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| Participants | Sum Insured |
| Main Cardholder | IDR200.000.000,- |
| Spouse | IDR200.000.000,- |
| 2(two) Children | IDR200.000.000,- |
| TOTAL | IDR600.000.000,- |
STANDARD INDONESIAN
PERSONAL ACCIDENT INSURANCE POLICY
ARTICLE 1 1
INSURED RISKS
ARTICLE 2
RIGHT OVER BENEFIT
ARTICLE 3
AMOUNT OF BENEFIT
| No. | Description | % |
| 1. | Right arm starting on the shoulder joint | 60 % |
| 2. | Left arm starting on the shoulder joint | 50 % |
| 3. | Right arm starting from the top of the elbow joint | 50 % |
| 4. | Left arm starting from the top of the elbow joint | 40 % |
| 5. | Right hand starting from top of the wristLeft arm starting from the top of the elbow joint | 40 % |
| 6. | Left hand starting from top of the wrist | 30 % |
| 7. | One leg starting from the knee up to the hip | 50 % |
| 8. | One leg starting from the ankle to the knee | 25 % |
| 9. | Right hand thumb | 15 % |
| 10. | Left hand thumb | 10 % |
| 11. | Right hand index finger | 10 % |
| 12. | Left hand index finger | 8 % |
| 13. | Right hand little finger | 8 % |
| 14. | Left hand little finger | 6 % |
| 15. | Right hand middle or ring finger | 5 % |
| 16. | Left hand middle or ring finger | 4 % |
| 17. | One big toe | 8 % |
| 18. | One other toe | 5 % |
| 19. | One eye | 50 % |
| 20. | Hearing in both ears | 50 % |
| 21. | Hearing in one ear | 25 % |
| 22. | One whole ear | 5 % |
| Transaction order | % Cashback |
| Tenth and above (≥ 10 ) | 5% |
| Sixth (6th) – Ninth (9th) | 3% |
| First (1st) – Fifth (5th) | 1% |
| Transaction order | % Cashback |
| Tenth and above (≥ 10 ) | 5% |
| Sixth (6th) – Ninth (9th) | 3% |
| First (1st) – Fifth (5th) | 1% |
| Date | Transaction Order | Transaction Details | Bill Amount | % Cashback | Cashback received (old terms) | Cashback received (new terms) |
| 11-Aug-18 | First (1st) | Shabu Slim | IDR 500.000 | 1% | IDR 5.000 | IDR 5.000 |
| 20-Aug-18 | Second (2nd) | PT. Yamaha Music | IDR 2.000.000 | 1% | IDR 20.000 | IDR 20.000 |
| 8-Sep-18 | Third (3rd) | EraPhone | IDR 2.500.000 | 1% | IDR 25.000 | IDR 25.000 |
| 9 Sept 18 * | N/A | Tokopedia | IDR 50.000 | - | IDR 0 | IDR 0 |
| 10-Sep-18 | Fourth (4th) | Payless | IDR 750.000 | 1% | IDR 7.500 | IDR 7.500 |
| Total | IDR 5.800.000 | IDR 57.500 | IDR 50.000 |
| Date | Transaction Order |
Transaction Details |
Bill Amount | % Cashback | Cashback received (old terms) | Cashback received (new terms) |
| 11-Feb-18 | First (1st) | Traveloka JAKARTA | IDR 950,000 | 1% | IDR 9,500 | IDR 9,500 |
| 12-Feb-18 | Second (2nd) | SPBU 34-17412 Bekasi | IDR 350,000 | 1% | IDR 3,500 | IDR 3,500 |
| 13-Feb-18 | Third (3rd) | Happy Fresh | IDR 200,000 | 1% | IDR 2,000 | IDR 2,000 |
| 14-Feb-18 | Fourth (4th) | RSIA Hermina Jakarta | IDR 3,000,000 | 1% | IDR 30,000 | IDR 30,000 |
| 15-Feb-18 | Fifth (5th) | Yamaha Music | IDR 2,750,000 | 1% | IDR 27,500 | IDR 27,500 |
| 16-Feb-18 | Sixth (6th) | SOUR SALLY MKG | IDR 200,000 | 3% | IDR 6,000 | IDR 6,000 |
| 17-Feb-18 | Seventh (7th) | GIANT HYPRMRKT | IDR 975,000 | 3% | IDR 29,250 | IDR 29,250 |
| 18-Feb-18 | Eighth (8th) | PT. TIP TOP | IDR 1,000,000 | 3% | IDR 30,000 | IDR 30,000 |
| 22-Feb-18 | Ninth (9th) | SUNSET DS | IDR 1,500,000 | 3% | IDR 30,000 | IDR 30,000 |
| 22-Feb-18 | tenth (10th) | SOLARIA West Jakarta | IDR 200,000 | 5% | IDR 10,000 | IDR 10,000 |
| 23-Feb-18 | Eleventh (11th) | SPBU 34-17412 East Jakarta | IDR 150,000 | 5% | IDR 7,500 | IDR 7,500 |
| 24-Feb-18 | Twelfth (12th) | RESTO PONDOK LAGUNA | IDR 295,000 | 5% | IDR 14,750 | IDR 14,750 |
| Total | IDR 200,000 | IDR 200,000 |