DRAFT

C / I : 2803021500216

POLICY SCHEDULE MARINE CARGO INSURANCE

TYPE OF INSURANCE : Marine Cargo Import

(NEW) POLICY NO. :

THE INSURED : PT ANAK JAYA BAPAK SEJAHTERA JL. RATNA NO.14 BLOK C-2, SURABAYA : CORRESPONDENCE ADDRESS

DATE OF SAILING : October 21, 2015 CONSIGNEE : PT. ANAK JAYA BAPAK SEJAHTERA

JL. RATNA NO.14 BLOK C-2, SURABAYA OOCL TOKYO 064W , GRT / THN : 89097 / 2007 - - VESSEL/CONVEYANCE :

VOYAGE : From : SHANGHAI, CHINA To : TANJUNG PERAK, SURABAYA, INDONESIA

: INVOICE NO SJFH-150708-1 : B/L NO. BSISHA15090598 : L/C NO. MI77252084571 : ISSUING BANK PT. BANK MANDIRI (PERSERO) TBK., INDONESIA

TYPE OF COVER : Institute Cargo Clause A ( 0.07000 % )

- 52PCS OF SOFA QUALITY : EXPORT STANDARTD COUNTRY OF ORIGIN : CHINA CONTRACT. NO :SJFH-150708-1 H.S. NO. : 9401 INCOTERMS 2010 FOB ANY PORT IN SHANGHAI, CHINA

USD 15,632.15 PROPERTY INSURED :

DEDUCTIBLE : - 0,1% of total sum insured min IDR 1,000,000.00 any one loss or series arising out the same event

PREMIUM CALCULATION :

Premium Premium Calculation

USD USD : : 15,632.15 x 0.07000% 10.94

USD : Biaya Polis (Policy Cost) 2.70 USD : Biaya Materai ( Duty Cost ) 0.65

USD 14.29

NOTE : KURS SAAT INI IDR. 14.305 In witness whereof the Undersigned being duly authorized by the Insurers and on behalf of the Insurers has (have) hereunto set his (their) hand(s).

Surabaya, October 21, 2015

A - M28PM00001/01 - M28PM00001 10/26/15 PSNSI0301E.RPT Page 1 of 2

DRAFT

C / I : 2803021500216 This page is a forming part of Policy No.

: Klausula (Clauses)

INSTITUTE THEFT,PILFERAGE AND NON-DELIVERY CLAUSE (1/12/82) . 1 CANCELLATION CLAUSE ( 30 DAYS ) . 2 DISPUTE CLAUSE . 3 WAIVER CLAUSE . 4 INSTITUTE STRIKES CLAUSE . 5 INSTITUTE WAR CLAUSES (A) (AIR CARGO) 1.1.82 . 6 TOTAL ASBESTOS EXCLUSION CLAUSE . 7 TERRORISM EXCLUSION CLAUSE (CARGO) . 8 INCLUDING TRANSHIPMENT RISK . 9 NOMINATED LOSS ADJUSTER : - PT CUNNINGHAM LINDSAY INDONESIA - PT RADITA HUTAMA INTERNUSA

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INSTITUTE CARGO CLAUSES (A) 1.1.82 . 11 INSTITUTE CARGO CLAUSES (A) (AIR CARGO) 1.1.82 . 12 ELECTRONIC DATE RECOGNITION EXCLUSION CLAUSE - EDRC ( A ) CARGO . 13 INFORMATION TECHNOLOGY HAZARD CLAUSE JEL16/11/01 . 14 RIOTS, STRIKES, MALICIOUS DAMAGE, CIVIL COMMOTION FOR ALL TRANSHIPMENT . 15 LOADING & UNLOADING CLAUSE . 16 INSTITUTE CLASSIFICATION CLAUSE 1/1/01 AMENDED TO INCLUDE B.K.I CLASSIFICATION AND AGE OF VESSEL NOT OLDER THAN 35 YEARS OF AGE

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CONCEALED DAMAGE CLAUSE (30 DAYS) . 18 WAIVER OF SUBROGATION . 19 INCLUDING HIJACK, ROBBERY AND PIRACY CLAUSE . 20 MALICIOUS DAMAGE CLAUSE 1/8/82 . 21 INSTITUTE WAR CANCELLATION CLAUSE (CARGO) 1/12/82 . 22 INSTITUTE WAR CLAUSE (A) (CARGO) 1.1.82 . 23 CARGO ISM ENDORSEMENT . 24 INSTITUTE CYBER ATTACK EXCLUSION CLAUSE . 25 SEEPAGE & POLLUTION EXCLUSION CLAUSE . 26 INSTITUTE RADIOACTIVE CONTAMINATION, CHEMICAL, BIOLOGICAL, BIO-CHEMICAL, ELECTROMAGNETIC WEAPON EXCLUSION CLAUSE

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