QSN/SGM-MV/VI/2026:466
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : OLIVIA JASMINE WIBISONO QQ DEWI SISWANTI SULIM
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 : 10 Juli 2026 to 10 Juli 2027
Territorial limit : For Business and Private used
License plate : B 2816 PBQ
Year : 2019
Brand/Model : MITSUBISHI XPANDER 1.5L SPORT K (4X2) AT
Acc Tambahan : Kaca Film Konica Full, Talang Air (Include TSI)
Sum Insured : Rp 200.100.000,-
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 2.08% =
Rp. 4.162.080
Loading rate 0.208% =
Rp. 416.208
Flood (Banjir) 0.1% =
Rp. 200.100
RSMDCC (Huru-Hara) 0.05% =
Rp. 100.050
Earthquake 0.1% =
Rp. 200.100
Terrorism & Sabotage 0.05% =
Rp. 100.050
Authorized Workshop 200.100.000 0.2 % =
Rp. 400.200
Third Party Liability (TJH Pihak ke 3) IDR 50.000.000 =
Rp. 375.000
=
Rp. 5.953.788
Discount 25% =
Rp. 1.488.447
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 4.527.341


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, 15 Agustus 2026





Dipersiapkan Oleh,