P

RENEWAL NOTICE POLICY

PEMBERITAHUAN PERPANJANGAN POLIS
AN: 01002899

Name and Address of the insured Policy No. 23 H0037286 HHH

Nama dan Alamat Tertanggung Policy No. 23 H0037287 HHH
No. Polis
VILLA BALI ASRI
QQ.KETUT GEDE BUDIARTA, ST
JL.DEWI SRI NO.39
SEMINYAK, KUTA – BALI

This policy soon will be due by: January 10, 2018

Polis ini akan segera berakhir pada

Interest Insured Building, Swimming Pool, Contents USD 2,000,000.00

And Machinery

Total Sum Insured USD 2,000,000.00

RATE PREMIUM : RENTED VILLA

- FLEXAS 0.0725%
- RSMDCC 0.0010%
- OTHERS 0.0010%
- TFSWD 0.0500%
- EQVET 0.1430%
TOTAL PAR + EQVET 0.2675%

PREMIUM USD 2,000,000.00 X 0.2675% = USD 5,350.00

CALCULATION : Discount = USD (400.00)
Adm Fee and Stamp Duty = USD 10.00
Total premium per annum = USD 4,960.00

LOCATION: VILLA BALI ASRI

JL.DEWI SRI NO.39
SEMINYAK, KUTA – BALI
Please ensure that above sum value are to be adjusted as per current price conditions to make your indemnity
value as correct.
Mohon agar dapat dipastikan bahwa nilai-nilai yang tercantum diatas adalah sesuai dengan harga yang sebenarnya
dan wajar pada saat sekarang.

We thank You for the attention and looking forward for your confirmation due on above notice
Kami sampaikan terima kasih dan menunggu konfirmasi dari Saudara berkaitan hal tersebut

Regards,

CONFIRMATION RETURN
KONFIRMASI PERPANJANGAN

Dear, Date.

We are confirm to our Policy No. H0037286 / H0037287 named of VILLA BALI ASRI QQ. KETUT GEDE BUDIARTA, ST
please being renewed for one year period
Kami konfirmasikan Polis diatas agar diperpanjang satu tahun lagi.

Please make some amend based on below comments:

Mohon dilakukan perubahan sebagai berikut

Regards,
Hormat kami

(……………………….………..)
Initial name/signature/company chop