QSN/SGM-MV/VII/2026:511
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : IRGINIA ROSI
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 : 28 Juli 2026 to 28 Juli 2027
Territorial limit : For Business and Private used
License plate : B 50 ROS
Year : 2025
Brand/Model : SUBARU FORESTER 2.5I-S EYESIGHT AWD CVT
Acc Tambahan : VELG IDR 42.000.000 (Include TSI)
Sum Insured : Rp 650.000.000,-
Coverage : Comprehensive , Flood, Riot, Strike, Civil Commotion, Earthquake
Third party liability cover max IDR 50.000.000 in Any One Accident
Premium :
Comprehensive 1.2% =
Rp. 7.800.000
Flood (Banjir) 0.1% =
Rp. 650.000
RSMDCC (Huru-Hara) 0.05% =
Rp. 325.000
Earthquake 0.1% =
Rp. 650.000
Third Party Liability (TJH Pihak ke 3) IDR 50.000.000 =
Rp. 375.000
=
Rp. 9.800.000
Discount 25% =
Rp. 2.450.000
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 7.412.000


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





Dipersiapkan Oleh,