QSN/SGM-MV/VIII/2026:651
Motor Vehicle Insurance
Wording : PSAKBI (Polis Standar Asuransi Kendaraan bermotor Indonesia)
The Insured : ADI SURIYANTO KHOW QQ SUWATI
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 September 2026 to 09 September 2027
Territorial limit : For Business and Private used
License plate : B 315 JJC
Year : 2022
Brand/Model : MERCEDES BENZ C300 AMG (W206) AT
Sum Insured : Rp 800.100.000,-
Coverage : Comprehensive
Third party liability cover max IDR 50.000.000 in Any One Accident
Premium :
Comprehensive 1.05% =
Rp. 8.401.050
Third Party Liability (TJH Pihak ke 3) IDR 50.000.000 =
Rp. 375.000
=
Rp. 8.776.050
Discount 20% =
Rp. 1.755.210
Stamp and Duty =
Rp. 62.000
Net Premium =
Rp. 7.082.840


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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