TYPE : MONEY INSURANCE
(MONEY IN THE PREMISES AND
MONEY IN TRANSIT)
INSURED : PT. _____________ including any and all past,
present or hereafter formed or acquired subsidiary, Affiliated or Allied
companies, corporations, trusts, foundations, entities, trustees, or
organizations which are owned, financially controlled, actively managed or in
which the named Insured has had, or has an interest now or hereafter
constituted of for which the named Insured has assumed the responsibility of
purchasing Insurance.
ADDRESS : to be advised
PERIOD : 12 (Twelve) months from the date to be advised
At 12.00 noon local time (both days
inclusive
LOCATION OF RISK : to be advised
THE BUSINESS : to be advised
OCCUPATION : to be advised
INTEREST AND SUM INSURED :
SECTION – I
MONEY IN THE PREMISES :
COVERAGE
|
:
|
Loss of money money orders by any cause whatsoever
in the personal custody of the insured and/or their authorized employees
and/or in the locked safes and/or petty cash and/or whilst in and/or about
the insured premises.
|
Limit of Indemnity
|
:
|
Rp. ………………. And/or equivalent with other
currencies per any one accident
|
Annual Rate
|
:
|
…… %
|
Annual Premium
|
:
|
Rp. ………………….
X …….. % = Rp.
|
----/2
Page : 2
CN No. ….(New/Renewal)
SECTION – II
MONEY IN TRANSIT :
COVERAGE
|
:
|
Loss of money money orders by any cause whatsoever
in the circumstances described in the schedule.
|
Limit of Indemnity
for anyone carrying
|
:
|
Rp. ………………. And/or equivalent with other
currencies per any one accident
|
Estimated
Annual Carrying
|
:
|
Rp. And/or equivalent with
other currencies per any one accident
|
Annual Rate
|
:
|
…… %
|
Annual Premium
|
:
|
Rp. ………………….
X …….. % = Rp.
|
Schedule
|
:
|
(The schedule shall include any
stop over until the final destination)
q From
the Banks to the Insured’s premises and Vice-versa
q From
the Insured’s premises to their Clients’ and/or Suppliers’ and Vice-versa
q From
the Insured’s premises to their other premises and Vice-versa
q In all areas within the plant and
including distribution with the Plant
q Travel
Allowances from Insured’s office to anywhere in Indonesia.
|
Teritorial Limit
|
:
|
Republic of Indonesia
|
TOTAL ANNUAL PREMIUM :
Section I – Money in the
Premises Rp. ….
Section II – Money in
Transit Rp. ….
Rp.
EXTENSION CLAUSES :
1. Automatic
Reinstatement of Loss Clause
2. Breach
of Warranty Clause
3. Damage
to Safe/Drawers/cabinets/Cash Registers/Cash Boxes Endorsement
It is hereby declared and agreed that this
policy shall extend to cover damage to Safe/Drawers/Cabinets/Cash
Registers/Cash Boxes containing the articles insured in furtherance of
Burglary, housebreaking or any attempt thereat, provided that the maximum
liability of the company is not exceeding that the limit of liability any one
loss/event”
4. Dishonesty
of Employees (if Discovered within 72 hours)
“Notwithstanding
of anything in the policy to the contrary, this Policy is extended to cover
dishonesty by the Insured’s Employee subject to being discovered within 72
hours.”
5. Indonesia
Jurisdiction Clause
6. Locks,
Keys and rolling door clause
7. Loss
Notification Clause (30 Days)
8. Notification
Clause (30 Days)
9. New
Location Clause (berlaku untuk penutupan outlet atau
showroom lebih dari satu)
10. Nominated
Loss Adjuster Clause :
It
is hereby noted and agreed that in the event of a loss the following adjusters
should be appointed and the Preliminary and/or Final Report should be forwarded
to the Agent and Broker concern.
Nominated
Loss Adjuster :
q PT.
CUNNINGHAM LINDSEY INDONESIA
q PT.
JAPENANSI NUSANTARA (GAB Robbins)”
11. Payment
on Account Clause
12. SRCC
Clause
13. Thirty
(30) Days Cancellation Notice Clause
“Both the Insurer and the Insured are entitled
to terminate this insurance upon thirty (30) days notice in writing being
given. Such termination should be effected by the registered letter and the
Insured entitle to a pro-rata refund premium for the un-expired period of
Insurance”.
14. Extended
to Cover Personal Accident for 2 (two) persons of the Insured’s employee(s) in
charge of the money which covers Death, Permanent Disablement (Continental
Scale) with Limit Rp. 50.000.000,00 and Medical Reimbursement with limit 10% of
Death benefit (anyone employee and anyone accident).
15. Extended
to include Fidelity Guarantee/embezzlement of the officer in charge whenever
discover within 15 days from the date of occurrence with limit IDR.
25.000.000,00 anyone accident (deductible : 10% of Recoverable Claim Amount for
anyone loss or series of losses arising out of the same event) atau Fidelity Guarantee Extension Clause
16. Anyone
carrying by motor cycle limit IDR. 25.000.000,00
SECURITY :
Jakarta, _____________, 2002
Sign
in and on behalf of
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