Code Name Address

arthagraha PT Arthagraha General Insurance

Artha Graha Building Lantai 3
Kawasan Niaga Terpadu Sudirman (SCBD)
Jl. Jend. Sudirman Kav 52-53
Jakarta Selatan 12190 - Indonesia

adira PT Asuransi Adira Dinamika

Graha Adira
Jl. MT Haryono Kav. 42
Jakarta 12780
Indonesia

allianz PT Asuransi Allianz Utama Indonesia

Allianz Tower
Jl. HR. Rasuna Said
Kawasan Kuningan Persada Super Blok 2
Jakarta 12980 - Indonesia

artarindo PT Asuransi Artarindo

Gedung Hermina Tower Lt. 12
Jl. HBR Motik Blok B. 10 Kav-4
Gunung Sahari Selatan, Kemayoran
Jakarta Pusat 10610 - Indonesia

asei PT Asuransi ASEI Indonesia

Gedung Menara Kadin Indonesia Lt. 21
Jl. HR Rasuna Said Blok X-5 Kav. 2-3
Jakarta 12950
Indonesia

astra PT Asuransi Astra Buana

Graha Asuransi Astra - 5th Floor
Jl. TB Simatupang Kav. 15
Jakarta 12440
Indonesia

axa PT Asuransi AXA Indonesia

AXA Tower 11th Floor
Jl. Prof. Dr. Satrio Kav. 18
Jakarta 12940
Indonesia

askrida PT Asuransi Bangun Askrida

Gedung Askrida Tower
Jl. Pramuka Raya Kav. 151
Jakarta Timur 13120
Indonesia

bhakti PT Asuransi Bhakti Bangun Bayangkara

 Jl. Palatehan No. 5
Melawai, Kebayoran Baru
Jakarta Selatan 12160
Indonesia

binadana PT Asuransi Bina Dana Arta Tbk

Plaza ABDA 27th Floor
Jl. Jendral Sudirman Kav. 59
Jakarta 12190
Indonesia

binagriya PT Asuransi Binagriya Upakara

Wisma Purna Batara Lantai 4-6
Jl. Kesehatan No. 56-58
Jakarta 10160
Indonesia

bintang PT Asuransi Bintang Tbk

Jl. RS. Fatmawati No. 32
Jakarta 12430
Indonesia

brins PT Asuransi Bringin Sejahtera Arthamakmur

Jl. Mampang Prapatan Raya No. 18
Jakarta Selatan 12790
Indonesia

buana PT Asuransi Buana Independent

Jl. Pintu Besar Selatan No. 78
Jakarta 11110
Indonesia

cakrawala PT Asuransi Cakrawala Proteksi Indonesia

AXA Tower
Kuningan City 32nd Floor Suite 01
Jl. Prof. Dr. Satrio Kav. 18
Jakarta 12940 - Indonesia

aca PT Asuransi Central Asia

Wisma Asia Lantai 10, 12-15
Jl. Letjen S. Parman Kav. 79
Jakarta 11420
Indonesia

chubbsyariah PT Asuransi Chubb Syariah Indonesia

Komp. Ruko Grand Boutique Centre Blok E No. 2-4
Jl. Mangga Dua Raya
 Jakarta 14430
Indonesia

dayin PT Asuransi Dayin Mitra Tbk

Wisma Hayam Wuruk 7th Floor
Jl. Hayam Wuruk No. 8
Jakarta Pusat 10120
Indonesia

etiqa PT Asuransi Etiqa Internasional Indonesia

Indosurya Life Center, 2nd Floor
Jl. MH. Thamrin No. 8-9
Jakartga 10230
Indonesia

fpg PT Asuransi FPG Indonesia

Chase Plaza Lt. 4
Jl. Jend. Sudirman Kav. 21
Jakarta 12920
Indonesia

ahap PT Asuransi Harta Aman Pratama Tbk

Jl. Balikpapan Raya No. 9
Jakarta 10130
Indonesia

aia PT Asuransi Intra Asia

Menara Hijau 8th Floor
Jl. Letjen MT Haryono Kav. 33
Jakarta Selatan 12770
Indonesia

jasindo PT Asuransi Jasa Indonesia (Persero)

Mulia Business Park
Jl. Letjend. MT Haryono Kav. 58-60
Jakarta 12780
Indonesia

jastan PT Asuransi Jasa Tania Tbk

Gedung Agro Plaza Lantai 9
Jl. HR Rasuna Said Kav. X2 No. 1
Jakarta 12950
Indonesia

jasaraharja PT Asuransi Jasaraharja Putera

Gedung Wisma Raharja Lt. III
Jl. TB Simatupang Kav. 1
Jakarta Selatan 12560
Indonesia
askrindo PT Asuransi Kredit Indonesia
Jl. Angkasa Blok B-9 Kav. B
Jakarta Pusat 10610
Indonesia

kresna PT Asuransi Kresna Mitra Tbk

Gedung Graha Kirana 6th Floor
Jl. Yos Sudarso No. 88
Jakarta Utara 14360
Indonesia

mega PT Asuransi Mega Pratama

Jl. Raya Pasar Minggu No. 14D
Jakarta Selatan 12510
Indonesia

mpm PT Asuransi Mitra Pelindung Mustika

Wisma Slipi 5th Floor
Jl. Jend. S. Parman Kav 12
Jakarta Barat 11480
Indonesia

msig PT Asuransi MSIG Indonesia

Summitmas II Building, 15th Floor
Jl. Jenderal Sudirman Kav. 61-62
Jakarta 12190
Indonesia

mag PT Asuransi Multi Artha Guna Tbk

The City Center Batavia Tower One Lt. 17
Jl. K.H. Mas Mansyur Kav. 126
Jakarta Pusat 10220
Indonesia

aspan PT Asuransi Purna Arthanugraha

Wisma Bumiputera Lt. 16
Jl. Jenderal Sudirman Kav. 75
Jakarta Selatan 12910
Indonesia

raksa PT Asuransi Raksa Praktikara

Wisma BSG 3rd Floor
Jl. Abdul Muis No. 40
Jakarta 10160
Indonesia

ramasatria PT Asuransi Rama Satria Wibawa

 Graha Irama 10th Floor
Jl. H.R. Rasuna Said Blok X-1 Kav. 1 & 2
Jakarta Selatan 12950
Indonesia

ramayana PT Asuransi Ramayana Tbk

Jl. Kebon Sirih No. 49
Jakarta 10340
Indonesia

reliance PT Asuransi Reliance Indonesia

Reliance Building
Jl. Pluit Sakti Raya No. 27 AB
Jakarta Utara 14450
Indonesia

samsung PT Asuransi Samsung Tugu

AIA Central 27th Floor
Jl. Jend. Sudirman Kav. 48A
Jakarta 12930
Indonesia

sinarmas PT Asuransi Sinar Mas

Plaza Simas
Jl. Fachrudin No. 18
Jakarta 10250
Indonesia

staco PT Asuransi Staco Mandiri

Wisma Tugu Raden Saleh Lantai 3 & 4
Jl. Raden Saleh No. 44
Jakarta 10330
Indonesia

tmi PT Asuransi Tokio Marine Indonesia

Gedung Sentral Senayan I, Lantai 3 & 4
Jl. Asia Afrika No. 8
Jakarta 10270
Indonesia

tripa PT Asuransi Tri Pakarta

Jl. Falatehan I No. 1
Jakarta Selatan 12160
Indonesia

tpi PT Asuransi Tugu Pratama Indonesia

Wisma Tugu I
Jl. H.R. Rasuna Said Kav. C8-9
 Jakarta 12920
Indonesia

umummega PT Asuransi Umum Mega

Menara Bank Mega Lantai 18
Jl. Kapten Tendean 12-14A
Jakarta Selatan 12790
Indonesia

aswata PT Asuransi Wahana Tata

Jl. H.R. Rasuna Said, C-4
Jakarta 12920
Indonesia

avrist PT Avrist General Insurance

Gedung Bank Panin Senayan 8th Floor
Jl. Jend. Sudirman
Jakarta 10270
Indonesia

bess PT Bess Central Insurance

Jl. Danau Sunter Utara Blok B 36A, Kav. 16-17
Jakarta Utara 14350
Indonesia

bosowa PT Bosowa Asuransi

Menara Global 2nd Floor
Jl. Jend. Gatot Subroto Kav. 27
Jakarta 12950
Indonesia

chinataiping PT China Taiping Insurance Indonesia

The Tower 16th Floor
Jl. Jend. Gatot Subroto Kav. 12
Jakarta 12930
Indonesia

chubb PT Chubb General Insurance Indonesia

Komp. Ruko Grand Boutique Centre Blok E No. 2-4
Jl. Mangga Dua Raya
Jakarta 14430
Indonesia

gegi PT Great Eastern General Insurance Indonesia

Mid Plaza 2 Lt. 23
Jl. Jend. Sudirman No. 10-11
Jakarta Pusat 10220
Indonesia
kb PT KB Insurance Indonesia
Sinarmas Land Plaza
Jl. M.H. Thamrin Kav. 22 No. 51
Jakarta Pusat 10350
Indonesia

ksk PT KSK Insurance Indonesia

Centennial Tower 15th Floor Unit E-G
Jl. Jend. Gatot Subroto Kav. 24 & 25
Jakarta Selatan 12930
Indonesia

lippo PT Lippo General Insurance Tbk

Karawaci Office Park Blok I No. 30-35
Lippo Village
Tangerang 15139
Indonesia

malacca PT Malacca Trust Wuwungan Insurance Tbk

Chase Plaza 8th Floor
Jl. Jend. Sudirman Kav. 21
Jakarta 12920
Indonesia

meritz PT Meritz Korindo Insurance

Wisma Korindo 1st Floor
Jl. M.T. Haryono Kav. 62
Jakarta 12780
Indonesia

mnc PT MNC Asuransi Indonesia

MNC Financial Center 11th Floor
Jl. Kebon Sirih No. 21-27
Jakarta Pusat 10340
Indonesia

panpacific PT Pan Pacific Insurance Indonesia

Graha Pratama Lt. 6
Jl. M.T. Haryono Kav. 15
Jakarta Selatan 12810
Indonesia

saranalindung PT Sarana Lindung Upaya

Gedung Tamansari Parama Lt. 9
Jl. Wahid Hasyim Kav. 84-88
Jakarta 10340
Indonesia

sompo PT Sompo Insurance Indonesia

 Mayapada Tower II, 19th Floor
Jl. Jend. Sudirman Kav. 27
Jakarta 12920
Indonesia

victoria PT Victoria Insurance Tbk

Graha BIP Lantai 3A
Jl. Gatot Subroto Kav. 22-23
Jakarta Selatan 12930
Indonesia

zurich PT Zurich Insurance Indonesia

Mayapada Tower II, Lantai 3
Jl. Jend. Sudirman Kav. 27
Jakarta 12920
Indonesia

axis PT Axis International Indonesia

Pusat Perfilman H. Usmar Ismail Building 2nd Floor
Jl. HR Rasuna Said Kav. C-22
Jakarta 12940
Indonesia

atlas PT Atlas Adjusting Indonesia

Komplek Golden Plaza Blok A No. 26
Jl. RS Fatmawati No. 15
Jakarta Selatan 12420
Indonesia

bahtera PT Bahtera Arung Persada

Royal Palace Office Centre Blok C No. 9
Jl. Prof. Dr. Soepomo No. 178
Jakarta 12870
Indonesia

cli PT Cunningham Lindsey Indonesia

Plaza Park View 3rd Floor
Jl. Taman kemang No. 27
Jakarta 12730
Indonesia

general PT General Adjuster Indonesia

Green Lake City
Rukan CBD Block F No. 19
Tangerang 15147
Indonesia

japenansi PT Japenansi Nusantara

Intiland Tower Floor 3A
Jl. Jend. Sudirman Kav. 32
 Jakarta 10220
Indonesia

kuadra PT Kuadra Inti Adjuster

Gd. MT Haryono Square Lt. 1
Jl. MT Haryono Kav. 10
Jakarta Timur 13330
Indonesia

mclarens PT McLarens Indonesia

Ventura Building 6th Floor
Jl. R.A. Kartini No. 26
Jakarta 12430
Indonesia

nk3 PT Nippon Kaiji Kentei Kyokai Indonesia

php PT Pandu Halim Perkasa

Rukan Fatmawati Mas Blok D III/ 310 & 314
Jl. Fatmawati Raya No. 20
Jakarta Selatan 12430
Indonesia

pramayasa PT Pramayasa Vaisha Adjuster

Ruko Bali View Point Blok A No. 2
Jl. Cirendeu Raya No. 10
Tangerang Selatan 15419
Indonesia

prima PT Prima Adjusterindo Mandiri

Jl. Bambu Apus Raya No. 12 B
Jakarta Timur 13890
Indonesia

rhi PT Radita Hutama Internusa

Gedung Artha Graha, Lantai 22
Jl. Jend. Sudirman Kav. 52-53
Jakarta 12190
Indonesia

royal PT Royal Conocean International Adjustment

Widya Dharma Artha Building, 4th Floor
Jl. K.H. Wahid Hasyim No. 12F
Jakarta Pusat 10340
Indonesia
sdp PT Satria Dharma Pusaka Crawford THG
Tokopedia Tower 20th Floor Unit A & F, Ciputra World 2
Jl. Prof. Dr. Satrio Kav. 11
Jakarta 12930
Indonesia
Job Number AF1-330
Date 17 October 2019
Description Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik, 6117
Date of Loss 04 August 2019
Policy no 12345678

Code PIC
Adjuster axis Mr Ignatius Wahyu Haryawan
Leader umummega Mr Irsyad Dozyn
Member malacca Mr Joko Kurniadi
mag Mr Rinto Cokrolukito
mnc
jasindo Mr Sadulloh
allianz Mr Ramli Saputra
adira
kresna Ms Eri Fitrinawati
aspan
brins Mr Ginanjar Amerti
axa
astra Ms Dyah Ayu Prameshwari
bintang Mr Dodi Herudiarto
fpg Mr Ahmad Helmy
ksk Mr Utu Wanahar
Jalan Raya Bambe KM 18, Driyorejo, Gresik, 61177, Indonesia
Date 17 October 2019
Our Ref AF1-330

PT Axis International Indonesia

Pusat Perfilman H. Usmar Ismail Building 2nd Floor
Jl. HR Rasuna Said Kav. C-22
Jakarta 12940
Indonesia

Dear Mr Ignatius Wahyu Haryawan

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our Final Report dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Report by signing and returning the duplicate
copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you.

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Umum Mega

Menara Bank Mega Lantai 18
Jl. Kapten Tendean 12-14A
Jakarta Selatan 12790
Indonesia

Dear Mr Irsyad Dozyn

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our Final Report and copies of
Invoices dated 17 October 2019 on the abovementioned investigation for your perusal and
information.

Kindly acknowledge receipt the copies of our Report and Invoices by signing and returning
the duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you.

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Malacca Trust Wuwungan Insurance Tbk

Chase Plaza 8th Floor
Jl. Jend. Sudirman Kav. 21
Jakarta 12920
Indonesia

Dear Mr Joko Kurniadi

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated
17 October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Multi Artha Guna Tbk

The City Center Batavia Tower One Lt. 17
Jl. K.H. Mas Mansyur Kav. 126
Jakarta Pusat 10220
Indonesia

Dear Mr Rinto Cokrolukito

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated
17 October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT MNC Asuransi Indonesia

MNC Financial Center 11th Floor
Jl. Kebon Sirih No. 21-27
Jakarta Pusat 10340
Indonesia

Dear

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated
17 October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Jasa Indonesia (Persero)

Mulia Business Park
Jl. Letjend. MT Haryono Kav. 58-60
Jakarta 12780
Indonesia

Dear Mr Sadulloh

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Allianz Utama Indonesia

Allianz Tower
Jl. HR. Rasuna Said
Kawasan Kuningan Persada Super Blok 2
Jakarta 12980 - Indonesia

Dear Mr Ramli Saputra

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Adira Dinamika

Graha Adira
Jl. MT Haryono Kav. 42
Jakarta 12780
Indonesia

Dear

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Kresna Mitra Tbk

Gedung Graha Kirana 6th Floor
Jl. Yos Sudarso No. 88
Jakarta Utara 14360
Indonesia

Dear Ms Eri Fitrinawati

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
Date 17 October 2019
Our Ref AF1-330

PT Asuransi Purna Arthanugraha

Wisma Bumiputera Lt. 16
Jl. Jenderal Sudirman Kav. 75
Jakarta Selatan 12910
Indonesia

Dear

Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
October 2019 on the abovementioned investigation for your perusal and information.

Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

Yours faithfully We hereby acknowledge receipt copy

Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT Asuransi Bringin Sejahtera Arthamakmur

Jl. Mampang Prapatan Raya No. 18
Jakarta Selatan 12790
Indonesia

Dear Mr Ginanjar Amerti

e KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

ur copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
rusal and information. October 2019 on the abovementioned investigation for your perusal and information.

signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

surer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

by acknowledge receipt copy Yours faithfully We hereby acknowledge receipt copy

ovementioned report Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT Asuransi AXA Indonesia

AXA Tower 11th Floor
Jl. Prof. Dr. Satrio Kav. 18
Jakarta 12940
Indonesia

Dear

e KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

ur copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
rusal and information. October 2019 on the abovementioned investigation for your perusal and information.

signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

surer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

by acknowledge receipt copy Yours faithfully We hereby acknowledge receipt copy

ovementioned report Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT Asuransi Astra Buana

Graha Asuransi Astra - 5th Floor
Jl. TB Simatupang Kav. 15
Jakarta 12440
Indonesia

Dear Ms Dyah Ayu Prameshwari

e KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

ur copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
rusal and information. October 2019 on the abovementioned investigation for your perusal and information.

signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

surer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

by acknowledge receipt copy Yours faithfully We hereby acknowledge receipt copy

ovementioned report Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT Asuransi Bintang Tbk

Jl. RS. Fatmawati No. 32
Jakarta 12430
Indonesia
0

Dear Mr Dodi Herudiarto

e KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

ur copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
rusal and information. October 2019 on the abovementioned investigation for your perusal and information.

signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

surer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

by acknowledge receipt copy Yours faithfully We hereby acknowledge receipt copy

ovementioned report Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT Asuransi FPG Indonesia

Chase Plaza Lt. 4
Jl. Jend. Sudirman Kav. 21
Jakarta 12920
Indonesia

Dear Mr Ahmad Helmy

e KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

ur copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invoices dated 17
rusal and information. October 2019 on the abovementioned investigation for your perusal and information.

signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and returning the
duplicate copy of the letter attached hereto.

surer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for further action.

co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for their further
action.

Thank you

by acknowledge receipt copy Yours faithfully We hereby acknowledge receipt copy

ovementioned report Approved Consultants Pte Ltd of the abovementioned report

…................................................ …....................................
Kirit Kumar Authorized Signatory
Director Name:
Position:
Date:
Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

PT KSK Insurance Indonesia

Centennial Tower 15th Floor Unit E-G
Jl. Jend. Gatot Subroto Kav. 24 & 25
Jakarta Selatan 12930
Indonesia

Dear Mr Utu Wanahar

an Raya Bambe KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driy
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

e herewith is our copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invo
tion for your perusal and information. October 2019 on the abovementioned investigation for your perusal and inform

ur Invoices by signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and r
duplicate copy of the letter attached hereto.

ce is sent to insurer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for furthe

es couriered to co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for
action.

Thank you

We hereby acknowledge receipt copy Yours faithfully

of the abovementioned report Approved Consultants Pte Ltd

….................................... …................................................
Authorized Signatory Kirit Kumar
Director

Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

#N/A
#N/A
#N/A
#N/A
#N/A

Dear

an Raya Bambe KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driy
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

e herewith is our copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invo
tion for your perusal and information. October 2019 on the abovementioned investigation for your perusal and inform

ur Invoices by signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and r
duplicate copy of the letter attached hereto.

ce is sent to insurer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for furthe

es couriered to co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for
action.

Thank you

We hereby acknowledge receipt copy Yours faithfully

of the abovementioned report Approved Consultants Pte Ltd

….................................... …................................................
Authorized Signatory Kirit Kumar
Director

Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

#N/A
#N/A
#N/A
#N/A
#N/A

Dear

an Raya Bambe KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driy
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

e herewith is our copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invo
tion for your perusal and information. October 2019 on the abovementioned investigation for your perusal and inform

ur Invoices by signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and r
duplicate copy of the letter attached hereto.

ce is sent to insurer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for furthe

es couriered to co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for
action.

Thank you

We hereby acknowledge receipt copy Yours faithfully

of the abovementioned report Approved Consultants Pte Ltd

….................................... …................................................
Authorized Signatory Kirit Kumar
Director

Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

#N/A
#N/A
#N/A
#N/A
#N/A

Dear

an Raya Bambe KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driy
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

e herewith is our copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invo
tion for your perusal and information. October 2019 on the abovementioned investigation for your perusal and inform

ur Invoices by signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and r
duplicate copy of the letter attached hereto.

ce is sent to insurer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for furthe

es couriered to co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for
action.

Thank you

We hereby acknowledge receipt copy Yours faithfully

of the abovementioned report Approved Consultants Pte Ltd

….................................... …................................................
Authorized Signatory Kirit Kumar
Director

Company’s Stamp:
 Date 17 October 2019
Our Ref AF1-330

#N/A
#N/A
#N/A
#N/A
#N/A

Dear

an Raya Bambe KM 18, Driyorejo, Gresik, Premises Fire Investigation carried out at Jalan Raya Bambe KM 18, Driy
61177, Indonesia
Date of Loss: 04 August 2019
Policy no: 12345678

e herewith is our copies of Invoices dated 17 We refer to the above and are pleased to enclose herewith is our copies of Invo
tion for your perusal and information. October 2019 on the abovementioned investigation for your perusal and inform

ur Invoices by signing and returning the Kindly acknowledge receipt the copies of our Invoices by signing and r
duplicate copy of the letter attached hereto.

ce is sent to insurer for further action. A hardcopy of our Final Report and Original Invoice is sent to insurer for furthe

es couriered to co-member for their further Softcopy of report (emailed) and original invoices couriered to co-member for
action.

Thank you

We hereby acknowledge receipt copy Yours faithfully

of the abovementioned report Approved Consultants Pte Ltd

….................................... …................................................
Authorized Signatory Kirit Kumar
Director

Company’s Stamp:
out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,

to enclose herewith is our copies of Invoices dated 17

investigation for your perusal and information.

pies of our Invoices by signing and returning the

hereto.

iginal Invoice is sent to insurer for further action.

nal invoices couriered to co-member for their further

We hereby acknowledge receipt copy

of the abovementioned report

…....................................
Authorized Signatory
Name:
Position:
Date:
Company’s Stamp:
out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,

to enclose herewith is our copies of Invoices dated 17

investigation for your perusal and information.

pies of our Invoices by signing and returning the

hereto.

iginal Invoice is sent to insurer for further action.

nal invoices couriered to co-member for their further

We hereby acknowledge receipt copy

of the abovementioned report

…....................................
Authorized Signatory
Name:
Position:
Date:
Company’s Stamp:
out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,

to enclose herewith is our copies of Invoices dated 17

investigation for your perusal and information.

pies of our Invoices by signing and returning the

hereto.

iginal Invoice is sent to insurer for further action.

nal invoices couriered to co-member for their further

We hereby acknowledge receipt copy

of the abovementioned report

…....................................
Authorized Signatory
Name:
Position:
Date:
Company’s Stamp:
out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,

to enclose herewith is our copies of Invoices dated 17

investigation for your perusal and information.

pies of our Invoices by signing and returning the

hereto.

iginal Invoice is sent to insurer for further action.

nal invoices couriered to co-member for their further

We hereby acknowledge receipt copy

of the abovementioned report

…....................................
Authorized Signatory
Name:
Position:
Date:
Company’s Stamp:
out at Jalan Raya Bambe KM 18, Driyorejo, Gresik,

to enclose herewith is our copies of Invoices dated 17

investigation for your perusal and information.

pies of our Invoices by signing and returning the

hereto.

iginal Invoice is sent to insurer for further action.

nal invoices couriered to co-member for their further

We hereby acknowledge receipt copy

of the abovementioned report

…....................................
Authorized Signatory
Name:
Position:
Date:
Company’s Stamp: