QSN/SGM-MV/IX/2026:678
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : ELEONOREZIESTANOVERA V.N QQ HIANITA GOTAMA
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 : 17 September 2026 to 17 September 2027
Territorial limit : For Business and Private used
License plate : B 1821 HZE
Year : 2023
Brand/Model : GWM HAVAL H6-HEV 1.5T DHT4X2AT
Sum Insured : Rp 401.000.000,-
Coverage : Comprehensive
Third party liability cover max IDR 30.000.000 in Any One Accident
Premium :
Comprehensive 1.2% =
Rp. 4.812.000
Third Party Liability (TJH Pihak ke 3) IDR 30.000.000 =
Rp. 275.000
=
Rp. 5.087.000
Discount 15% =
Rp. 763.050
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 4.385.950


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 Oktober 2026





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