RI372-02 Claims Declined

AS AT 07/11/2019
Company: 2 Prudential Life Assurance Run Date: 07/11/2019
Branch: 10 Head Office Time: 23:43:58
Currency:IDR Indonesian Rupiah Page: 31

Office: JM7 - FIN WINNER - JAMBI

Agent: 00655182/ELLY CHANDRA
e-mail: ELLY.CHANDRA@YAHOO.CO.ID

Policy# Life Assured Risk Com. Coverage Amount Curr Type of Claim Caused by Reason to Decline
Date Period/month Code

54216121 SUSANTO 23/01/2014 68 80,000,000.00 IDR Early Stage Crisis Cover G20

Note:
Surat Pemberitahuan akan dikirimkan tiga hari kerja setelah Klaim tidak disetujui untuk dibayarkan.