QSN/SGM-MV/I/2026:4
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : LUCIAWATI SELOPRANOTO QQ PT CIMONE JAYA CHEMICAL INDUSTRY
as owner and / or its associated and / or its subsidiary and / or inter related companies
for their respective rights and interests
Area : 2 Jakarta, Jawa Barat dan Banten
Period : 09 Januari 2026 to 09 Januari 2027
Territorial limit : For Business and Private used
License plate : B 210 SAM
Year : 2017
Brand/Model : MERCEDEZ BENZ C 200 AT (W205) CKD
Acc Tambahan : KACA FILM LLUMAR (Include TSI)
Sum Insured : Rp 401.000.000,-
Coverage : Comprehensive , Flood, Riot, Strike, Civil Commotion, Earthquake, Terrorism & Sabotage
Third party liability cover max IDR 50.000.000 in Any One Accident
Premium :
Comprehensive 1.2% =
Rp. 4.812.000
Loading rate 0.24% =
Rp. 962.400
Flood (Banjir) 0.1% =
Rp. 401.000
RSMDCC (Huru-Hara) 0.05% =
Rp. 200.500
Earthquake 0.1% =
Rp. 401.000
Terrorism & Sabotage 0.05% =
Rp. 200.500
Authorized Workshop 401.000.000 0.2 % =
Rp. 802.000
Third Party Liability (TJH Pihak ke 3) IDR 50.000.000 =
Rp. 375.000
=
Rp. 8.154.400
Discount 10% =
Rp. 815.440
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 7.400.960


Deductible :

Comprehensive Rp. 300.000 in any one accident
RSMDCC, TSFWD, Earthquake and TS are 10% of claim or min Rp. 500.000 in any one accident
CTL and Stolen are 5% of sum insured

 
Security : Avrist


Disetujui Oleh, Jakarta, 13 Juni 2026





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