted and agreed that the property insured by this policy has
been mortgaged with :
Name of Bank : .................. if any ............................
and that in consequence thereof, it has been agreed with the said
mortgage and the Insured, that in case of loss, if any, payable
under this Policy any payment up to the amount to which the said
mortgage is entitled for principal, interest accrued and costs shall
be made to the said mortgage without prejudice to the rights the
Insured may have on the difference.

This clause to be null and void no receipt of advice from the said
mortgaged that they are no longer interested in the property
insured under this policy.
61. Cancellation Clause (30 days), except 3 days for RSMDCC
62. Cost of Re-writing Records and Claim Preparation Clause
63. Currency Clause
64. Error and Omission Clause
65. Loss Notification Clause (30 days)
66. Nominated Loss Adjuster Clause:
It is hereby noted and agreed that in the event of a claim, loss
adjusters to be selected from the following panel :

- VRS PT. Prima Adjusterindo Mandiri

- PT. Cunningham Lindsey
- PT. Mclarens Indonesia

67. Payment on Account Clause (25%)

68. Professional Fees Clause (10% of Total Sum Insured)
69. Waiver of Subrogation Clause (Against Subsidiary only)
70. EDRC “A”
71. Property Damage Clarification Clause
72. Extra Contractual Obligation exclusion Clause
73. Transmission and Distribution Lines Exclusion Clause (1,000
meters only)
74. Industries Seepage, Pollution and Contamination exclusion
Clause – NMA 1685
75. IT Hazard Clarification Clause (NMA 2912)
76. Nuclear Energy Risk Exclusion Clause
77. War and Civil War Exclusion Clause
78. Forfeiture of Rights to indemnification Clause
79. Institute Radioactive Contamination, Chemical, Biological, Bio-
chemical and Electromagnetic Weapons Exclusion Clause – CL.
370
80. Political Risk, Financial Guarantee & Credit Risk Exclusion
Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 4 of 7
KAHATEX, PT
 Clause
81. Indonesia Jurisdiction Clause
82. Cyber Risk Exclusion Clause – NMA 2915
83. Sanction Limitation and Exclusion Clause
84. Waiver to article 1266 & 1267 of Indonesian Civil Code Clause
85. LMA 5393 - Communicable Disease Endorsement
86. LMA 5401 - Property Cyber and Data Exclusion
87. Infectious/Contagious Disease Exclusion
88. Non Automatic Renewal Clause
89. Compliance Clause
90. Terrorism and Sabotage Exclusion Clause
91. IT Clarification Agreement
92. Total Asbestos Exclusion Clause
93. Klausula Penyesuaian (AAUI 2016)
94. War and Terrorism Exclusion Endorsement (NMA 2918)
95. Cyber Loss Limited Exclusion Clause LMA5410
96. Electronic Recognition Clause EDRC “B” (Amended)

Additional Clauses : 1. Automatic Reinstatement of Sum Insured Clause (With Additional

(Applicable for
Machinery Breakdown)
- For Lokasi Rancaekek
(Synthetic Fiber)
Premium)
2. Alteration Clause (30 days)
3. Automatic Cover for newly acquired machinery subject to 30 days
notification loss
4. Appraisement Clause (5% of Total Sum Insured)
5. Average Relief Clause (85%)
6. Cost of Re writing Records and Claims Preparation Clause
7. Cover for Overtime, Night work and Express Freight Clause-
MR 006 (10% of Limit of Loss)
8. Capital Addition (5% of Sum Insured)
9. Cover for Internal Fire, Internal Chemical Explosion and Direct
Lightning Clause - MR 313
10. Cover for Refractory Materials and/or Masonry In Industrial
Furnace and Boilers - MR 319
11. Cover for Explosion in Internal Combustion Engines and
Hydrogen Cooled Generator
12. Cover for Lubricating Oil or Refrigerant – MR 320
13. Cover for conveyor belt and chains - MR 321
14. Cover for Wires and Non-Electrical Cables – MR 322
15. Currency Clause
16. Defunct Spares Clause
17. Expediting Clause (10% of Claim)
18. Fire Brigades Charges Clause (Reasonable Cost, maximum Limit
USD 10,000.00)
19. Fire Extinguishing Cost Clause (Reasonable Cost, maximum
Limit USD 10,000.00)
20. Loss Notification Clause (30 days)
21. Nominated Loss Adjuster Clause
It is hereby noted and agreed that in the event of a claim, loss
adjusters to be selected from the following panel:

- VRS PT. Prima Adjusterindo Mandiri

- PT. Cunningham Lindsey
- PT. Mclarens Indonesia

22. Professional Fees and Claims Preparation Costs Clause (10%

of TSI)
23. Replacement Value Clause
It is understood and agreed that otherwise subject to the terms,
Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 5 of 7
KAHATEX, PT
 exclusion, provision and conditions contained in the policy or
endorsed thereon, where an insure items totally destroyed or
damaged, the basis upon which the amount payable under the
policy is to be calculated shall be the full replacement value of
the item destroyed or damage.
“Replacement Value” shall mean the cost, which would have
to be incurred immediately before destruction of or damage to
an insured item for replacing the destroyed or damaged item by
a new item of similar kind, capacity, size and quality.
Provided always that in no case shall the liability of
underwriters exceed the insured value of the complete machine
or equipment
24. Removal of Debris Clause (Limit USD 250,000.00)
25. Temporary Removal Clause (Exclude Aceh, Papua and
Maluku)
26. LMA 5397 - Communicable Disease Endorsement

Rate : As Per List Attached

Discount OJK : As Per List Attached

Premium Calculation : As Per List Attached

(Plus Policy and Administration Cost)

Additional Discount : 12.5%

Deffered Premium : 2 installment as per deferred premium clause as follow:

Clause
1st installment due to 30 days from inception date (50%)
2nd installment due to 60 days from inception date (50%)

Security : PT. MALACCA TRUST WUWUNGAN INSURANCE - 17.5% (Leader)

PT. TUGU PRATAMA INDONESIA - 13.75% (Member)
PT. ASURANSI ETIQA INDONESIA - 10% (Member)
PT. LIPPO GENERAL INSURANCE - 7.7% (Member)
PT. ASURANSI JASA INDONESIA - 7.25% (Member)
PT. ASURANSI CENTRAL ASIA - 6.75% (Member)
PT. ASURANSI WAHANA TATA - 5.25 (Member)
PT. ASURANSI TRI PAKARTA - 4.55% (Member)
PT. ASURANSI MULTI ARTHA GUNA - 4% (Member)
PT. ASURANSI UMUM BCA - 2.5% (Member)
PT. ASURANSI BINAGRIYA UPAKARA - 0.75% (Member)
SELF INSURED - 20%

We hereby acknowledge the risk offer under this cover note,

regardless occupation code stated

Jakarta, October 19, 2023 Jakarta, October 19, 2023

Signed for and on behalf of Signed for and on behalf of
PT. TUGU PRATAMA INDONESIA PT. MALACCA TRUST WUWUNGAN
INSURANCE

___________________________ ___________________________

Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 6 of 7

KAHATEX, PT
 Jakarta, October 19, 2023 Jakarta, October 19, 2023
Signed for and on behalf of Signed for and on behalf of
PT. LIPPO GENERAL INSURANCE PT. ASURANSI ETIQA INDONESIA

___________________________ ___________________________

Jakarta, October 19, 2023 Jakarta, October 19, 2023

Signed for and on behalf of Signed for and on behalf of
PT. ASURANSI CENTRAL ASIA PT. ASURANSI JASA INDONESIA

___________________________ ___________________________

Jakarta, October 19, 2023 Jakarta, October 19, 2023

Signed for and on behalf of Signed for and on behalf of
PT. ASURANSI TRI PAKARTA PT. ASURANSI WAHANA TATA

___________________________ ___________________________

Jakarta, October 19, 2023 Jakarta, October 19, 2023

Signed for and on behalf of Signed for and on behalf of
PT. ASURANSI UMUM BCA PT. ASURANSI MULTI ARTHA GUNA

___________________________ ___________________________

Jakarta, October 19, 2023

Signed for and on behalf of
PT. ASURANSI BINAGRIYA UPAKARA

___________________________

Cover note NO. 028589/CV/IAR/999.S16-KBRU/10/2023 Page 7 of 7

KAHATEX, PT