QUOTATION SLIP
No. ………………….
Validity of Quotation : 7 (Seven) days (Indicative & Non
Binding)
Remarks : The Period of cover will be effective
1 (one) week after receiving your
approval.
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T
Y P E
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THIRD PARTY LIABILITY INSURANCE
(Automobile Liability)
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FORM/WORDING
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Indonesian
Standard Motor Vehicle Insurance
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INSURED
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PT. XXXXXX as the first owner of the Insured and/or its
subsidiaries companies and/or any other company owned, operated and/or
controlled by and/or Affiliated with the company and/or their Associated
and/or f.t.r.r.i.
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ADDRESS
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XXXXXX
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PERIOD
COVER
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12
(twelve) months from the date to be advised
at
12.00 noon local time
(both days inclusive)
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OCCUPATION
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Trucking Cargo Transporter
and/or any other activities related thereto.
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INTEREST
INSURED
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On all Types of Truck,
Container Trucks, Box Van Vehicle and/or any kind of Trucks and/or any kind
of Box Vehicle.
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COVERAGE
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Third
Party Liability for the attached list of Vehicles
Personal
Accident for Drivers of the attached list of vehicles
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TERRITORIAL
LIMIT
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Any
where in the Republic
of Indonesia
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LIMIT
OF LIABILITY
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ª Option
I : IDR. 30.000.000,- / Vehicle
PA
Drivers IDR. 10.000.000,-
(Including
Medical Reimbursement)
ª Option
II : IDR. 50.000.000,- / Vehicle
PA
Drivers IDR. 10.000.000,-
(Including Medical Reimbursement)
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DEDUCTIBLE
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NIL,
except Personal Accident is IDR. XXXX.000,-
for any one loss or series of losses arising out of the same events.
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GARAGE
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Approved
garage and/or others garage as agreed by the Insurer.
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EXTENSION
CLAUSES
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THE
ANNUAL RATE
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XXXXX %
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PREMIUM
COMPUTATION
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ª Option I :
=
IDR. 30.000.000,- x XXX Unit x XXXX%
=
IDR. XXXXX,-
ª Option II :
=
IDR. 50.000.000,- x XXX Unit x XXXX%
=
IDR. XXXXX,-
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POLICY
COST AND STAMP
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:
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Xxxx
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SECURITY
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PT.
XXXXXX
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Jakarta, XXXXX
Signed in and on behalf of
PT. XXXXXXX Approved
By,
………………………. …………………………
AGREED AND ACCEPTED BY,
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