QSN/SGM-MV/VIII/2026:600
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : YENI SUSIANA QQ PT GOLDEN RIVER
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 : 23 Agustus 2026 to 23 Agustus 2027
Territorial limit : For Business and Private used
License plate : B 1963 NZO
Year : 2021
Brand/Model : MITSUBISHI XPANDER 1.5L SPORT-L (4X2) AT
Sum Insured : Rp 201.000.000,-
Coverage : Comprehensive
Third party liability cover max IDR 10.000.000 in Any One Accident
Premium :
Comprehensive 2.08% =
Rp. 4.180.800
Third Party Liability (TJH Pihak ke 3) IDR 10.000.000 =
Rp. 100.000
=
Rp. 4.280.800
Discount 22.5% =
Rp. 963.180
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 3.379.620


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 Agustus 2026





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