Yth.

Bpk Jeffry Gunawan

QUOTATION SLIP
Ex.Polis No. 10901160218 & 109011601283

Type of Insurance : • Property All Risks (termasuk gempa bumi, kebakaran menyusul
gempa bumi, letusan gunung berapi & Tsunami)
• Asuransi Gempa Bumi, Letusan gunung Berapi, dan Tsunami

Form/ Wording : • Propertt All Risks - Munich-Re Wording

• Polis Standar Asuransi Gempa Bumi Indonesia (PSAGBI)

The Insured : Selvia Jauw

Address : Restoran Bambuden III, Jl. Gunung Latimojong No. 62, Makassar, Sulawesi
Selatan 90141

Occupation : Convention Hall (2974) / Restaurant (2945)

Risk Location : Restoran Upper Hill

Jl. Metro Tanjung Bunga / Jl. H M Daeng Patompo KM 3 No. 995,
Tanjung Bunga, Kota Makassar - 90141

Period of Insurance : 6th February 2018 - 6th February 2019

(Both dates inclusively 12 o’clock local noon time)

Total Sum Insured : Building IDR 40,000,000,000.00

Content IDR 80,000,000,000.00
Total IDR 120,000,000,000.00

Deductible : • FLEXAS/Kebakaran, Petir, Peledakan, Kejatuhan Pesawat Terbang dan Asap :

NIL
• RSMDCC/ Kerusuhan, Pemogokan, Perbuatan Jahat dan Huru-hara :
10 % dari jumlah klaim yang disetujui, minimal. IDR 10,000,000
setiap kejadian
• TSFWD /Angin Topan, Badai, Banjir dan Kerusakan Akibat Air : 10 %
dari jumlah klaim yang disetujui setiap kejadian
• E.Q / Gempa Bumi, Letusan Guunung Berapi dan Tsunami : 2.5 % dari
jumlah uang pertanggungan setiap kejadian
• Others : IDR 1,000,000 e.e.l.

Clauses : Attacment

Premium Rate : Flexas : 1.4790 %o

RSMDCC : 0.0010 %o
TSFWD : 0.4500 %o
Others : 0.0010 %o

E.Q : 0.7600 %o

Premium Calculation : Rp. 120.000.000.000,- x 1.931 %o = Rp. 231.720.000,-

Rp. 120.000.000.000,- x 0.76 %o = Rp. 91.200.000,-
Adm. Fee & Materai = Rp. 94.000,-
Total Premium = Rp. 323.014.000,-

Jakarta, 9 Januari 2018. Approval By,

Benny Darmastuti _________________

Clauses : • Architects, Surveyors, and Consulting Engineers Expenses Clause
(limit 5 % of Sum Insured)
• Alteration Clause (30 days)
• Appraisement Clause (5 % of Sum Insured)
• Average Relief Clause (85 %)
• Brand And Label Clause
• Cancellation Clause
(30 days, 3 days for RSMDCC, 5 days for EQ)
• Capital Addition Clause (10 % of Total Sum Insured)
• Computer Records Clause
• Civil Authorities Clause
• Errors and Omission Clause
• Fire Brigade Clause (reasonable cost)

• Fire Extinguisher Cost Clause (reasonable cost)

• General Interest Clause
• Internal Removal Clause
• Loss Notification Clause (14 days) + 30 days for Reinsurer
• Loss of Damaged Goods Clause
• Minor Alteration and Repair Clause
• Misdescription Clause
• Non-Invalidation Clause
• Notification Clause
• Outbuildings Clause
• Payment on Account Clause
• Public Authorities Clause
• Removal of Debris Clause (10% of Total Sum Insured)
• Structural Alteration Clause
• Services Clause
• Temporary Removal Clause
• Vehicle Load Clause
• Workmen Clause
• 72 Hours Clause
• Flood, Windstorm, Tempest, Water Damage (4.3A)
• Industries Seepage, Pollution, and Contamination Clause
• Information Technology Hazards Clarification Clause (NMA 2912)
 • Terrorism Exclusion Endorsement (NMA 2920)
• Total Asbestos Exclusion Clause
• Transmission and Distribution Lines Exclusion Clause
• War and Civil War Exclusion Clause
• Sanction Limitation Exclusion Clause (LMA 3100)
• Currency Clause (Klausul Mata Uang)
• Settlement of Dispute Clause C (Klausul Penyelesaian Sengketa C)
• Premium Payment Clause (Klausul Pembayaran Premi)
• Extra Contractual Obligation Exclusion Clause
• Terrorism and Sabotage Exclusion Clause
• Cyber Attack Exclusion Clause
• Nuclear Energy Risk
Indonesia Jurisdcit