The Schedule

ALL RISK INSURANCE POLICY

POLICY NO. : 16180000346405

THE INSURED : Fajar Muhamad Shidia
ADDRESS : Ruko Icon 21 Blok B No.17

INSURED PERIOD : 23 Jul 2018 - 23 Jul 2019

Both dates at 12 o'clock noon local time at the location of insured object
TERRITORIAL LIMIT : Anywhere in Indonesia
THE PROPERTY INSURED
Description Unit Sum Insured
XIAOMI MI 6X ROSE GOLD,64GB,1 Tahun Distributor,4Gb, imi: 869067036744950 1 Rp. 3.700.000,00
TOTAL SUM INSURED Rp. 3.700.000,00
Deductible:
10% if claim any one of accident

Endorsement / Clauses attaching to and forming part of this policy:

- Extra Contractual Obligations Exclusion Clause
- Seepage, Pollution & Contamination Exclusion Clause
- Total Asbestos Exclusion Clause
- Klausul Kebongkaran / Pencurian dengan Tindakan Kekerasan
- Electronic Date Recognition Clause(EDRC)"A"
- Indonesia Jurusdiction Clause
- Subject to Brand New
- Sunject To No Claim
- Terrorism Exclusion Clause

Premium Calculation:
Premium Rp. 10.000,00 X 1,00 = Rp. 10.000,00
Admin Fee................................................................................ = Rp. 5.000,00
+
Total Premium.......................................................................... = Rp. 15.000,00

Jakarta, 2018
PT. ASURANSI SIMAS NET

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dan rekanannya melalui sarana komunikasi pribadi (telepon, short message
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