Scribd Logo
Upload

Welcome to Scribd!

  • 22 views

    Sompo Insurance

    Uploaded by

    zeinharitsah.zh
    The document provides an insurance policy schedule for a motor vehicle. It lists the insured's name and address, policy period, details of the insured vehicle, sum insured amounts, premium calculations, deductibles, and clauses included in the policy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Sompo Insurance

    Uploaded by

    zeinharitsah.zh
    22 views3 pages
    The document provides an insurance policy schedule for a motor vehicle. It lists the insured's name and address, policy period, details of the insured vehicle, sum insured amounts, premium calculations, deductibles, and clauses included in the policy.

    Original Description:

    contoh sompo insurance kendaraan

    Original Title

    sompo insurance

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides an insurance policy schedule for a motor vehicle. It lists the insured's name and address, policy period, details of the insured vehicle, sum insured amounts, premium calculations, deductibles, and clauses included in the policy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views3 pages

    Sompo Insurance

    Uploaded by

    zeinharitsah.zh
    The document provides an insurance policy schedule for a motor vehicle. It lists the insured's name and address, policy period, details of the insured vehicle, sum insured amounts, premium calculations, deductibles, and clauses included in the policy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Original

    IKHTISAR PERTANGGUNGAN ASURANSI KENDARAAN BERMOTOR


    INSURANCE POLICY SCHEDULE MOTOR VEHICLE
    Nomor Polis : 00502240400055 Ex.
    Policy Number
    Nama Tertanggung : LAILIN MAHDRULI
    Insured Name
    Alamat : JL. OVITEN NO.7 RT 04 RW 08, KEL. SUKARAJA, KEC. CICENDO,
    Address KOTA BANDUNG

    Nomor Referensi : 0159/QS-DLSZ/MKT-BD/SOMPO/IV/2024


    Reference No.

    Periode Polis : 04 Apr 2024 - 04 Apr 2025


    Policy Period Mulai dan berakhir pada jam 12:00 waktu setempat di lokasi objek tertanggung.
    Starts and ends at 12:00 local time at the location of the insured object.

    Objek Pertanggungan
    Insured Object

    Vehicle Make : SUZUKI


    Vehicle Model : NEW XL-7 03 BETA AT HYBRID
    Year of Manufacturing : 2024
    Vehicle Chasis Number : MHYANC32SRJ101847
    Vehicle Machine Number : K15BT1601637
    Vehicle License Number : TBA
    Vehicle Function : Angkutan Penumpang - Mobil Pribadi
    New or Used : New
    Vehicle Color : SNOW WHITE

    Condition : - Subject to no claim up to 25 March 2024


    Condition .
    Information : - AWS PT. NJS
    Information .

    Nilai Pertanggungan : - Kendaraan Bermotor IDR 304,400,000.00


    Sum Insured - Kecelakaan Diri Terhadap Pengemudi IDR 10,000,000.00
    - Kecelakaan Diri Terhadap IDR 10,000,000.00
    Penumpang
    - Tanggung Jawab Hukum Terhadap IDR 10,000,000.00
    Pihak Ketiga

    PSNSI0000S Page 1 of 3
    Original
    Satu Kesatuan dengan dan bagian dari Polis No. 00502240400055
    Attaching to and forming part of Policy No. 00502240400055

    Perhitungan Premi :
    Premium Calculation

    Period Pertanggungan Perhitungan Premi Premi


    Periode Coverage Premium Calculation Premium
    04 Apr 2024 - 04 Apr 2025 Comprehensive IDR 304,400,000.00 x 2.08% IDR 6,331,520.00

    04 Apr 2024 - 04 Apr 2025 Third Party Liability IDR 10,000,000.00 x 1.0% IDR 100,000.00

    04 Apr 2024 - 04 Apr 2025 PA Passenger IDR 10,000,000.00 x 0.4% IDR 40,000.00

    04 Apr 2024 - 04 Apr 2025 PA Driver IDR 10,000,000.00 x 0.5% IDR 50,000.00

    04 Apr 2024 - 04 Apr 2025 RSCC IDR 304,400,000.00 x 0.05% IDR 152,200.00

    04 Apr 2024 - 04 Apr 2025 Flood IDR 304,400,000.00 x 0.1% IDR 304,400.00

    04 Apr 2024 - 04 Apr 2025 Terrorism & Sabotage IDR 304,400,000.00 x 0.05% IDR 152,200.00

    04 Apr 2024 - 04 Apr 2025 Earthquake IDR 304,400,000.00 x 0.1% IDR 304,400.00

    04 Apr 2024 - 04 Apr 2025 Suzuki Insurance Feature IDR 304,400,000.00 x 0.05% IDR 152,200.00

    TOTAL PREMIUM IDR 7,586,920.00


    Discount (25.00%) IDR -1,896,730.00

    Biaya Administrasi IDR 40,000.00

    TOTAL IDR 5,730,190.00

    Resiko Sendiri : - Comprehensive : IDR 300,000.00 for any one accident


    Deductibles - Earthquake, Tsunami, Volcanic Eruption : 10% of Claim, Minimum IDR
    500,000.00
    - Windstorm, Tempest, Flood and Water Damage (4.3) : 10% of Claim,
    Minimum IDR 500,000.00
    - Riot, Strike, Civil Commotion : 10% of Claim, Minimum IDR
    500,000.00
    - Terrorism & Sabotage : 10% of Claim, Minimum IDR 500,000.00

    Klausul : All Clause


    Clauses 1. Cancellation Clause 30 (Thirty) Days - C00005
    2. Dispute Clause (as per AAUI No 1 2021) - D00014
    3. Earthquake, Tsunami and Volcanic Eruption Clause - E00014
    4. Personal Accident Clause (For Driver and Passenger) - P00027
    5. Property Cyber And Data Exclusion Clause (LMA 5401) - P00031
    6. Storm, Hail, Flood and/or Landslide Clause - S00030
    7. Riots, Strikes, and Civil Commotion including Terrorism and
    Sabotage Clause - S00032
    8. Sanction Limitation and Exclusion Clause (LMA 3100) - S00033
    9. Suzuki Insurance Feature Clause - S02052
    10. Third Party Liability Clause - T00031
    11. Waiver Clause (Article 1266 and 1267 Indonesia Civil Code) -
    W00036
    12. English Language Prevalance Clause - Z99999

    Bandung, 05 Apr 2024


    PT Sompo Insurance Indonesia

    PSNSI0000S Page 2 of 3
    Original
    Satu Kesatuan dengan dan bagian dari Polis No. 00502240400055
    Attaching to and forming part of Policy No. 00502240400055

    Catatan Penting Important Note


    1. Dokumen ini merupakan dokumen resmi dari PT Sompo Insurance Indonesia yang diproses secara elektronik dan disajikan sesuai dengan
    aslinya sehingga tidak memerlukan tanda tangan dan berlaku sebagai alat bukti yang sah. This document is an official document of PT Sompo
    Insurance Indonesia which is electronically processed and presented exactly as the original and therefore no signature is required and serves as valid evidence.

    2. Produk ini terdaftar di OJK (Otoritas Jasa Keuangan). This product is registered by Otoritas Jasa Keuangan (OJK).
    3. Premi yang dibayarkan oleh Tertanggung sudah termasuk biaya komisi kepada pihak lain. This premium paid by the Insured including the cost of
    insurance to another part.

    PSNSI0000S Page 3 of 3

    You might also like