01105_baru
137
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION 0000020430 0000028890 0000031410 0000041110 0000041120 0000042940 0000042950 0000057440 0000058790 0000058800 0000058830 0000064840 0000064890 0000020520 0000025200 0000030630 0000034150 0000034330 0000034970 0000036070 0000041950 LIST OF CHANGE & PREMIUM ADJUSTMENT ACCOUNTING ENTR C U R R E N C Y C O M P A N Y : : : 2nd RUPIAH PT ASURANSI CIGNA TYPE OF REINS. LINE OF BUSINESS CLASS OF BUSINESS : : : TREATY INDIVIDUAL NON MEDICAL P O O L C O D E : 022 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 AE00020430 AE00028890 AE00031410 AE00041110 AE00041120 AE00042940 AE00042950 AE00057440 AE00058790 AE00058800 AE00058830 AE00064840 AE00064890 AP00020520 AP00025200 AP00030630 AP00034150 AP00034330 AP00034970 AP00036070 AP00041950 19.06.2008 27.04.2012 27.01.2012 29.11.2010 29.11.2010 29.11.2010 29.11.2010 27.04.2012 28.12.2010 28.12.2010 29.11.2010 27.04.2012 27.04.2012 10.07.2008 27.01.2009 27.04.2012 27.02.2012 28.03.2011 29.11.2010 02.03.2011 28.03.2011 23.05.2012 16.05.2012 28.05.2012 09.05.2012 09.05.2012 25.05.2012 25.05.2012 28.05.2012 23.05.2012 23.05.2012 28.05.2012 28.05.2012 28.05.2012 10.05.2012 10.05.2012 28.05.2012 22.05.2012 28.05.2012 09.05.2012 14.05.2012 01.05.2012 NO. CERT. NO. POLICY NO. DATE OF COMMENC. DATE OF CHANGES NATURE OF CH. PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO REINSURERS PREM. DUE TO CEDANT REFUND.COMM. SUM REASSURED 01105/II/2012/01 NO : Quarter 2012 NON POOL 1 PAGE : RATNO SUBAGIO UUS MIFTAHUL JALAL . KARSONO RUCIE NOVIHARI RUCIE NOVIHARI R.D DIANA KENCANA SA R.D DIANA KENCANA SA ALI RAMDANI RATNO SUBAGIO RATNO SUBAGIO DENDY KOMARAJAYA YANTI RISMAYANTI HERLIANA SOLIHIN B HAPMI ONGKOWIJAYA DR DESSY KUSUMAYATI ALI RAMDANI UMI FADHILAH TIMBUL SAUT SAKKAP S RUCIE NOVIHARI WING HANGGODO HERYANTO SUTANTO 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA2 UBCA1 UBCA1 UBCA1 UBCA1 UBCA1 UBCA1 UBCA1 UBCA1 0.00 504,167.00 0.00 0.00 160,417.00 0.00 0.00 0.00 0.00 82,833.00 90,000.00 134,750.00 0.00 0.00 0.00 32,083.00 0.00 0.00 320,833.00 0.00 0.00 2011 2012 2012 2011 2011 2011 2011 2012 2011 2011 2011 2012 2012 2011 2012 2012 2012 2012 2011 2012 2012 0.00 550,000.00 0.00 0.00 275,000.00 0.00 0.00 0.00 0.00 142,000.00 180,000.00 147,000.00 0.00 0.00 0.00 35,000.00 0.00 0.00 550,000.00 0.00 0.00 0.00 55,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14,700.00 0.00 0.00 0.00 3,500.00 0.00 0.00 0.00 0.00 0.00 100,000,000.00 200,000,000.00 100,000,000.00 200,000,000.00 200,000,000.00 100,000,000.00 100,000,000.00 100,000,000.00 150,000,000.00 150,000,000.00 250,000,000.00 250,000,000.00 150,000,000.00 200,000,000.00 100,000,000.00 100,000,000.00 100,000,000.00 100,000,000.00 200,000,000.00 200,000,000.00 150,000,000.00 0.00 200,000,000.00 0.00 0.00 100,000,000.00 0.00 0.00 0.00 0.00 100,000,000.00 250,000,000.00 150,000,000.00 0.00 0.00 0.00 50,000,000.00 0.00 0.00 200,000,000.00 0.00 0.00 0.00 50,417.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13,475.00 0.00 0.00 0.00 3,208.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 453,750.00 0.00 0.00 160,417.00 0.00 0.00 0.00 0.00 82,833.00 90,000.00 121,275.00 0.00 0.00 0.00 28,875.00 0.00 0.00 320,833.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 453,750.00 0.00 0.00 160,417.00 0.00 0.00 0.00 0.00 82,833.00 90,000.00 121,275.00 0.00 0.00 0.00 28,875.00 0.00 0.00 320,833.00 0.00 0.00
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PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000020430
0000028890
0000031410
0000041110
0000041120
0000042940
0000042950
0000057440
0000058790
0000058800
0000058830
0000064840
0000064890
0000020520
0000025200
0000030630
0000034150
0000034330
0000034970
0000036070
0000041950
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
AE00020430
AE00028890
AE00031410
AE00041110
AE00041120
AE00042940
AE00042950
AE00057440
AE00058790
AE00058800
AE00058830
AE00064840
AE00064890
AP00020520
AP00025200
AP00030630
AP00034150
AP00034330
AP00034970
AP00036070
AP00041950
19.06.2008
27.04.2012
27.01.2012
29.11.2010
29.11.2010
29.11.2010
29.11.2010
27.04.2012
28.12.2010
28.12.2010
29.11.2010
27.04.2012
27.04.2012
10.07.2008
27.01.2009
27.04.2012
27.02.2012
28.03.2011
29.11.2010
02.03.2011
28.03.2011
23.05.2012
16.05.2012
28.05.2012
09.05.2012
09.05.2012
25.05.2012
25.05.2012
28.05.2012
23.05.2012
23.05.2012
28.05.2012
28.05.2012
28.05.2012
10.05.2012
10.05.2012
28.05.2012
22.05.2012
28.05.2012
09.05.2012
14.05.2012
01.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
1PAGE :
RATNO SUBAGIO
UUS MIFTAHUL JALAL
. KARSONO
RUCIE NOVIHARI
RUCIE NOVIHARI
R.D DIANA KENCANA SA
R.D DIANA KENCANA SA
ALI RAMDANI
RATNO SUBAGIO
RATNO SUBAGIO
DENDY KOMARAJAYA
YANTI RISMAYANTI
HERLIANA SOLIHIN
B HAPMI ONGKOWIJAYA
DR DESSY KUSUMAYATI
ALI RAMDANI
UMI FADHILAH
TIMBUL SAUT SAKKAP S
RUCIE NOVIHARI
WING HANGGODO
HERYANTO SUTANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA2
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
0.00
504,167.00
0.00
0.00
160,417.00
0.00
0.00
0.00
0.00
82,833.00
90,000.00
134,750.00
0.00
0.00
0.00
32,083.00
0.00
0.00
320,833.00
0.00
0.00
2011
2012
2012
2011
2011
2011
2011
2012
2011
2011
2011
2012
2012
2011
2012
2012
2012
2012
2011
2012
2012
0.00
550,000.00
0.00
0.00
275,000.00
0.00
0.00
0.00
0.00
142,000.00
180,000.00
147,000.00
0.00
0.00
0.00
35,000.00
0.00
0.00
550,000.00
0.00
0.00
0.00
55,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,700.00
0.00
0.00
0.00
3,500.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
200,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
150,000,000.00
150,000,000.00
250,000,000.00
250,000,000.00
150,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
150,000,000.00
0.00
200,000,000.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
100,000,000.00
250,000,000.00
150,000,000.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
50,417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13,475.00
0.00
0.00
0.00
3,208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
453,750.00
0.00
0.00
160,417.00
0.00
0.00
0.00
0.00
82,833.00
90,000.00
121,275.00
0.00
0.00
0.00
28,875.00
0.00
0.00
320,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
453,750.00
0.00
0.00
160,417.00
0.00
0.00
0.00
0.00
82,833.00
90,000.00
121,275.00
0.00
0.00
0.00
28,875.00
0.00
0.00
320,833.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000078660
0000080980
0000097690
0000101130
0000102070
0000102280
0000102340
0000102350
0000102390
0000102420
0000103870
000000183Z
0000003760
0000005650
000000634Z
0000010270
000001102Z
000001130V
000001140V
0000048040
0000048120
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
AP00078660
AP00080980
AP00097690
AP00101130
AP00102070
AP00102280
AP00102340
AP00102350
AP00102390
AP00102420
AP00103870
BD0000183Z
BD00003760
BD00005650
BD0000634Z
BD00010270
BD0001102Z
BD0001130V
BD0001140V
BD00048040
BD00048120
21.10.2009
29.06.2010
29.11.2010
28.07.2010
27.03.2012
27.03.2012
27.04.2012
27.04.2012
27.04.2012
27.04.2012
27.03.2012
28.09.2009
28.01.2010
20.04.2009
22.06.2010
25.03.2009
25.07.2011
27.10.2011
27.10.2011
01.07.2011
26.09.2011
09.05.2012
09.05.2012
25.05.2012
28.05.2012
14.05.2012
07.05.2012
28.05.2012
23.05.2012
28.05.2012
28.05.2012
08.05.2012
02.05.2012
28.05.2012
28.05.2012
04.05.2012
25.05.2012
01.05.2012
10.05.2012
01.05.2012
23.05.2012
26.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
2PAGE :
DEWI ISABELA
ADI DHARMA
R.D. DIANA KENCANA S
MUHAMAD BAGJA DIRGAN
UUS MIFTAHUL JALAL
ZAENAL ABIDIN
HERLIANA SOLIHIN
HESTI SAPTARINI
RIZA ARIANA
SARI NURANI
DUDUNG BENI HERMAWAN
NI WAYAN PADMI .
MUHAMMAD YUSUF INDRA
ISWANTI
YASIR .
NOOR WAHYUNI
CHRISTINA .
KASDU PENDIK DEWANTARA .
RONALD FREDERICH SITOHANG .
SONY HARPRIYONO
NANA JUHANA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
UBCA1
LBD01
UBDN2
UBDN2
LBD01
UBDN2
LBD01
LBD01
LBD01
UBDN2
UBDN2
0.00
0.00
0.00
29,167.00
229,167.00
0.00
36,208.00
0.00
0.00
96,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2011
2012
2011
2011
2011
2011
2011
0.00
0.00
0.00
175,000.00
275,000.00
0.00
39,500.00
0.00
0.00
105,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
27,500.00
0.00
3,950.00
0.00
0.00
10,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
100,000,000.00
100,000,000.00
350,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
150,000,000.00
150,000,000.00
100,000,000.00
60,000,000.00
60,000,000.00
100,000,000.00
36,000,000.00
100,000,000.00
300,000,000.00
200,000,000.00
36,000,000.00
60,000,000.00
0.00
0.00
0.00
250,000,000.00
100,000,000.00
0.00
50,000,000.00
0.00
0.00
150,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22,917.00
0.00
3,621.00
0.00
0.00
9,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
206,250.00
0.00
32,587.00
0.00
0.00
86,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
206,250.00
0.00
32,587.00
0.00
0.00
86,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0030000007
000000312Y.02
0000013810
0000058880
0000083680
0000087500
0000096100
0000117860
0000118400
0000127950
0000133040
0000155250
0000161860
0000161870
0000167170
0000169530
0000200380
0000211350
0000217680
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
BP30000007
CD0000312Y
CM00013810
CM00058880
CM00083680
CM00087500
CM00096100
CM00117860
CM00118400
CM00127950
CM00133040
CM00155250
CM00161860
CM00161870
CM00167170
CM00169530
CM00200380
CM00211350
CM00217680
26.05.2008
29.12.2009
19.10.2006
27.09.2006
17.10.2006
27.11.2006
27.11.2006
03.01.2007
13.12.2006
04.01.2007
26.01.2007
05.02.2008
28.05.2007
28.05.2007
26.02.2007
14.01.2008
17.04.2007
28.06.2007
11.04.2008
26.05.2012
01.05.2012
04.05.2012
27.05.2012
24.05.2012
25.05.2012
22.05.2012
03.05.2012
21.05.2012
08.05.2012
26.05.2012
05.05.2012
01.05.2012
01.05.2012
29.05.2012
02.05.2012
17.05.2012
16.05.2012
11.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
3PAGE :
ROBBY KUSUMAHARTA
KENYO AYU KARTIKA .
RAFI ALMASA MUHAMMAD
IDA AYU KOMANG DWIST
GUNAWAN WASKITO AJI
IMAM PRAKOSO
TRISTA WIJAYANTI
RINANDA ASTRIANI BTB
DONNY YANUAR RIZALDI
ANNY ISFANDIYARIE
ARIEF LUSENA,ST.
MAR'I FIRDAUS
YULIANTI RAHAYU
TAMARA FRANSISKA .N.
ASEP AHMADI .ST
YULIANA BUDIANTI
WULANDARI SUSI LESMA
TEDY WAHYUDI
GERALD HADISOEMARTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CBP01
DN305
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2011
2011
2011
2011
2011
2012
2011
2012
2012
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
185,000,000.00
15,000,000.00
5,970,000.00
6,330,000.00
5,160,000.00
7,590,000.00
9,930,000.00
5,160,000.00
5,160,000.00
8,010,000.00
9,930,000.00
15,090,000.00
6,330,000.00
6,330,000.00
5,970,000.00
5,970,000.00
8,010,000.00
14,370,000.00
5,160,000.00
8,010,000.00
9,930,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000225310
0000226160
0000234760
0000241820
0000262970
0000262980
0000264600
0000265320
0000265720
0000268460
0000270980
0000275110
0000275120
0000277600
0000281060
0000287680
0000289210
0000289220
0000291530
0000291540
0000298510
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
CM00225310
CM00226160
CM00234760
CM00241820
CM00262970
CM00262980
CM00264600
CM00265320
CM00265720
CM00268460
CM00270980
CM00275110
CM00275120
CM00277600
CM00281060
CM00287680
CM00289210
CM00289220
CM00291530
CM00291540
CM00298510
25.07.2007
21.05.2007
04.09.2007
12.03.2008
12.11.2007
12.11.2007
29.10.2007
04.04.2008
17.09.2007
28.08.2007
25.09.2007
10.08.2007
10.08.2007
27.03.2008
27.11.2007
19.03.2008
21.02.2008
21.02.2008
23.11.2007
23.11.2007
23.11.2007
25.05.2012
08.05.2012
07.05.2012
12.05.2012
29.05.2012
29.05.2012
03.05.2012
10.05.2012
02.05.2012
21.05.2012
25.05.2012
28.05.2012
28.05.2012
27.05.2012
27.05.2012
19.05.2012
14.05.2012
14.05.2012
03.05.2012
03.05.2012
07.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
4PAGE :
SALSABILA NAFISAH. H
RITA LAKSMITASARI RA
ELUS TRISNAWATI
JHON FERRY PARDEDE
SHARI ROSSIDA
RAFEYFA ASHYLLA
IDA BAGUS SUPUTRA
LINDA
DATIKA WIDIANI
EKA LISTIANI
FARREL MUHAMMAD ATHI
WIWIK DWI PRAMUDYANI
RIO BAGUS WAHYUDIANO
HERU SANYOTO
SINDY PURBASARI
LINDA SIHOMBING
ITA SOFIANA
FANDI FATURRAHMAN
LIVIANA CANNY DEWINT
KENNY OCTAVIANTO J
MAHENDRA WIBISONO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2011
2012
2011
2011
2011
2012
2011
2011
2011
2011
2011
2012
2011
2012
2012
2012
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,970,000.00
23,100,000.00
5,160,000.00
8,010,000.00
8,010,000.00
9,330,000.00
8,010,000.00
8,010,000.00
8,010,000.00
5,160,000.00
9,330,000.00
17,610,000.00
9,330,000.00
31,860,000.00
8,010,000.00
18,930,000.00
17,610,000.00
9,330,000.00
17,760,000.00
17,760,000.00
12,030,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000305920
0000305930
0000308410
0000327900
0000348110
0000350790
0000365250
0000365260
0000365390
0000377140
0000379930
0000390310
0000397410
0000398480
0000399130
0000428010
0000508580
000000200Z
000000206Z
000000107Z
0000468413
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
CM00305920
CM00305930
CM00308410
CM00327900
CM00348110
CM00350790
CM00365250
CM00365260
CM00365390
CM00377140
CM00379930
CM00390310
CM00397410
CM00398480
CM00399130
CM00428010
CM00508580
DL0000200Z
DL0000206Z
HL0000107Z
IMKIN0000468413
27.03.2008
24.04.2008
12.02.2008
25.04.2008
12.12.2007
11.01.2008
26.12.2007
26.12.2007
11.01.2008
19.12.2007
23.04.2008
27.03.2008
13.03.2008
27.03.2008
25.04.2008
18.04.2008
21.10.2008
14.10.2011
20.10.2011
22.12.2011
25.01.2006
07.05.2012
07.05.2012
12.05.2012
14.05.2012
12.05.2012
02.05.2012
22.05.2012
22.05.2012
02.05.2012
22.05.2012
14.05.2012
23.05.2012
13.05.2012
29.05.2012
25.05.2012
02.05.2012
09.05.2012
14.05.2012
21.05.2012
01.05.2012
25.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
5PAGE :
DIAN INDAH SYAHBANI
FRANKY FONDA ABDI GU
SUSI PARLINA
CHRISTIAN
MASRIFAH S.SOS
CHRISTA LINTANG TYAS
APRILIA PRASETYAWATI
AGUNG LUKITO
IDA AYU MIRAH SH
MUHAMMAD MUALIM
I.B. MADE PASTIKA
NURHAYATI NOVIKA PAN
MUTIA TJOKROKOESOEMO
AMSINAH
NI GUSTI AYU NYOMAN
IKA DUTIA KRISNAMUSI
ALBERT SAHAT HALOMOA
PRISCA ADIWIJAYA
YENNI SANTI FLORIDA
CHANDRA HARTISAN SS
SUSSY MACHTALINDA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
UNMPS
HDRHL
HDRHL
HUMHL
PMTSHT
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
23,600.00
0.00
2012
2012
2012
2012
2011
2012
2011
2011
2012
2011
2012
2012
2012
2012
2012
2012
2011
2011
2011
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
35,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,540.00
0.00
8,010,000.00
8,010,000.00
9,930,000.00
15,090,000.00
9,930,000.00
8,010,000.00
9,930,000.00
9,930,000.00
8,010,000.00
8,010,000.00
8,010,000.00
8,010,000.00
14,370,000.00
14,370,000.00
15,090,000.00
8,010,000.00
27,780,000.00
40,000,000.00
50,000,000.00
30,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
30,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,360.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
21,240.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
21,240.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000484500
0000484501
0000484503
0000484843
0000488942
0000489214.01
0000489556
0000489900
0000491907
0000492506
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
104
105
106
107
108
109
110
111
112
113
IMKIN0000484500
IMKIN0000484501
IMKIN0000484503
IMKIN0000484843
IMKIN0000488942
IMKIN0000489214
IMKIN0000489556
IMKIN0000489900
IMKIN0000491907
IMKIN0000492506
23.02.2006
23.02.2006
23.02.2006
24.02.2006
01.03.2006
24.02.2006
01.03.2006
01.03.2006
06.03.2006
09.03.2006
23.03.2012
23.03.2012
23.03.2012
24.03.2012
01.02.2012
24.02.2012
01.02.2012
01.02.2012
06.02.2012
09.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
6PAGE :
KANIA BAGUS HUTAMA
RUSMAN
ADI BAGUS HUTAMA
DONY ELLY KURNIAWAN
HENI PUJIATI
NOVA SRI B NASUTION
MAULANA ARIEF
TONI
PIPIT ARDHYA RINI
CUT MAHYUTI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
PMTSHT
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
0.00
45,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2011
2011
2012
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
0.00
50,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
150,000,000.00
300,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
50,000,000.00
7,500,000.00
150,000,000.00
7,500,000.00
150,000,000.00
7,500,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
0.00
250,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000493570
0000493677
0000493680
0000493728
0000493854
0000496154
0000496462
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
114
115
116
117
118
119
120
IMKIN0000493570
IMKIN0000493677
IMKIN0000493680
IMKIN0000493728
IMKIN0000493854
IMKIN0000496154
IMKIN0000496462
10.03.2006
10.03.2006
10.03.2006
10.03.2006
13.03.2006
18.03.2006
21.03.2006
10.02.2012
10.02.2012
10.04.2012
10.02.2012
13.02.2012
18.02.2012
21.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
7PAGE :
EVA LIDIAWATI
MUHAMAD SYARFIAN
AGUSTIN SATRIA
HISNAWATI
ARDI NURDIN
MUNTHE RATNA
WADY MURSIDHA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBK
GEBBKB
GEBBK
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
60,000,000.00
3,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000499522.01
0000504467
0000506881
0000508255.01
0000510038
0000510177
0000510479
0000510552
0000510552.01
0000510658
0000510696
0000511153
0000511195
0000512044
0000512119
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
IMKIN0000499522
IMKIN0000504467
IMKIN0000506881
IMKIN0000508255
IMKIN0000510038
IMKIN0000510177
IMKIN0000510479
IMKIN0000510552
IMKIN0000510552
IMKIN0000510658
IMKIN0000510696
IMKIN0000511153
IMKIN0000511195
IMKIN0000512044
IMKIN0000512119
04.04.2006
25.04.2006
01.05.2006
04.05.2006
10.05.2006
09.05.2006
10.05.2006
11.05.2006
11.05.2006
11.05.2006
11.05.2006
09.05.2006
11.05.2006
15.05.2006
16.05.2006
04.02.2012
25.03.2012
01.05.2012
04.02.2012
10.05.2012
09.05.2012
10.05.2012
11.05.2012
11.05.2012
11.05.2012
11.05.2012
09.02.2012
11.02.2012
15.05.2012
16.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
8PAGE :
GUNAWAN RADIWISOTO
ALWIN NOVENDAR
DADDY PRAWIRAKUSUMAH
SUPRIATINI
PERDANA HALIM
H DOLLAR DURASID
DEWAKI KRAMADIBRATA
JOKO HARYONO
MARDIANA HUSIN
AGUS SUSETYO
ROSMINI ALIGAPAR
EDY SUSILO
DANI FRANSYO LAHAY
MAS SOEWITO PRIYO
ADE PURNAMA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
PMTSHT
PMTSHT
PMTSHT
GEBBKB
GEBBKB
PMTBPS
PMTBPS
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2012
2011
2012
2011
2012
2012
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2011
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
60,000,000.00
3,000,000.00
60,000,000.00
7,500,000.00
7,500,000.00
50,000,000.00
50,000,000.00
50,000,000.00
3,000,000.00
3,000,000.00
5,000,000.00
300,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000512119.01
0000512166
0000512184
0000512184.01
0000515177
0000515253
0000515349
0000515551
0000518347
0000521119.01
0000521302.01
0000521926
0000521987.01
0000522347
0000522347.01
0000523475.01
0000523500.01
0000523597.01
0000523754.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
IMKIN0000512119
IMKIN0000512166
IMKIN0000512184
IMKIN0000512184
IMKIN0000515177
IMKIN0000515253
IMKIN0000515349
IMKIN0000515551
IMKIN0000518347
IMKIN0000521119
IMKIN0000521302
IMKIN0000521926
IMKIN0000521987
IMKIN0000522347
IMKIN0000522347
IMKIN0000523475
IMKIN0000523500
IMKIN0000523597
IMKIN0000523754
16.05.2006
16.05.2006
16.05.2006
16.05.2006
17.05.2006
17.05.2006
17.05.2006
18.05.2006
01.06.2006
14.06.2006
14.06.2006
16.06.2006
16.06.2006
19.06.2006
19.06.2006
20.06.2006
20.06.2006
20.06.2006
20.06.2006
16.05.2012
16.05.2012
16.05.2012
16.05.2012
17.05.2012
17.02.2012
17.05.2012
18.03.2012
01.03.2012
14.02.2012
14.02.2012
16.02.2012
16.02.2012
19.02.2012
19.02.2012
20.02.2012
20.02.2012
20.02.2012
20.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
9PAGE :
ENIH SUNIATI
FARID SETIAWAN
JOHNY LENGKONG
NENGSUARSIH
PUDJI ASTUTI
ADE YANA
NANIEK YUNAENI
IBNU HAJAR DAMANIK M
JULIATI JUDO SURYA
MUHAMMAD ASKARI UTOM
SRI SUMARYATI
ALI WARDANA
IKA DINA LISAPUTRI
SARIYONO
WINA WINARTI
AHMAD TAUFAN
MUKIYAT
EVA VERONICA
QUEENA DJAJAPRAWIRA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
PMTBPS
PMTBPS
GEBBKB
GEBBKB
GECRPL
GEBBKB
GECRPL
GECRPL
GEBBKB
GEBBKB
GEBBKB
GEBBKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,906.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2011
2012
2012
2011
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
51,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
500,000,000.00
3,000,000.00
3,000,000.00
50,000,000.00
3,000,000.00
50,000,000.00
50,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
206,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,906.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,906.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000523873.01
0000524031.01
0000525783.01
0000534895.01
0000536242.01
0000537182.01
0000548798.01
0000551438
0000551438.01
0000551842.01
0000552087.01
0000552782.01
0000554389
0000554791
0000561632
0000561826
0000561826.01
0000563076
0000563182.01
0000563243.01
0000569924
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
IMKIN0000523873
IMKIN0000524031
IMKIN0000525783
IMKIN0000534895
IMKIN0000536242
IMKIN0000537182
IMKIN0000548798
IMKIN0000551438
IMKIN0000551438
IMKIN0000551842
IMKIN0000552087
IMKIN0000552782
IMKIN0000554389
IMKIN0000554791
IMKIN0000561632
IMKIN0000561826
IMKIN0000561826
IMKIN0000563076
IMKIN0000563182
IMKIN0000563243
IMKIN0000569924
21.06.2006
21.06.2006
16.06.2006
22.06.2006
01.07.2006
05.07.2006
02.08.2006
08.08.2006
08.08.2006
10.08.2006
10.08.2006
11.08.2006
03.08.2006
04.08.2006
24.08.2006
24.08.2006
24.08.2006
26.08.2006
26.08.2006
26.08.2006
01.09.2006
21.02.2012
21.02.2012
16.04.2012
22.02.2012
01.05.2012
05.02.2012
02.05.2012
08.03.2012
08.03.2012
10.02.2012
10.02.2012
11.02.2012
03.03.2012
04.03.2012
24.03.2012
24.04.2012
24.04.2012
26.02.2012
26.02.2012
26.02.2012
01.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
10PAGE :
MARIAMIN IBRAHIM
SUKAMTO YACOBUS
R NINO SUTRISNO
EUIS A MARIANA
SRI SUHARTINAH
NUSRAMFERI
AMIR HASAN
MUHAMMAD ARSYAD
KRESTIYATIE HARIYANT
MARIA B I ERNAWATI
DEWI YANI
LILY S HALIM
EKO PRISTIAWAN
GT BRATA
ERNA J PONTOH
LEKSI NOORA HENDRA
MASRUROH
AHMAD HUZAIFAH
IRSAN CANDRA
ALOYSIA YUDHAWATI
SYABRIANSYAH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
PMTSHT
PMTSHT
GEBBKB
GEBBKB
GEBBKB
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
GECRPL
GEBBKB
GEBBKB
DANLFP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,500.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
59,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
7,500,000.00
3,000,000.00
50,000,000.00
50,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
57,000,000.00
34,000,000.00
57,000,000.00
57,000,000.00
57,000,000.00
50,000,000.00
0.00
0.00
85,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,500.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000569961
0000572890.01
0000577635.01
0000580379
0000580379.01
0000580839
0000581881
0000581881.01
0000600599
0000600644
0000600644.01
0000600912
0000615740
0000618430.01
0000639230
0000658012.01
0000658408
0000658748
0000658824
0000664166.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
IMKIN0000569961
IMKIN0000572890
IMKIN0000577635
IMKIN0000580379
IMKIN0000580379
IMKIN0000580839
IMKIN0000581881
IMKIN0000581881
IMKIN0000600599
IMKIN0000600644
IMKIN0000600644
IMKIN0000600912
IMKIN0000615740
IMKIN0000618430
IMKIN0000639230
IMKIN0000658012
IMKIN0000658408
IMKIN0000658748
IMKIN0000658824
IMKIN0000664166
25.08.2006
14.09.2006
20.09.2006
21.09.2006
21.09.2006
22.09.2006
01.09.2006
01.09.2006
02.11.2006
02.11.2006
02.11.2006
08.11.2006
07.12.2006
12.12.2006
24.01.2007
01.03.2007
02.03.2007
05.03.2007
22.02.2007
02.03.2007
25.03.2012
14.02.2012
20.02.2012
21.03.2012
21.03.2012
22.03.2012
01.05.2012
01.05.2012
02.05.2012
02.05.2012
02.05.2012
08.05.2012
07.03.2012
12.02.2012
24.02.2012
01.02.2012
02.03.2012
05.05.2012
22.02.2012
02.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
11PAGE :
RR LEO RUNTUWENE
YANS ZAILANI
IRWAN AKNIS
JEMMY W SUAWA SH
MAYA MAMAHIT
YULIZAR DEWA AJI
TANING YANDONO
MUI IE HALIM
W.LUSYE TULUNG
NUR ASNAINI
RAHMAT SALAM
INDRA HARTAWAN A
SANTO SUHARTO
IMAN SANTOSA
DANI WARDHANA FIRMAN
ANDI NOVIADI
MISLAN
SYLVIA FRANSISCA T
NURHIDAYATI NALAM HUDI
MELLY NANGOI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANLFP
GEBBKB
GEBBKB
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
DANLFP
PMTSHI
GEBBKB
GECRPL
GEBBKB
GEBBKB
PMTSHI
PMTSHI
CIGLCF
GEBBKB
0.00
0.00
0.00
0.00
0.00
38,675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,356.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2012
2011
2012
2012
2012
2012
2011
0.00
0.00
0.00
0.00
0.00
77,350.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
64,275.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
85,000,000.00
3,000,000.00
7,500,000.00
85,000,000.00
85,000,000.00
85,000,000.00
85,000,000.00
85,000,000.00
85,000,000.00
34,000,000.00
34,000,000.00
57,000,000.00
50,000,000.00
7,500,000.00
50,000,000.00
7,500,000.00
7,500,000.00
50,000,000.00
50,000,000.00
500,000,000.00
7,500,000.00
0.00
0.00
0.00
0.00
0.00
85,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
38,675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,356.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
38,675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,356.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000668609.01
0000676047
0000676047.01
0000683817.01
0000689020.01
0000691419
0000708169.01
0000712691
0000714648
0000714818
0000714963
0000738859
0000738859.01
0000738917
0000745490
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
IMKIN0000668609
IMKIN0000676047
IMKIN0000676047
IMKIN0000683817
IMKIN0000689020
IMKIN0000691419
IMKIN0000708169
IMKIN0000712691
IMKIN0000714648
IMKIN0000714818
IMKIN0000714963
IMKIN0000738859
IMKIN0000738859
IMKIN0000738917
IMKIN0000745490
20.03.2007
21.03.2007
21.03.2007
11.04.2007
18.04.2007
21.04.2007
19.05.2007
24.05.2007
01.05.2007
05.05.2007
28.05.2007
12.06.2007
12.06.2007
13.06.2007
01.07.2007
20.02.2012
21.02.2012
21.02.2012
11.02.2012
18.02.2012
21.03.2012
19.02.2012
24.02.2012
01.05.2012
05.05.2012
28.05.2012
12.05.2012
12.05.2012
13.04.2012
01.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
12PAGE :
SITI SUNDARI S
IR TRI PURWANTO
SURI EKA APRIANI
THOMAS TANUDJAJA
BUDI LUKITOYO FAKKA
CARTINI
Y ADI SUSENO
MAHYUDIN
FARIDA
SIGIT SISWANTO
TULONG R VICTOR
ERNINAH
YULIAS SAPARUDDIN
MUHAMAD ALFATIH
DADANG SUPRIATNA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBBKB
GEBBKB
CIGLPN
CIGLPN
CIGLPN
CIGLPN
GEBBKB
GEBBKB
GEBBKB
GEBBKB
AMNTLF
AMNTLF
GEBBKB
GEBBKB
CIGLPN
CIGLPN
AMNTLF
AMNTLF
GECRPL
DANLFP
DANLFP
DANLFP
PMTBPS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2011
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
591,600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,500,000.00
7,500,000.00
7,500,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
7,500,000.00
7,500,000.00
7,500,000.00
7,500,000.00
120,000,000.00
120,000,000.00
7,500,000.00
7,500,000.00
50,000,000.00
50,000,000.00
120,000,000.00
120,000,000.00
75,000,000.00
57,000,000.00
57,000,000.00
57,000,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
120,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000750565.01
000775043
0000797909
0000818902
0000818902.01
0000832316
0000836714
0000836714.01
0000838503
0000839810
0000839917
0000839936
0000863591
0000863723
0000863751
0000863828
0000864710
0000872172
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
IMKIN0000750565
IMKIN0000775043
IMKIN0000797909
IMKIN0000818902
IMKIN0000818902
IMKIN0000832316
IMKIN0000836714
IMKIN0000836714
IMKIN0000838503
IMKIN0000839810
IMKIN0000839917
IMKIN0000839936
IMKIN0000863591
IMKIN0000863723
IMKIN0000863751
IMKIN0000863828
IMKIN0000864710
IMKIN0000872172
09.07.2007
10.08.2007
18.09.2007
02.10.2007
02.10.2007
19.10.2007
25.10.2007
25.10.2007
01.11.2007
01.11.2007
01.11.2007
01.11.2007
15.11.2007
17.11.2007
17.11.2007
19.11.2007
20.11.2007
23.11.2007
09.02.2012
10.02.2012
18.03.2012
02.02.2012
02.02.2012
19.02.2012
25.02.2012
25.02.2012
01.03.2012
01.02.2012
01.02.2012
01.02.2012
15.05.2012
17.02.2012
17.04.2012
19.02.2012
20.05.2012
23.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
13PAGE :
IR. M. ARIF PAPUTUNG
INDRA FAJAR A
ANDY SANTOSO
H. RAJA ALI SABRI DA
SITI HANNIM HASIBUAN
FAHD MIRZA GAZALI
ANIK ANDAYANI
RUDOLF KUSINDRIA
SUMARNI MUSTAFA
GABRIEL SUARUBUN
FERDIYAN
CHAIRUL SALEH SE MSI
BENYAMIN WIDJAJA
YULIANTY
SUNARNO
TJONG FIFI
YOGI IRAWAN
DEDI SUTISNA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPS
GEBBKB
GECRPL
PMTBPS
PMTBPS
GECRPL
GECRPL
GECRPL
GECRPL
GECRPL
PMTBPS
PMTBPS
GECRPL
GECRPL
GECRPL
CIGLPN
CIGLPN
CIGLPN
CIGLPN
CIGLPN
PMTBPS
PMTBPS
8,604.00
0.00
13,300.00
0.00
38,313.00
0.00
0.00
35,000.00
0.00
0.00
0.00
833.00
0.00
96,750.00
0.00
54,000.00
157,500.00
236,075.00
0.00
2,125.00
0.00
833.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
51,625.00
0.00
26,600.00
0.00
76,625.00
0.00
0.00
52,500.00
0.00
0.00
0.00
1,250.00
0.00
129,000.00
0.00
108,000.00
210,000.00
404,700.00
0.00
4,250.00
0.00
1,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
500,000,000.00
7,500,000.00
75,000,000.00
6,500,000.00
500,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
300,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
100,000,000.00
300,000,000.00
500,000,000.00
50,000,000.00
200,000,000.00
5,000,000.00
300,000,000.00
206,500,000.00
0.00
38,000,000.00
0.00
306,500,000.00
0.00
0.00
75,000,000.00
0.00
0.00
0.00
5,000,000.00
0.00
75,000,000.00
0.00
100,000,000.00
300,000,000.00
285,000,000.00
0.00
5,000,000.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,604.00
0.00
13,300.00
0.00
38,313.00
0.00
0.00
31,500.00
0.00
0.00
0.00
833.00
0.00
96,750.00
0.00
54,000.00
157,500.00
236,075.00
0.00
2,125.00
0.00
833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,604.00
0.00
13,300.00
0.00
38,313.00
0.00
0.00
31,500.00
0.00
0.00
0.00
833.00
0.00
96,750.00
0.00
54,000.00
157,500.00
236,075.00
0.00
2,125.00
0.00
833.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000876029
0000893927.01
0000895373
0000895373.01
0000921297
0000928800
0000954285
0000965172
0001008229
0001008294
0001008484
0001022895
0001023447
0001024479
0001025218
0001028547
0001037686
0001038347
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
IMKIN0000876029
IMKIN0000893927
IMKIN0000895373
IMKIN0000895373
IMKIN0000921297
IMKIN0000928800
IMKIN0000954285
IMKIN0000965172
IMKIN0001008229
IMKIN0001008294
IMKIN0001008484
IMKIN0001022895
IMKIN0001023447
IMKIN0001024479
IMKIN0001025218
IMKIN0001028547
IMKIN0001037686
IMKIN0001038347
03.12.2007
02.01.2008
03.01.2008
03.01.2008
01.02.2008
05.02.2008
03.03.2008
04.03.2008
15.05.2008
15.05.2008
19.05.2008
01.06.2008
03.06.2008
11.06.2008
17.06.2008
13.06.2008
04.07.2008
04.07.2008
03.02.2012
02.02.2012
03.03.2012
03.03.2012
01.05.2012
05.02.2012
03.05.2012
04.05.2012
15.03.2012
15.05.2012
19.05.2012
01.05.2012
03.03.2012
11.05.2012
17.05.2012
13.03.2012
04.03.2012
04.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
14PAGE :
DRS PENDI
PAHING PRIJANTO
SAMSIR
SAMSIR
EDY
HASANUDDIN
ZULHAMIDI
TREESYA ROZA
NUZULUL MAULUDAH
USMAN
SITTA GAMILIYA
SUKADA I PUTU
H MHD BARKAH
NAMPAN
TEGUH JAYA PRASODJO
SRIHANDAYANI
TAMAN RIANTO
PRASETYA JOKO PRANOT
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GECRPL
GEBBKB
PMTBPS
PMTBPS
PMTBPS
CIGLPN
CIGLPN
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
1,354.00
0.00
0.00
0.00
0.00
0.00
24,000.00
0.00
0.00
0.00
20,250.00
36,000.00
8,167.00
17,750.00
0.00
0.00
65,417.00
0.00
17,208.00
2011
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
1,625.00
0.00
0.00
0.00
0.00
0.00
144,000.00
0.00
0.00
0.00
243,000.00
144,000.00
98,000.00
213,000.00
0.00
0.00
196,250.00
0.00
51,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
7,500,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
500,000,000.00
500,000,000.00
300,000,000.00
200,000,000.00
100,000,000.00
500,000,000.00
200,000,000.00
200,000,000.00
50,000,000.00
10,000,000.00
1,000,000,000.00
6,500,000.00
500,000,000.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
100,000,000.00
200,000,000.00
100,000,000.00
150,000,000.00
0.00
0.00
785,000,000.00
0.00
206,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,354.00
0.00
0.00
0.00
0.00
0.00
24,000.00
0.00
0.00
0.00
20,250.00
36,000.00
8,167.00
17,750.00
0.00
0.00
65,417.00
0.00
17,208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,354.00
0.00
0.00
0.00
0.00
0.00
24,000.00
0.00
0.00
0.00
20,250.00
36,000.00
8,167.00
17,750.00
0.00
0.00
65,417.00
0.00
17,208.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001042429.01
0001042504.01
0001042504.03
0001044891
0001044969
0001045051
0001045322
0001045419
0001045570
0001045649
0001046023
0001049569
0001050608.01
0001050751.01
0001050889.01
0001051004.01
0001051004.03
0001064939
0001069279
0001069280
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
IMKIN0001042429
IMKIN0001042504
IMKIN0001042504
IMKIN0001044891
IMKIN0001044969
IMKIN0001045051
IMKIN0001045322
IMKIN0001045419
IMKIN0001045570
IMKIN0001045649
IMKIN0001046023
IMKIN0001049569
IMKIN0001050608
IMKIN0001050751
IMKIN0001050889
IMKIN0001051004
IMKIN0001051004
IMKIN0001064939
IMKIN0001069279
IMKIN0001069280
25.07.2008
25.07.2008
25.07.2008
19.07.2008
27.06.2008
01.07.2008
02.07.2008
02.07.2008
04.07.2008
05.07.2008
11.07.2008
24.07.2008
21.07.2008
22.07.2008
23.07.2008
24.07.2008
24.07.2008
20.08.2008
22.08.2008
22.08.2008
25.03.2012
25.05.2012
25.05.2012
19.03.2012
27.03.2012
01.03.2012
02.03.2012
02.03.2012
04.03.2012
05.05.2012
11.05.2012
24.05.2012
21.05.2012
22.03.2012
23.03.2012
24.05.2012
24.05.2012
20.03.2012
22.05.2012
22.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
15PAGE :
HERISEN SINLUK
MUJIYANA
DWI ASTUTI
DODI KUSMAYADI HASAN
FENIA KOESNANHADI
YULIA AMIN
SUSANTO DWI PRASETYO
HENY SUPROBOWATI
EDWIN JAYANDARU
SLAMET SULISTYOBUDI.
DADANG DARMAWAN SAPU
PARULIAN MARPAUNG
SILVANA K
YOSEPH KUMALA
OEY PIT ENG
NY. YULI SETIADY
HANDI SETIADI
PRATIKTO
TRI NUGROHO
ERWIN HUSEIN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UOBEXP
UOBEXP
UOBEXP
PMCSHP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
LIFCRP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
LIFCRP
PMTBPL
PMTBPL
PMTBPL
35,367.00
3,600.00
2,150.00
0.00
35,000.00
0.00
0.00
0.00
108,000.00
0.00
47,333.00
59,000.00
21,800.00
14,667.00
39,300.00
11,500.00
19,650.00
0.00
0.00
17,594.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
106,100.00
21,600.00
12,900.00
0.00
140,000.00
0.00
0.00
0.00
324,000.00
0.00
284,000.00
354,000.00
130,800.00
44,000.00
117,900.00
69,000.00
117,900.00
0.00
0.00
70,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
10,000,000.00
10,000,000.00
75,000,000.00
300,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
300,000,000.00
200,000,000.00
500,000,000.00
300,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
50,000,000.00
6,500,000.00
500,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
0.00
200,000,000.00
0.00
0.00
0.00
300,000,000.00
0.00
200,000,000.00
300,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
0.00
0.00
281,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
35,367.00
3,600.00
2,150.00
0.00
35,000.00
0.00
0.00
0.00
108,000.00
0.00
47,333.00
59,000.00
21,800.00
14,667.00
39,300.00
11,500.00
19,650.00
0.00
0.00
17,594.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
35,367.00
3,600.00
2,150.00
0.00
35,000.00
0.00
0.00
0.00
108,000.00
0.00
47,333.00
59,000.00
21,800.00
14,667.00
39,300.00
11,500.00
19,650.00
0.00
0.00
17,594.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001072140
0001072152
0001072330
0001072351
0001074700.01
0001074991
0001078637.01
0001078637.03
0001078637.05
0001084345.01
0001084345.03
0001084505.01
0001084701.01
0001086179
0001097141.01
0001097216.01
0001098160
0001111199.01
0001113276
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
IMKIN0001072140
IMKIN0001072152
IMKIN0001072330
IMKIN0001072351
IMKIN0001074700
IMKIN0001074991
IMKIN0001078637
IMKIN0001078637
IMKIN0001078637
IMKIN0001084345
IMKIN0001084345
IMKIN0001084505
IMKIN0001084701
IMKIN0001086179
IMKIN0001097141
IMKIN0001097216
IMKIN0001098160
IMKIN0001111199
IMKIN0001113276
26.08.2008
25.08.2008
01.08.2008
01.08.2008
10.09.2008
01.09.2008
10.09.2008
10.09.2008
10.09.2008
25.09.2008
25.09.2008
25.09.2008
25.09.2008
10.09.2008
27.10.2008
27.10.2008
10.10.2008
21.11.2008
03.11.2008
26.03.2012
25.03.2012
01.02.2012
01.02.2012
10.05.2012
01.05.2012
10.03.2012
10.03.2012
10.03.2012
25.03.2012
25.03.2012
25.03.2012
25.03.2012
10.03.2012
27.03.2012
27.03.2012
10.05.2012
21.03.2012
03.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
16PAGE :
DYAH AYUNI RESPITORA
IDA ELFANI
DENNY ARIEF SETIAWAN
CAHYANINGSIH SRI MUL
ARIS SOESANTO
JASMIN SETIADI
ERLY SINATRA
LIEMANTO
MATTHEW
TAN MUI LOAN
TJIE PUTRA ARIEF W
BARMAWAN SANUSI
BUDI LUKITOYO FAKK
BENNY TEGUH SANTOSO
EDI J KARYOTO
BAGUS UTORO
JEFANYA
INDRA GUNAWAN
DESI NURAIDAH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
LIFCRP
LIFCRP
CIGLPN
CIGLPN
UOBEXP
DANLFP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
UOBEXP
DANLFP
UOBEXP
UOBEXP
PMCSHP
UOBEXP
PMTBPL
PMTBPL
49,063.00
58,333.00
98,333.00
0.00
220,000.00
39,300.00
0.00
3,950.00
7,100.00
0.00
58,950.00
47,750.00
0.00
0.00
0.00
0.00
0.00
0.00
14,400.00
0.00
17,500.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
196,250.00
140,000.00
236,000.00
0.00
440,000.00
117,900.00
0.00
7,900.00
14,200.00
0.00
117,900.00
95,500.00
0.00
0.00
0.00
0.00
0.00
0.00
21,600.00
0.00
26,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,000,000,000.00
500,000,000.00
200,000,000.00
300,000,000.00
200,000,000.00
10,000,000.00
85,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
5,000,000.00
5,000,000.00
57,000,000.00
5,000,000.00
5,000,000.00
75,000,000.00
10,000,000.00
5,000,000.00
300,000,000.00
785,000,000.00
200,000,000.00
200,000,000.00
0.00
100,000,000.00
10,000,000.00
0.00
10,000,000.00
10,000,000.00
0.00
10,000,000.00
10,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
0.00
105,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,063.00
58,333.00
98,333.00
0.00
220,000.00
39,300.00
0.00
3,950.00
7,100.00
0.00
58,950.00
47,750.00
0.00
0.00
0.00
0.00
0.00
0.00
14,400.00
0.00
17,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,063.00
58,333.00
98,333.00
0.00
220,000.00
39,300.00
0.00
3,950.00
7,100.00
0.00
58,950.00
47,750.00
0.00
0.00
0.00
0.00
0.00
0.00
14,400.00
0.00
17,500.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001113276.01
0001115576
0001115576.01
0001116917
0001125690
0001125690.01
0001126293
0001133333.01
0001137847
0001138103.01
0001140842
0001141793.01
0001142487
0001143955
0001145931
0001151754
0001156231
0001156485
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
IMKIN0001113276
IMKIN0001115576
IMKIN0001115576
IMKIN0001116917
IMKIN0001125690
IMKIN0001125690
IMKIN0001126293
IMKIN0001133333
IMKIN0001137847
IMKIN0001138103
IMKIN0001140842
IMKIN0001141793
IMKIN0001142487
IMKIN0001143955
IMKIN0001145931
IMKIN0001151754
IMKIN0001156231
IMKIN0001156485
03.11.2008
06.11.2008
06.11.2008
01.11.2008
19.11.2008
19.11.2008
17.11.2008
26.11.2008
01.12.2008
01.12.2008
04.12.2008
05.12.2008
05.12.2008
10.12.2008
12.12.2008
17.12.2008
04.12.2008
12.12.2008
03.03.2012
06.03.2012
06.03.2012
01.03.2012
19.05.2012
19.05.2012
17.05.2012
26.03.2012
01.05.2012
01.05.2012
04.03.2012
05.03.2012
05.05.2012
10.03.2012
12.03.2012
17.03.2012
04.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
17PAGE :
HERI PATMONO
D BAMBANG
D BAMBANG KUSWIDIANT
WARSONO
ENDANG SURYANI
JAMALUDDIN SE AK
ANDY
HOTMAN DAPOT SINAGA
IKA PERMATASARI
ERWANTO
ADI SUCIPTO (F509368
AGUS SANTOSA
I GST AYU OKA RASMIN
ADI WITOYO
RAHMAT OKTYANSYAH
NENI FONAWATI
ACHMAD SYAUGI
SUTJIPTO.
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
DANLFP
DANLFP
LIFCRP
BNIDRD
LIFCRP
MANDEX
LIFCRP
PMTBPL
PMTBPL
BNIJBT
LIFCRP
LIFCRP
BNIJBX
PMCSHP
PMCSHP
0.00
17,500.00
0.00
34,417.00
0.00
34,417.00
0.00
131,325.00
0.00
39,500.00
85,000.00
0.00
455,000.00
0.00
0.00
38,719.00
203,583.00
405,000.00
162,000.00
81,000.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
26,250.00
0.00
51,625.00
0.00
51,625.00
0.00
262,650.00
0.00
79,000.00
127,500.00
0.00
780,000.00
0.00
0.00
51,625.00
349,000.00
540,000.00
216,000.00
108,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
300,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
75,000,000.00
85,000,000.00
85,000,000.00
300,000,000.00
150,000,000.00
300,000,000.00
500,000,000.00
100,000,000.00
6,500,000.00
500,000,000.00
100,000,000.00
500,000,000.00
300,000,000.00
150,000,000.00
75,000,000.00
25,000,000.00
0.00
105,000,000.00
0.00
206,500,000.00
0.00
206,500,000.00
0.00
85,000,000.00
0.00
100,000,000.00
150,000,000.00
0.00
500,000,000.00
0.00
0.00
206,500,000.00
100,000,000.00
500,000,000.00
300,000,000.00
150,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,500.00
0.00
34,417.00
0.00
34,417.00
0.00
131,325.00
0.00
39,500.00
85,000.00
0.00
455,000.00
0.00
0.00
38,719.00
203,583.00
405,000.00
162,000.00
81,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,500.00
0.00
34,417.00
0.00
34,417.00
0.00
131,325.00
0.00
39,500.00
85,000.00
0.00
455,000.00
0.00
0.00
38,719.00
203,583.00
405,000.00
162,000.00
81,000.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001157610
0001158457
0001161391
0001161391.01
0001163200.01
0001166461
0001167205
0001167227
0001170454.01
0001172435.01
0001173612.01
0001173634.01
0001179836
0001183721
0001184743
0001186568
0001190643
0001192599
0001197308
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
IMKIN0001157610
IMKIN0001158457
IMKIN0001161391
IMKIN0001161391
IMKIN0001163200
IMKIN0001166461
IMKIN0001167205
IMKIN0001167227
IMKIN0001170454
IMKIN0001172435
IMKIN0001173612
IMKIN0001173634
IMKIN0001179836
IMKIN0001183721
IMKIN0001184743
IMKIN0001186568
IMKIN0001190643
IMKIN0001192599
IMKIN0001197308
22.12.2008
19.12.2008
23.12.2008
23.12.2008
01.01.2009
07.01.2009
08.01.2009
05.01.2009
08.01.2009
07.01.2009
09.01.2009
10.01.2009
13.01.2009
21.01.2009
17.01.2009
19.01.2009
22.01.2009
15.01.2009
02.02.2009
22.02.2012
19.05.2012
23.05.2012
23.05.2012
01.05.2012
07.05.2012
08.04.2012
05.02.2012
08.05.2012
07.05.2012
09.05.2012
10.05.2012
13.05.2012
21.02.2012
17.03.2012
19.03.2012
22.05.2012
15.05.2012
02.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
18PAGE :
SUPARDI
RAYA REDINA NAIBAHO
HARY SUHARJONO
RINI EKA LUCIANA
SANTI INDRIYARINI
TITIN RATNAWATI SE
HERI TANTA SAPUTRA
MUHAMMAD SYARIEF
DANIEL ALEXANDER
ASFAR BUSTAMIN LAMON
HENDRIK GUNAWAN
ISMAIL ARIFIN
TOUFAN WIDHI H.
RONNY SUADI SUDIBYO
YOHANES WAHONO
DEWI WENINGSIH
ARDI SETIADI
HERMAN PAU
LILIS MAWATI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGLPN
LIFCRP
DANLFP
DANLFP
MANDEX
PMTBPL
PMTBPL
CIGLPN
CIGLPN
MANDEX
MANDEX
MANDEX
MANDEX
CIGLPN
CIGLPN
DANLFP
PMTBPL
PMTBPL
CIGLPN
DANLFP
LIFCRP
653,333.00
0.00
0.00
0.00
393,333.00
0.00
1,083.00
0.00
0.00
430,000.00
573,333.00
1,163,333.00
810,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
784,000.00
0.00
0.00
0.00
590,000.00
0.00
1,625.00
0.00
0.00
645,000.00
860,000.00
1,745,000.00
1,215,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
50,000,000.00
85,000,000.00
85,000,000.00
500,000,000.00
6,500,000.00
500,000,000.00
200,000,000.00
100,000,000.00
500,000,000.00
500,000,000.00
500,000,000.00
500,000,000.00
300,000,000.00
50,000,000.00
85,000,000.00
5,000,000.00
300,000,000.00
200,000,000.00
85,000,000.00
300,000,000.00
200,000,000.00
0.00
0.00
0.00
500,000,000.00
0.00
6,500,000.00
0.00
0.00
500,000,000.00
500,000,000.00
500,000,000.00
500,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
653,333.00
0.00
0.00
0.00
393,333.00
0.00
1,083.00
0.00
0.00
430,000.00
573,333.00
1,163,333.00
810,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
653,333.00
0.00
0.00
0.00
393,333.00
0.00
1,083.00
0.00
0.00
430,000.00
573,333.00
1,163,333.00
810,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001197822.01
0001209275
0001210113.01
0001223265
0001224272
0001224341
0001228504
0001233171
0001233625
0001234915.01
0001240080
0001240178
0001240211
0001240261
0001244787
0001248643
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
IMKIN0001197822
IMKIN0001209275
IMKIN0001210113
IMKIN0001223265
IMKIN0001224272
IMKIN0001224341
IMKIN0001228504
IMKIN0001233171
IMKIN0001233625
IMKIN0001234915
IMKIN0001240080
IMKIN0001240178
IMKIN0001240211
IMKIN0001240261
IMKIN0001244787
IMKIN0001248643
01.02.2009
01.02.2009
16.02.2009
20.02.2009
01.03.2009
01.03.2009
04.03.2009
12.03.2009
12.03.2009
12.03.2009
10.03.2009
06.03.2009
12.03.2009
14.03.2009
20.03.2009
21.03.2009
01.04.2012
01.05.2012
16.05.2012
20.03.2012
01.05.2012
01.03.2012
04.05.2012
12.03.2012
12.03.2012
12.03.2012
10.02.2012
06.02.2012
12.02.2012
14.02.2012
20.03.2012
21.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
19PAGE :
NATA SUHENDI
HEADY ERLYANTY
ALFA KARDINAL T
BUDIARTO SETIOPUTRO
ANGGA YUDIS BIMANTOR
FREDI TRI YUNIANTO
DIDIEK SATRIO PURBAW
MEDIO NOVALDI CHANTR
LENNY SULISTYORINI
UNTUNG SUBAGYO
IDA AYU S. KARTIKA
RIZQI SURYANI
SLAMET SUHARIADI
AMIRUL MUKMININ
ANGGORO BUDI SETYAWA
MICU
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
PMSSHP
MANDEX
DANLFP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
LIFCRP
LIFCRP
MANDEX
CIGLPN
CIGLPN
CIGLPN
CIGLPN
CIGLPN
CIGLPN
CIGLPN
CIGLPN
LIFCRP
DANLFP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,354.00
0.00
0.00
2,200,000.00
0.00
0.00
0.00
0.00
19,750.00
255,000.00
23,667.00
468,000.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,625.00
0.00
0.00
2,200,000.00
0.00
0.00
0.00
0.00
237,000.00
255,000.00
284,000.00
468,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
50,000,000.00
100,000,000.00
85,000,000.00
5,000,000.00
300,000,000.00
5,000,000.00
300,000,000.00
6,500,000.00
500,000,000.00
100,000,000.00
300,000,000.00
500,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
500,000,000.00
500,000,000.00
300,000,000.00
300,000,000.00
200,000,000.00
57,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
500,000,000.00
0.00
0.00
0.00
0.00
300,000,000.00
300,000,000.00
200,000,000.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,354.00
0.00
0.00
2,200,000.00
0.00
0.00
0.00
0.00
19,750.00
255,000.00
23,667.00
468,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,354.00
0.00
0.00
2,200,000.00
0.00
0.00
0.00
0.00
19,750.00
255,000.00
23,667.00
468,000.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001249731
0001253314
0001254476.01
0001257708.01
0001258914
0001258914.01
0001264804.01
0001264843.01
0001267416.01
0001267821
0001271958
0001271976
0001272618.01
0001272959
0001283889
0001285266.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
IMKIN0001249731
IMKIN0001253314
IMKIN0001254476
IMKIN0001257708
IMKIN0001258914
IMKIN0001258914
IMKIN0001264804
IMKIN0001264843
IMKIN0001267416
IMKIN0001267821
IMKIN0001271958
IMKIN0001271976
IMKIN0001272618
IMKIN0001272959
IMKIN0001283889
IMKIN0001285266
25.03.2009
24.03.2009
01.04.2009
03.04.2009
06.04.2009
06.04.2009
01.04.2009
06.04.2009
07.04.2009
14.04.2009
15.04.2009
15.04.2009
16.04.2009
04.04.2009
21.04.2009
21.04.2009
25.02.2012
24.05.2012
01.05.2012
03.05.2012
06.04.2012
06.04.2012
01.05.2012
06.04.2012
07.03.2012
14.03.2012
15.03.2012
15.03.2012
16.05.2012
04.05.2012
21.03.2012
21.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
20PAGE :
SUZI NOOR WIJAYA
SITI NURHANDINI
HENDY SUTRISNO
ISHAR MADI
ONG TJWAN NIO
SRI PURWANTO
ANDI SAPUTRA BASTARI
TOTO KUSRIANTO
ISBAGI HARYADI
NURUL HASANAH
ASNI PRICORIN
I KETUT MARTIN
MOCHAMAD IQBAL ZUALM
SUGENDAR
IDA NURHAYATI
DENNY FERDINAND ALBE
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGLPN
CIGLPN
BNIJBT
MANDEX
MANDEX
DANLFP
DANLFP
MANDEX
MANDEX
MANDEX
MANDEX
PMCSHP
PMCSHP
PMSSHP
PMSSHP
PMSSHP
PMSSHP
MANDEX
DANLFP
PMSSHP
PMSSHP
MANDEX
MANDEX
0.00
0.00
0.00
0.00
785,583.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22,917.00
0.00
2011
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2011
2012
2011
2012
0.00
0.00
0.00
0.00
857,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
275,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
85,000,000.00
85,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
85,000,000.00
75,000,000.00
75,000,000.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
785,583.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22,917.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
785,583.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22,917.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001285466
0001285556
0001285829.01
0001286093
0001286228
0001286228.01
0001286298
0001287183
0001287390
0001287731
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
355
356
357
358
359
360
361
362
363
364
IMKIN0001285466
IMKIN0001285556
IMKIN0001285829
IMKIN0001286093
IMKIN0001286228
IMKIN0001286228
IMKIN0001286298
IMKIN0001287183
IMKIN0001287390
IMKIN0001287731
27.04.2009
25.04.2009
08.04.2009
01.05.2009
01.05.2009
01.05.2009
01.05.2009
01.05.2009
04.05.2009
01.05.2009
27.03.2012
25.02.2012
20.03.2012
01.05.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
04.05.2012
01.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
21PAGE :
SRIHAYATI
ARIES WIJAYA
HARIS SOMPANA
MUHAMAD HERY
EKA SAPTA ADINARA
NURYAMAH
TUGIMIN
ERNAWATI
HADI SUMARYONO ST
HJ ANDI MEGAWATI M,S
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMSSHP
PMSSHP
CIGHLP
CIGHLP
UOBEXP
UOBEXP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
BNIJBX
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
1,608.00
12,500.00
0.00
0.00
0.00
1,625.00
0.00
1,625.00
0.00
2011
2012
2011
2012
2011
2012
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,625.00
0.00
51,625.00
0.00
1,625.00
0.00
51,625.00
0.00
1,625.00
9,650.00
75,000.00
0.00
0.00
0.00
1,625.00
0.00
1,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
75,000,000.00
10,000,000.00
10,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
5,000,000.00
300,000,000.00
5,000,000.00
300,000,000.00
6,500,000.00
500,000,000.00
6,500,000.00
500,000,000.00
150,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
206,500,000.00
0.00
6,500,000.00
0.00
206,500,000.00
0.00
6,500,000.00
5,000,000.00
300,000,000.00
0.00
0.00
0.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
1,608.00
12,500.00
0.00
0.00
0.00
1,625.00
0.00
1,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
0.00
8,604.00
0.00
1,625.00
1,608.00
12,500.00
0.00
0.00
0.00
1,625.00
0.00
1,625.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001288266.01
0001288334
0001288867
0001290545
0001290545.01
0001296597.01
0001296938.01
0001299897
0001303309.01
0001303393.01
0001307160
0001307275
0001311409
0001311701
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
365
366
367
368
369
370
371
372
373
374
375
376
377
378
IMKIN0001288266
IMKIN0001288334
IMKIN0001288867
IMKIN0001290545
IMKIN0001290545
IMKIN0001296597
IMKIN0001296938
IMKIN0001299897
IMKIN0001303309
IMKIN0001303393
IMKIN0001307160
IMKIN0001307275
IMKIN0001311409
IMKIN0001311701
01.05.2009
01.05.2009
01.05.2009
06.05.2009
06.05.2009
05.05.2009
12.05.2009
14.05.2009
15.05.2009
15.05.2009
20.05.2009
20.05.2009
26.05.2009
26.05.2009
01.05.2012
01.05.2012
01.03.2012
06.03.2012
06.03.2012
05.05.2012
12.04.2012
14.05.2012
15.03.2012
15.03.2012
20.05.2012
20.05.2012
26.05.2012
26.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
22PAGE :
MELLA MEYLANDINI
WENNY ROSITA
WAWAN HERMAWAN
HARIS PERDANA
RUSMIATI WERNER SH
MOCHAMMAD TRIBEKTI M
FIRDAUS HAZAIRIN
YULIANI NINGSIH
NERRISA NADIA SHANVI
BUDI SUSETYO MUHARTO
MULYOTO,BSC
DADANG SUHARNA
I PUTU LINGGIH ARTA
PRISCILLA ELIZABETH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
BNIJBX
LIFCRP
LIFCRP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANDEX
MANDEX
MANDEX
BNIJBX
MANDEX
MANDEX
MANDEX
MANDEX
DANLFP
DANLFP
BNIJBT
PMTBPL
0.00
0.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
46,000.00
0.00
0.00
11,667.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2011
2012
2011
2011
2012
2012
2011
2011
2012
2012
2012
2011
2012
2012
2011
2012
2011
2012
2012
2012
2012
2011
0.00
0.00
0.00
0.00
0.00
1,250.00
0.00
0.00
0.00
1,250.00
0.00
0.00
0.00
552,000.00
0.00
0.00
70,000.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
5,000,000.00
300,000,000.00
5,000,000.00
300,000,000.00
5,000,000.00
300,000,000.00
5,000,000.00
300,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
85,000,000.00
57,000,000.00
100,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
46,000.00
0.00
0.00
11,667.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
46,000.00
0.00
0.00
11,667.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001312568.01
0001312947
0001312969
0001312969.01
0001313917
0001316234
0001316247
0001316289
0001316298
0001320634.01
0001321119
0001324047
0001324410
0001326561
0001332722
0001335537
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
IMKIN0001312568
IMKIN0001312947
IMKIN0001312969
IMKIN0001312969
IMKIN0001313917
IMKIN0001316234
IMKIN0001316247
IMKIN0001316289
IMKIN0001316298
IMKIN0001320634
IMKIN0001321119
IMKIN0001324047
IMKIN0001324410
IMKIN0001326561
IMKIN0001332722
IMKIN0001335537
20.05.2009
25.05.2009
26.05.2009
26.05.2009
01.06.2009
01.06.2009
01.06.2009
01.06.2009
01.06.2009
02.06.2009
03.06.2009
05.06.2009
05.06.2009
01.06.2009
10.06.2009
16.06.2009
20.04.2012
25.05.2012
26.05.2012
26.05.2012
01.03.2012
01.03.2012
01.05.2012
01.03.2012
01.05.2012
02.05.2012
03.03.2012
05.03.2012
05.05.2012
01.03.2012
10.05.2012
16.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
23PAGE :
ELIN WIDARTI
SUTRISNO TANDI
DESY KRISTINA
FAUZI NOVIAN
HARIS MENDOPA
BUNYAMIN
ERNA AGUSTINA
LILIK PRASTOWO
EKO PRIYOHARSONO
TRISNI LOEKITAWATI
ERNA YULIANTI
MUHAMMAD SOFYAN GINT
DIDIEK SATRIO PURBAW
MUHAMMAD FARID
HANA NORAWATI
OEIJ CAROLIVI WIRYAD
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
MANDEX
MANDEX
DANLFP
DANLFP
DANLFP
PMTBPL
PMTBPL
LIFCRP
LIFCRP
LIFCRP
LIFCRP
MANCLP
PMTBPL
PMTBPL
LIFCRP
PMCSHP
LIFCRP
MANTLP
LIFCRP
208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
313.00
110,000.00
0.00
22,750.00
0.00
0.00
0.00
313.00
0.00
0.00
27,000.00
0.00
6,583.00
2011
2012
2012
2011
2012
2012
2012
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
1,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,250.00
440,000.00
0.00
91,000.00
0.00
0.00
0.00
1,250.00
0.00
0.00
108,000.00
0.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
5,000,000.00
300,000,000.00
50,000,000.00
50,000,000.00
85,000,000.00
57,000,000.00
57,000,000.00
5,000,000.00
300,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
300,000,000.00
50,000,000.00
5,000,000.00
300,000,000.00
200,000,000.00
50,000,000.00
50,000,000.00
300,000,000.00
200,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
100,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
50,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
313.00
110,000.00
0.00
22,750.00
0.00
0.00
0.00
313.00
0.00
0.00
27,000.00
0.00
6,583.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
313.00
110,000.00
0.00
22,750.00
0.00
0.00
0.00
313.00
0.00
0.00
27,000.00
0.00
6,583.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001335965
0001341096
0001346228.01
0001347130
0001349335
0001349903
0001349964.01
0001350920
0001351778
0001354056
0001354058
0001354770
0001354996.01
0001355533
0001355548
0001355699
0001357279
0001357359
0001357868
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
IMKIN0001335965
IMKIN0001341096
IMKIN0001346228
IMKIN0001347130
IMKIN0001349335
IMKIN0001349903
IMKIN0001349964
IMKIN0001350920
IMKIN0001351778
IMKIN0001354056
IMKIN0001354058
IMKIN0001354770
IMKIN0001354996
IMKIN0001355533
IMKIN0001355548
IMKIN0001355699
IMKIN0001357279
IMKIN0001357359
IMKIN0001357868
17.06.2009
17.06.2009
24.06.2009
19.06.2009
01.07.2009
01.07.2009
01.07.2009
01.07.2009
02.07.2009
04.07.2009
04.07.2009
06.07.2009
01.07.2009
03.07.2009
03.07.2009
06.07.2009
07.07.2009
09.07.2009
09.07.2009
17.03.2012
17.03.2012
10.05.2012
19.03.2012
01.03.2012
01.05.2012
01.03.2012
01.03.2012
02.02.2012
04.05.2012
04.03.2012
06.03.2012
01.05.2012
03.02.2012
03.02.2012
06.02.2012
07.03.2012
09.05.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
24PAGE :
TAMAN RIANTO
A SIGIT PURNOMO
JUMADIL JOHAR
FREDY
STAFANUS ANDRI WINAR
WILLIAM F.JOHANNES
M NOVALINA TRIATI
KARTIKA WATI
RIDA ROSALINA
ONIS SIUS RESI
NATANAEL ANDREAS
YEYEN RISMAYANTI
DETTY S H R LIMPELEH
ABDUL HAMID SE
TERDY MENGKO
DWI CAHYONO
AHMAD SETIAWAN
CHRYSANTHUS CANDRA P
ANAS MASKUR
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
DANHCP
UOBEXP
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANDEX
PMTBPL
PMTBPL
CIGLPN
DANLFP
DANLFP
LIFCRP
MANDEX
CIGLPN
CIGLPN
CIGLPN
LIFCRP
LIFCRP
HSBTLC
0.00
0.00
0.00
1,800.00
0.00
417.00
0.00
29,583.00
12,000.00
2,367.00
25,000.00
143,333.00
6,120.00
40,233.00
0.00
36,000.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
7,200.00
0.00
1,250.00
0.00
177,500.00
36,000.00
7,100.00
75,000.00
344,000.00
36,720.00
120,700.00
0.00
216,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
10,000,000.00
5,000,000.00
10,000,000.00
5,000,000.00
300,000,000.00
10,000,000.00
1,000,000,000.00
50,000,000.00
5,000,000.00
300,000,000.00
500,000,000.00
34,000,000.00
85,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
30,000,000.00
0.00
0.00
0.00
10,000,000.00
0.00
5,000,000.00
0.00
710,000,000.00
50,000,000.00
5,000,000.00
300,000,000.00
200,000,000.00
34,000,000.00
85,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,800.00
0.00
417.00
0.00
29,583.00
12,000.00
2,367.00
25,000.00
143,333.00
6,120.00
40,233.00
0.00
36,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,800.00
0.00
417.00
0.00
29,583.00
12,000.00
2,367.00
25,000.00
143,333.00
6,120.00
40,233.00
0.00
36,000.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001357888.01
0001358772
0001358781
0001358998
0001359086
0001359086.01
0001365553
0001365917
0001370570.01
0001376807.01
0001378652
0001379185
0001380510
0001380681
0001383667
0001385524
0001385725
0001386706
0001386843
0001386950
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
IMKIN0001357888
IMKIN0001358772
IMKIN0001358781
IMKIN0001358998
IMKIN0001359086
IMKIN0001359086
IMKIN0001365553
IMKIN0001365917
IMKIN0001370570
IMKIN0001376807
IMKIN0001378652
IMKIN0001379185
IMKIN0001380510
IMKIN0001380681
IMKIN0001383667
IMKIN0001385524
IMKIN0001385725
IMKIN0001386706
IMKIN0001386843
IMKIN0001386950
21.07.2009
09.07.2009
10.07.2009
10.07.2009
11.07.2009
11.07.2009
14.07.2009
15.07.2009
14.07.2009
21.07.2009
28.07.2009
17.07.2009
01.08.2009
01.08.2009
04.08.2009
01.08.2009
04.08.2009
01.08.2009
04.08.2009
05.08.2009
21.03.2012
09.05.2012
10.03.2012
10.03.2012
11.05.2012
11.05.2012
14.05.2012
15.03.2012
14.05.2012
21.03.2012
28.05.2012
17.03.2012
01.03.2012
01.03.2012
04.05.2012
01.03.2012
04.03.2012
01.03.2012
04.05.2012
05.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
25PAGE :
LISMEILI
GUPRANSYAH
CAHYO WIDODO
MAHFUDIN
MASNIWATI MSY
SYAMSUAR
ABU HANIFAH SP
KIKI SADIKIN
DODI ASEP MASKAR
ENDAH YULI ASTUTI
CAKTI KRISJONO WITAR
MOCHAMMAD CHOLILIH
JONI HERMANTO
ARIEF WAHYUDI NUGRAH
SULIANA
HERTADI POERNOMO
MEY ENDRAYANI SH
EDI
WIDJAJANTO K
NIKEN EKA PRIARNANI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UOBEXP
LIFCRP
LIFCRP
PMTBPL
PMTBPL
DANLFP
DANLFP
BNIJBX
HSBTLC
MANDEX
MANDEX
LIFCRP
PMCSHP
PMTBPL
PMTBPL
PMCSHP
LIFCRP
LIFCRP
HSBTLC
HSBTLC
HSBTLC
16,433.00
58,333.00
0.00
0.00
38,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
143,750.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
49,300.00
350,000.00
0.00
0.00
114,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
345,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
500,000,000.00
200,000,000.00
7,500,000.00
750,000,000.00
85,000,000.00
85,000,000.00
150,000,000.00
30,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
75,000,000.00
6,500,000.00
5,000,000.00
75,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
30,000,000.00
30,000,000.00
10,000,000.00
500,000,000.00
0.00
0.00
457,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16,433.00
58,333.00
0.00
0.00
38,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
143,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16,433.00
58,333.00
0.00
0.00
38,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
143,750.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001389665
0001389938
0001391099.01
0001392131
0001392132
0001397010
0001398349.01
0001398606
0001401928
0001401932
0001401959
0001403460
0001403548
0001404588
0001405650
0001408179
0001409260
0001409737.01
0001410014
0001410876
0001412118
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
IMKIN0001389665
IMKIN0001389938
IMKIN0001391099
IMKIN0001392131
IMKIN0001392132
IMKIN0001397010
IMKIN0001398349
IMKIN0001398606
IMKIN0001401928
IMKIN0001401932
IMKIN0001401959
IMKIN0001403460
IMKIN0001403548
IMKIN0001404588
IMKIN0001405650
IMKIN0001408179
IMKIN0001409260
IMKIN0001409737
IMKIN0001410014
IMKIN0001410876
IMKIN0001412118
08.08.2009
03.08.2009
10.08.2009
11.08.2009
11.08.2009
08.08.2009
13.08.2009
18.08.2009
12.08.2009
12.08.2009
12.08.2009
19.08.2009
20.08.2009
21.08.2009
27.08.2009
24.08.2009
25.08.2009
25.08.2009
25.08.2009
01.09.2009
01.09.2009
08.03.2012
03.03.2012
10.03.2012
11.05.2012
11.03.2012
08.03.2012
13.05.2012
18.03.2012
12.03.2012
12.03.2012
12.03.2012
19.03.2012
20.03.2012
21.05.2012
27.05.2012
24.03.2012
25.03.2012
25.05.2012
25.02.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
26PAGE :
ALBERT YOSIETO
ASAD MULYA POHAN, IR
DJAROT WINARNO
JASMINTO
ISMAWARNI SP
J.SRI PURWANTO
KUNTO WIDIARTO
DINATA
MASSITOH
YUSAK ANTON WIJAYA
BAMBANG BUDIYONO
HERIE SUSANTO
HARDI
WAHYU ASTUTI
MONIQUE (MONICA) SUT
PAUL ARIF BUDIMAN
JOHNNY M PANGGABEAN
BALGIS MUHAMMAD,SP
DR. GANDA E.M. TAMPU
SETIYONO
SUJANTO BE
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
DANHCP
MANDEX
HSBTLC
HSBTLC
PMTBPL
MANDEX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
HSBTLC
HSBTLC
HSBTLC
NIAPMK
CIGHLP
HSBTLC
MANDEX
CIGLPN
PMTBPL
HSBTLC
0.00
0.00
366,667.00
0.00
0.00
0.00
30,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,375.00
0.00
18,000.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
880,000.00
0.00
0.00
0.00
121,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,900.00
0.00
72,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
30,000,000.00
25,000,000.00
200,000,000.00
30,000,000.00
50,000,000.00
6,500,000.00
50,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
30,000,000.00
50,000,000.00
30,000,000.00
6,000,000.00
10,000,000.00
30,000,000.00
200,000,000.00
100,000,000.00
6,500,000.00
50,000,000.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
366,667.00
0.00
0.00
0.00
30,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,375.00
0.00
18,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
366,667.00
0.00
0.00
0.00
30,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,375.00
0.00
18,000.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001413749
0001413973
0001415300
0001415300.01
0001420962.01
0001420962.03
0001421326
0001421622.01
0001422226
0001422269
0001422546
0001425791.01
0001426593
0001428580
0001430095
0001431519
0001433033
0001433106.01
0001433906
0001434334
0001434334.02
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
IMKIN0001413749
IMKIN0001413973
IMKIN0001415300
IMKIN0001415300
IMKIN0001420962
IMKIN0001420962
IMKIN0001421326
IMKIN0001421622
IMKIN0001422226
IMKIN0001422269
IMKIN0001422546
IMKIN0001425791
IMKIN0001426593
IMKIN0001428580
IMKIN0001430095
IMKIN0001431519
IMKIN0001433033
IMKIN0001433106
IMKIN0001433906
IMKIN0001434334
IMKIN0001434334
01.09.2009
01.09.2009
03.09.2009
03.09.2009
04.09.2009
04.09.2009
11.09.2009
02.09.2009
10.09.2009
10.09.2009
09.09.2009
10.09.2009
14.09.2009
16.09.2009
15.09.2009
08.09.2009
25.09.2009
17.09.2009
25.09.2009
01.10.2009
01.10.2009
01.03.2012
01.05.2012
03.03.2012
03.03.2012
21.05.2012
21.05.2012
11.03.2012
02.05.2012
10.05.2012
10.03.2012
09.02.2012
10.03.2012
14.03.2012
16.02.2012
15.03.2012
08.03.2012
25.03.2012
17.03.2012
25.03.2012
01.05.2012
01.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
27PAGE :
SARAH LAYLA
ELY MULYANI
MARTEN ENDRA MUKARTO
RAGIL SETYORINI S.PD
CHIDMAT INDERA
INDERAWATI MUTIARA
RYNI VANDITTA
FAISAL MARIF
WILLIAM F.JOHANNES
FERI LUKMANSARI
IDAWATI .AMD
DEWA AYU ASRINI
INDRA ARI YUDHANTO
AGUNG NUGROHO
AHMADI
MARIANDA
HENY HATISAH
A BISRUN
CALVIENO PANGAU
HENNI NOORITA
KUSHARDIYANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
CIGLPN
PMCSHP
PMCSHP
UOBEXP
UOBEXP
NIAPMD
MANDEX
PMCSHP
PMCSHP
CIGLPN
MANDEX
HSBTLC
CIGLPN
DANHCP
PMCSHP
HSBTLC
MANDEX
LIFCRP
PMTBPL
PMTBPL
0.00
72,000.00
31,875.00
0.00
9,800.00
5,400.00
35,000.00
91,667.00
92,000.00
0.00
0.00
91,000.00
0.00
247,917.00
0.00
21,250.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
216,000.00
63,750.00
0.00
39,200.00
21,600.00
70,000.00
275,000.00
276,000.00
0.00
0.00
182,000.00
0.00
425,000.00
0.00
42,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
10,000,000.00
10,000,000.00
300,000,000.00
100,000,000.00
50,000,000.00
75,000,000.00
100,000,000.00
200,000,000.00
50,000,000.00
500,000,000.00
10,000,000.00
50,000,000.00
30,000,000.00
50,000,000.00
50,000,000.00
5,000,000.00
5,000,000.00
0.00
200,000,000.00
75,000,000.00
0.00
10,000,000.00
10,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
0.00
0.00
200,000,000.00
0.00
500,000,000.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
72,000.00
31,875.00
0.00
9,800.00
5,400.00
35,000.00
91,667.00
92,000.00
0.00
0.00
91,000.00
0.00
247,917.00
0.00
21,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
72,000.00
31,875.00
0.00
9,800.00
5,400.00
35,000.00
91,667.00
92,000.00
0.00
0.00
91,000.00
0.00
247,917.00
0.00
21,250.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001434993
0001436186.01
0001437217
0001437238
0001437318
0001437425
0001439533
0001439611
0001441500.01
0001441763
0001442671
0001443504
0001443667
0001443706
0001443706.02
0001444023.01
0001445634
0001448013
0001448021
0001448159
0001449061
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
IMKIN0001434993
IMKIN0001436186
IMKIN0001437217
IMKIN0001437238
IMKIN0001437318
IMKIN0001437425
IMKIN0001439533
IMKIN0001439611
IMKIN0001441500
IMKIN0001441763
IMKIN0001442671
IMKIN0001443504
IMKIN0001443667
IMKIN0001443706
IMKIN0001443706
IMKIN0001444023
IMKIN0001445634
IMKIN0001448013
IMKIN0001448021
IMKIN0001448159
IMKIN0001449061
01.10.2009
01.10.2009
12.10.2009
01.10.2009
01.10.2009
05.10.2009
01.10.2009
01.10.2009
06.10.2009
07.10.2009
08.10.2009
23.10.2009
10.10.2009
10.10.2009
10.10.2009
21.10.2009
12.10.2009
14.10.2009
14.10.2009
15.10.2009
14.10.2009
01.03.2012
01.02.2012
12.03.2012
01.04.2012
01.03.2012
05.02.2012
01.03.2012
01.03.2012
06.02.2012
07.05.2012
08.04.2012
23.05.2012
10.03.2012
10.03.2012
10.03.2012
21.05.2012
12.03.2012
14.05.2012
14.02.2012
15.04.2012
14.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
28PAGE :
RIZAL SUPRIADI, SE
AGUS SURURI
ADITYA DARMAWAN
DAHLIA FN
SANDRA
NI KADEK ARYAWATI. S
IR ARIANTO SUFAAT
RUDI PRAJOGO SH
AGUNG NUGROHO
IMMACULATA TRI WAHJU
R YULIESTIE
HANIF RALIBI
FERRY TOBING
KUSMIATI
SURYANTO
THIO TJOEN HONG
TJENAH AKEMAH
ERNI WIDAYATI
AA GEDE SEMARA PUTRA
MORUK HALE MAXIMUS D
STEPHANNIE LOUIS
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
CIGSRN
NIAPMD
HSBTLC
HSBTLC
CIGLPN
PMTBPL
PMTBPL
CIGSRN
MANTLF
HSBTLC
NIAPMD
PMTBPL
PMTBPL
PMTBPL
UOBEXP
MANTLF
HSBTLC
CIGLPN
BNIJBT
CIGLPN
0.00
354,667.00
40,833.00
0.00
0.00
144,000.00
0.00
0.00
256,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
31,500.00
0.00
0.00
0.00
140,000.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
532,000.00
70,000.00
0.00
0.00
216,000.00
0.00
0.00
384,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
54,000.00
0.00
0.00
0.00
280,000.00
0.00
53,200.00
7,000.00
0.00
0.00
21,600.00
0.00
0.00
38,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,400.00
0.00
0.00
0.00
28,000.00
6,500,000.00
400,000,000.00
100,000,000.00
30,000,000.00
50,000,000.00
300,000,000.00
10,000,000.00
5,000,000.00
400,000,000.00
75,000,000.00
30,000,000.00
100,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
75,000,000.00
50,000,000.00
300,000,000.00
50,000,000.00
500,000,000.00
0.00
400,000,000.00
100,000,000.00
0.00
0.00
300,000,000.00
0.00
0.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
25,000,000.00
0.00
0.00
0.00
400,000,000.00
0.00
35,467.00
4,083.00
0.00
0.00
14,400.00
0.00
0.00
25,600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,150.00
0.00
0.00
0.00
14,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
319,200.00
36,750.00
0.00
0.00
129,600.00
0.00
0.00
230,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
28,350.00
0.00
0.00
0.00
126,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
319,200.00
36,750.00
0.00
0.00
129,600.00
0.00
0.00
230,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
28,350.00
0.00
0.00
0.00
126,000.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001449169
0001449227.01
0001449461
0001450290
0001452436.01
0001453579
0001453654
0001453654.02
0001453708
0001456390
0001456923
0001457703
0001458187
0001458360
0001458592.01
0001459537
0001460715
0001461075
0001461688.01
0001462059.01
0001462096
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
IMKIN0001449169
IMKIN0001449227
IMKIN0001449461
IMKIN0001450290
IMKIN0001452436
IMKIN0001453579
IMKIN0001453654
IMKIN0001453654
IMKIN0001453708
IMKIN0001456390
IMKIN0001456923
IMKIN0001457703
IMKIN0001458187
IMKIN0001458360
IMKIN0001458592
IMKIN0001459537
IMKIN0001460715
IMKIN0001461075
IMKIN0001461688
IMKIN0001462059
IMKIN0001462096
13.10.2009
15.10.2009
09.10.2009
15.10.2009
20.10.2009
21.10.2009
21.10.2009
21.10.2009
21.10.2009
23.10.2009
19.10.2009
23.10.2009
26.10.2009
09.11.2009
26.10.2009
26.10.2009
23.10.2009
09.11.2009
20.10.2009
27.10.2009
01.11.2009
13.03.2012
15.05.2012
09.03.2012
15.04.2012
20.05.2012
21.03.2012
21.03.2012
21.03.2012
21.03.2012
23.03.2012
19.05.2012
23.03.2012
26.03.2012
09.05.2012
03.03.2012
26.05.2012
23.02.2012
14.05.2012
20.03.2012
27.05.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
29PAGE :
ANNA FAUZAN
PAULUS ADI WIJAYA YO
DARMSTATER MARTINUS
IR. IGN HIMAWAN SULI
WEWE
ARTHA ULY NAINGGOLAN
AGUSTINA SETYOWATI
KUSRYANTO SH MH
I KETUT MARTIN
YATNO
HUDSON DIESNATALIS
SELVI CHRISTINE TJU
TJHIA FUI PHIN
WIDI WAHYUDI
ROMLAH LAELA
ADI ABDILAH
MUHAMMAD ROSYAD WIDO
MUSTIKAWATI SANJAYA
EDI ENIKA KAHAR
CHANDRA HARTISAN SS
WIWIN RAHAYU
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
MANDEX
PMTBPL
CIGLPN
MANDEX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGLPN
HSBTLC
PMTBPL
NIAPMK
UOBEXP
BNIJBX
CIGLPN
NIAPMK
MANDEX
CIGSRN
BNIJBT
0.00
0.00
0.00
129,000.00
107,500.00
0.00
0.00
0.00
0.00
0.00
71,667.00
16,567.00
0.00
790.00
0.00
0.00
0.00
0.00
0.00
241,667.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
258,000.00
258,000.00
0.00
0.00
0.00
0.00
0.00
172,000.00
28,400.00
0.00
1,580.00
0.00
0.00
0.00
0.00
0.00
580,000.00
0.00
0.00
0.00
0.00
25,800.00
25,800.00
0.00
0.00
0.00
0.00
0.00
17,200.00
2,840.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
58,000.00
0.00
25,000,000.00
50,000,000.00
10,000,000.00
500,000,000.00
200,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
100,000,000.00
50,000,000.00
6,500,000.00
2,000,000.00
5,000,000.00
200,000,000.00
100,000,000.00
2,000,000.00
50,000,000.00
400,000,000.00
100,000,000.00
0.00
0.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
20,000,000.00
0.00
2,000,000.00
0.00
0.00
0.00
0.00
0.00
400,000,000.00
0.00
0.00
0.00
0.00
12,900.00
10,750.00
0.00
0.00
0.00
0.00
0.00
7,167.00
1,657.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
24,167.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
116,100.00
96,750.00
0.00
0.00
0.00
0.00
0.00
64,500.00
14,910.00
0.00
790.00
0.00
0.00
0.00
0.00
0.00
217,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
116,100.00
96,750.00
0.00
0.00
0.00
0.00
0.00
64,500.00
14,910.00
0.00
790.00
0.00
0.00
0.00
0.00
0.00
217,500.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001462916
0001463133
0001464000
0001466603
0001467952
0001469612
0001469613
0001470844.01
0001470881.01
0001470882.01
0001471805
0001471805.02
0001472058.01
0001472495.01
0001472709.01
0001473771
0001474830
0001475374
0001477132
0001478295.01
0001478593
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
IMKIN0001462916
IMKIN0001463133
IMKIN0001464000
IMKIN0001466603
IMKIN0001467952
IMKIN0001469612
IMKIN0001469613
IMKIN0001470844
IMKIN0001470881
IMKIN0001470882
IMKIN0001471805
IMKIN0001471805
IMKIN0001472058
IMKIN0001472495
IMKIN0001472709
IMKIN0001473771
IMKIN0001474830
IMKIN0001475374
IMKIN0001477132
IMKIN0001478295
IMKIN0001478593
01.11.2009
01.11.2009
01.11.2009
01.11.2009
03.11.2009
09.11.2009
09.11.2009
06.11.2009
09.11.2009
09.11.2009
10.11.2009
10.11.2009
09.11.2009
10.11.2009
18.11.2009
11.11.2009
13.11.2009
02.11.2009
16.11.2009
11.11.2009
18.11.2009
01.05.2012
01.03.2012
01.03.2012
09.05.2012
03.03.2012
09.05.2012
09.05.2012
06.03.2012
09.05.2012
09.05.2012
10.05.2012
10.05.2012
09.05.2012
10.02.2012
18.05.2012
11.05.2012
13.03.2012
02.03.2012
16.03.2012
11.05.2012
18.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
30PAGE :
WARRIYODI SH
FRISKA FEBRINA
ELLY SYLVIANA
ELNATH ALPHA YONATAN
BUDI MOKO PRABOWO
YENNY GUNAWAN
IZMAL B SIREGAR
MIMIN SUPRIYADI
SUPRIYONO
LAU DAVID WIJAYA
IVAN P
OKTAFIANI
ATING BUDIARTI
FARIDA LEILASARI
JAUWLY
INDRA SUSANTI SH
DOLLY NOVIE RUMUAT
BASYIR AKHMAD ISKAND
R EVI SAVITRI P
MOCHAMMAD TRIBEKTI M
AKHMAD SYAMSI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
LIFCRP
CIGLPN
HSBTLC
HSBTLC
HSBTLC
MANDEX
MANDEX
MANDEX
HSBTLC
HSBTLC
MANDEX
CIGSRN
UOBEXP
BNIJBX
HSBTLC
PMTBPL
HSBTLC
MANDEX
BNIJBX
0.00
0.00
0.00
105,000.00
0.00
21,300.00
0.00
91,667.00
129,000.00
59,000.00
0.00
0.00
48,250.00
1,042,500.00
15,450.00
0.00
0.00
0.00
0.00
0.00
252,000.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
210,000.00
0.00
42,600.00
0.00
137,500.00
258,000.00
118,000.00
0.00
0.00
96,500.00
1,390,000.00
30,900.00
0.00
0.00
0.00
0.00
0.00
432,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
5,000,000.00
50,000,000.00
300,000,000.00
50,000,000.00
30,000,000.00
30,000,000.00
100,000,000.00
200,000,000.00
100,000,000.00
20,000,000.00
20,000,000.00
50,000,000.00
400,000,000.00
10,000,000.00
150,000,000.00
50,000,000.00
6,500,000.00
30,000,000.00
100,000,000.00
200,000,000.00
0.00
0.00
0.00
300,000,000.00
0.00
30,000,000.00
0.00
50,000,000.00
200,000,000.00
100,000,000.00
0.00
0.00
50,000,000.00
200,000,000.00
10,000,000.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
105,000.00
0.00
21,300.00
0.00
91,667.00
129,000.00
59,000.00
0.00
0.00
48,250.00
1,042,500.00
15,450.00
0.00
0.00
0.00
0.00
0.00
252,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
105,000.00
0.00
21,300.00
0.00
91,667.00
129,000.00
59,000.00
0.00
0.00
48,250.00
1,042,500.00
15,450.00
0.00
0.00
0.00
0.00
0.00
252,000.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001478610
0001479239.01
0001479966
0001480105.01
0001480607
0001480651.01
0001481375
0001481419
0001482947.01
0001485172
0001485183
0001485612.01
0001486015
0001487334
0001489426
0001490407
0001491048
0001491289
0001492292
0001492974
0001493083
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
IMKIN0001478610
IMKIN0001479239
IMKIN0001479966
IMKIN0001480105
IMKIN0001480607
IMKIN0001480651
IMKIN0001481375
IMKIN0001481419
IMKIN0001482947
IMKIN0001485172
IMKIN0001485183
IMKIN0001485612
IMKIN0001486015
IMKIN0001487334
IMKIN0001489426
IMKIN0001490407
IMKIN0001491048
IMKIN0001491289
IMKIN0001492292
IMKIN0001492974
IMKIN0001493083
23.11.2009
13.11.2009
19.11.2009
20.11.2009
21.11.2009
19.11.2009
20.11.2009
20.11.2009
23.11.2009
24.12.2009
24.12.2009
24.11.2009
25.11.2009
01.12.2009
01.12.2009
01.12.2009
01.12.2009
29.12.2009
04.12.2009
04.12.2009
03.12.2009
23.03.2012
25.03.2012
19.03.2012
20.02.2012
21.05.2012
19.03.2012
20.03.2012
20.05.2012
23.03.2012
24.05.2012
24.03.2012
24.05.2012
25.02.2012
01.03.2012
01.05.2012
01.05.2012
01.03.2012
29.05.2012
04.03.2012
04.04.2012
03.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
31PAGE :
PARSIYO
AGUS GUNAWAN
ELVIA F
MUHAMMAD SYARIEF
JUNAEDI
BONG MUSRIONO
YENNY HARSONO
GABRIEL SUKOCO
RUDI EE PAKPAHAN
ARKELAUS SANGIAN
LANJAR RETNO SARI
TUTY SYARIFAH SYAHPU
ABU SISWANTO
CITY MIRACLE
LIE KHIANG
SUKWANI SABRAN
PAUL ARIF BUDIMAN
LINA MAJUSIP
DWIWINDIANA
ZAINUDIN JOHANSYAH
KENNETH ROBERT SUTHR
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NIAPMD
UOBEXP
HSBTLC
CIGSRN
HSBTLC
MANDEX
HSBTLC
HSBTLC
PMTBPL
NIAPMD
NIAPMD
MANDEX
CIGLPN
PMTBPL
PMTBPL
DANHCP
CIGLPN
NIAPMK
BNIJBT
MANTLF
HSBTLC
56,667.00
14,400.00
0.00
0.00
0.00
162,000.00
0.00
0.00
9,360.00
0.00
88,500.00
78,000.00
0.00
0.00
0.00
0.00
483,750.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
85,000.00
21,600.00
0.00
0.00
0.00
243,000.00
0.00
0.00
14,040.00
0.00
118,000.00
156,000.00
0.00
0.00
0.00
0.00
645,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
10,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
30,000,000.00
50,000,000.00
6,500,000.00
300,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
10,000,000.00
500,000,000.00
2,000,000.00
100,000,000.00
75,000,000.00
30,000,000.00
100,000,000.00
10,000,000.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
6,500,000.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
500,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
56,667.00
14,400.00
0.00
0.00
0.00
162,000.00
0.00
0.00
9,360.00
0.00
88,500.00
78,000.00
0.00
0.00
0.00
0.00
483,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
56,667.00
14,400.00
0.00
0.00
0.00
162,000.00
0.00
0.00
9,360.00
0.00
88,500.00
78,000.00
0.00
0.00
0.00
0.00
483,750.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001493083.02
0001493158
0001493177
0001493177.02
0001494700.01
0001497581.01
0001497612.01
0001498217
0001498808
0001498915.01
0001499307
0001499335
0001500388.01
0001500417.01
0001500438.01
0001501714
0001502590
0001503093.01
0001505481.01
0001505524.01
0001507387
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
IMKIN0001493083
IMKIN0001493158
IMKIN0001493177
IMKIN0001493177
IMKIN0001494700
IMKIN0001497581
IMKIN0001497612
IMKIN0001498217
IMKIN0001498808
IMKIN0001498915
IMKIN0001499307
IMKIN0001499335
IMKIN0001500388
IMKIN0001500417
IMKIN0001500438
IMKIN0001501714
IMKIN0001502590
IMKIN0001503093
IMKIN0001505481
IMKIN0001505524
IMKIN0001507387
03.12.2009
05.12.2009
07.12.2009
07.12.2009
09.12.2009
11.12.2009
14.12.2009
15.12.2009
15.12.2009
08.12.2009
15.12.2009
24.12.2009
16.12.2009
10.12.2009
12.12.2009
03.12.2009
11.12.2009
17.12.2009
16.12.2009
21.12.2009
16.12.2009
03.03.2012
05.05.2012
07.03.2012
07.03.2012
15.05.2012
11.05.2012
14.03.2012
15.05.2012
15.03.2012
08.04.2012
15.03.2012
07.05.2012
16.03.2012
01.05.2012
28.05.2012
03.05.2012
11.03.2012
17.03.2012
16.03.2012
21.03.2012
16.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
32PAGE :
SANDRA ASRININGRUM
DAISY PAULINA R
H MARHENTO
LISTIANINGSIH P
SITI NURCAHYANI
CHRISTIAN LUTHER PAP
GELAR PANGERSA MUNGG
NURWIYANTO
PENI HERMAWATI
SUKIRMAN
IMAS CUCU ROHAENI
APRINUS
SUPRIA
NAJIB NENDRA
SALLY OCTAVIA
WAHYU DWINARKO LEKSO
OMEGA PERMATA SARI
BUDIYONO
ANDRES CHANDRA
TONI
NOVAYANTI BIRINGKANA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
HSBTLC
HSBTLC
HSBTLC
UOBEXP
MANDEX
MANDEX
BNIJBT
HSBTLC
MANDEX
BNIJBX
NIAPMD
MANDEX
UOBEXP
UOBEXP
PMCSHP
HSBTLC
MANDEX
MANDEX
MANDEX
PMCSHP
20,475.00
0.00
0.00
0.00
4,083.00
0.00
105,000.00
228,667.00
0.00
93,333.00
392,625.00
284,000.00
72,375.00
36,050.00
0.00
0.00
53,250.00
0.00
52,500.00
369,750.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
27,300.00
0.00
0.00
0.00
7,000.00
0.00
140,000.00
392,000.00
0.00
140,000.00
523,500.00
426,000.00
96,500.00
61,800.00
0.00
0.00
71,000.00
0.00
70,000.00
493,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
30,000,000.00
50,000,000.00
30,000,000.00
30,000,000.00
10,000,000.00
100,000,000.00
200,000,000.00
100,000,000.00
20,000,000.00
200,000,000.00
150,000,000.00
300,000,000.00
50,000,000.00
10,000,000.00
5,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
30,000,000.00
0.00
0.00
0.00
10,000,000.00
0.00
200,000,000.00
100,000,000.00
0.00
200,000,000.00
150,000,000.00
300,000,000.00
50,000,000.00
10,000,000.00
0.00
0.00
50,000,000.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
20,475.00
0.00
0.00
0.00
4,083.00
0.00
105,000.00
228,667.00
0.00
93,333.00
392,625.00
284,000.00
72,375.00
36,050.00
0.00
0.00
53,250.00
0.00
52,500.00
369,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
20,475.00
0.00
0.00
0.00
4,083.00
0.00
105,000.00
228,667.00
0.00
93,333.00
392,625.00
284,000.00
72,375.00
36,050.00
0.00
0.00
53,250.00
0.00
52,500.00
369,750.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001508656.01
0001509336
0001509336.02
0001509664
0001509664.01
0001511484
0001511508
0001511949.01
0001512004
0001512477
0001513351.01
0001516209
0001516312
0001516781
0001519836
0001520282.01
0001520338.01
0001521074
0001521769
0001522870
0001523020
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
598
599
600
601
IMKIN0001508656
IMKIN0001509336
IMKIN0001509336
IMKIN0001509664
IMKIN0001509664
IMKIN0001511484
IMKIN0001511508
IMKIN0001511949
IMKIN0001512004
IMKIN0001512477
IMKIN0001513351
IMKIN0001516209
IMKIN0001516312
IMKIN0001516781
IMKIN0001519836
IMKIN0001520282
IMKIN0001520338
IMKIN0001521074
IMKIN0001521769
IMKIN0001522870
IMKIN0001523020
01.01.2010
01.01.2010
01.01.2010
01.01.2010
01.01.2010
01.01.2010
01.01.2010
04.01.2010
02.01.2010
05.01.2010
04.01.2010
11.01.2010
11.01.2010
07.01.2010
13.01.2010
06.01.2010
11.01.2010
13.01.2010
14.01.2010
11.02.2010
14.01.2010
01.04.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.04.2012
01.05.2012
04.05.2012
02.05.2012
05.05.2012
04.05.2012
11.03.2012
11.03.2012
07.05.2012
13.03.2012
06.05.2012
11.05.2012
13.05.2012
14.03.2012
11.03.2012
14.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
33PAGE :
YUDHI WAHYUDI
DIAR PRATIWI
MOCH. ZEIN AL ASHAR
DESI NURAIDAH
HERI PATMONO
SUPARMAN
JULISTIYOWATI
ZAINUL IKHWAN
ELISABETTH RIANG H
H MANSUR,DRS
WAWAN ERAWAN
KARTIKA WATI
WAHJU KURDIJANTI
HERI SISWOYO
LO FARRAH KARTIKA
WIWIK CHITRA PRATIWI
I GEDE PARTANAYASA
MARTIANA NIKMATURROH
SRI RAHMADANI
RR ANNISA BUDIUTOMO
MUZAKKIR H HASAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
PMTBPL
PMTBPL
PMCSHP
PMCSHP
BNIJBT
BNIJBT
MANDEX
HSBTLC
BNIJBT
MANDEX
PMCSHP
PMCSHP
DANHCP
PMCSHP
MANDEX
MANDEX
BNIJBX
PMCSHP
NIAPMK
DANHCP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
6,500,000.00
6,500,000.00
25,000,000.00
25,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
330,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
25,000,000.00
10,600,000.00
25,000,000.00
100,000,000.00
100,000,000.00
150,000,000.00
50,000,000.00
2,000,000.00
10,600,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001523033
0001524571
0001524571.01
0001524940
0001524976
0001524998
0001525038
0001525353
0001529341.01
0001529723
0001530199
0001531312.01
0001531354.01
0001531861
0001533472.01
0001535074
0001536743.01
0001537027.01
0001537038.01
0001537389
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
621
IMKIN0001523033
IMKIN0001524571
IMKIN0001524571
IMKIN0001524940
IMKIN0001524976
IMKIN0001524998
IMKIN0001525038
IMKIN0001525353
IMKIN0001529341
IMKIN0001529723
IMKIN0001530199
IMKIN0001531312
IMKIN0001531354
IMKIN0001531861
IMKIN0001533472
IMKIN0001535074
IMKIN0001536743
IMKIN0001537027
IMKIN0001537038
IMKIN0001537389
14.01.2010
23.02.2010
23.02.2010
18.01.2010
19.01.2010
19.01.2010
05.03.2010
19.01.2010
22.01.2010
18.01.2010
20.01.2010
22.01.2010
25.01.2010
17.03.2010
23.01.2010
01.02.2010
01.02.2010
02.02.2010
02.02.2010
01.02.2010
14.03.2012
23.05.2012
23.05.2012
18.05.2012
19.04.2012
19.05.2012
05.02.2012
19.05.2012
22.03.2012
18.03.2012
20.03.2012
22.03.2012
25.05.2012
17.05.2012
23.02.2012
01.03.2012
01.05.2012
02.03.2012
02.05.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
34PAGE :
WILLIAM
A RIVAI RUSJDIN
A RIVAI RUSJDIN
SETIYANTO YUWONO
BONNY SANGGAH SH
YOHANES RAJAWALI
SUSANTI
PATHURAHMAN,ST
FATIMAH HATTA
HARTADI HENDRATMOKO
BUDIANTO
MADA
RENANDI
YANI NOVIANA
SUPRIYANDI
ARIE KURNIAWAN
GUSMAN RYNHOT PANJAI
MARY PUDJIASTUTI SUS
HARNI HAMDAN TAMLI
SUMARSIYAM
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
RBSTLE
RBSTLE
BNIJBX
BNIJBT
BNIJBT
CIGHCH
CIGHCH
BNIJBT
MANDEX
PMCSHP
PMCSHP
MANDEX
MANDEX
NIAPMK
CIGSRN
HSBTLC
MANDEX
MANDEX
MANDEX
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
42,250,000.00
150,000,000.00
75,000,000.00
200,000,000.00
50,000,000.00
50,000,000.00
10,000,000.00
10,000,000.00
100,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
100,000,000.00
100,000,000.00
10,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001537745
0001540062
0001541864
0001543222
0001543222.02
0001543713
0001543925
0001544924.01
0001545963
0001546107
0001547737
0001548194
0001548231
0001548346
0001548844.01
0001549886
0001549888
0001549888.02
0001550512
0001551844
0001551851
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
641
642
IMKIN0001537745
IMKIN0001540062
IMKIN0001541864
IMKIN0001543222
IMKIN0001543222
IMKIN0001543713
IMKIN0001543925
IMKIN0001544924
IMKIN0001545963
IMKIN0001546107
IMKIN0001547737
IMKIN0001548194
IMKIN0001548231
IMKIN0001548346
IMKIN0001548844
IMKIN0001549886
IMKIN0001549888
IMKIN0001549888
IMKIN0001550512
IMKIN0001551844
IMKIN0001551851
03.02.2010
05.02.2010
11.02.2010
09.02.2010
09.02.2010
05.02.2010
03.02.2010
12.02.2010
12.02.2010
23.02.2010
04.02.2010
12.02.2010
16.02.2010
17.02.2010
17.02.2010
16.02.2010
16.02.2010
16.02.2010
18.02.2010
19.02.2010
17.02.2010
03.03.2012
05.03.2012
11.03.2012
09.05.2012
09.05.2012
05.05.2012
03.03.2012
12.05.2012
12.03.2012
23.03.2012
04.05.2012
12.05.2012
16.05.2012
17.03.2012
17.05.2012
16.03.2012
16.05.2012
16.05.2012
18.03.2012
19.03.2012
17.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
35PAGE :
ELFI AFIFAH
SRI EKA YULIANI
ENDAH TRISETYAWATI
RAJEEV KUMAR R
VIDYA S
ABDUL RAHIM SP
SUNOKO
DRS SUYANTO SE
M JAYADI
ODO FADLOELI
JIMMY MANGAMPUL SIMA
NOVINDRA M
MEI CHRISTINA ROTUA
IDA BAGUS PUTU ADNYA
PRATMIN
RAYMOND WIDJAJA
AZHAR SE AK
RINI IRAWATI
SUPRIYANTO
MARULI S R SINAGA
BUDI RAHMANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
PMCSHP
PMCSHP
HSBTLC
HSBTLC
PMTBPL
PMCSHP
MANDEX
HSBTLC
NIAPMK
PMCSHP
PMCSHP
BNIJBX
PMTBPL
MANDEX
HSBTLC
HSBTLC
HSBTLC
HSBTLC
DANHCP
DANHCP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
75,000,000.00
75,000,000.00
20,000,000.00
20,000,000.00
5,000,000.00
75,000,000.00
50,000,000.00
30,000,000.00
2,000,000.00
50,000,000.00
75,000,000.00
150,000,000.00
6,500,000.00
100,000,000.00
50,000,000.00
20,000,000.00
20,000,000.00
20,000,000.00
10,000,000.00
10,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001551926
0001553590.01
0001553738.01
0001555652
0001556445
0001556917
0001557140
0001557410
0001557410.01
0001558855.01
0001558880.01
0001559708
0001559711
0001560284
0001561954
0001561957
0001562677.01
0001562760
0001562776
0001563434
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
643
644
645
646
647
648
649
650
651
652
653
654
655
656
657
658
659
660
661
662
IMKIN0001551926
IMKIN0001553590
IMKIN0001553738
IMKIN0001555652
IMKIN0001556445
IMKIN0001556917
IMKIN0001557140
IMKIN0001557410
IMKIN0001557410
IMKIN0001558855
IMKIN0001558880
IMKIN0001559708
IMKIN0001559711
IMKIN0001560284
IMKIN0001561954
IMKIN0001561957
IMKIN0001562677
IMKIN0001562760
IMKIN0001562776
IMKIN0001563434
19.02.2010
19.02.2010
20.02.2010
01.03.2010
01.03.2010
01.03.2010
01.03.2010
01.03.2010
01.03.2010
02.03.2010
03.03.2010
02.03.2010
02.03.2010
03.03.2010
17.03.2010
05.03.2010
01.03.2010
08.03.2010
17.03.2010
08.03.2010
19.05.2012
19.05.2012
20.05.2012
01.05.2012
01.04.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
03.05.2012
02.03.2012
02.03.2012
03.02.2012
17.03.2012
05.05.2012
01.05.2012
08.05.2012
17.05.2012
08.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
36PAGE :
HUNGKONO CHANDRA
YANTI CHRISNAVIANTI
PRI ARTCAHYO
FIRA MARDIANI
KAMILUS N. U.
WIDJANARKO ANDANG
IDA NURHAYATI
THEDORE EDWARD CHRIS
YOHANES CHRISTIANTO
ARI TITIS SETIAWAN
ANDY TANO TJANDRA
ARI NUGRAHA P
RANGGA C NUGRAHA
ERIC YUNIAR WIBOWO
ROLAND RIAN ULIANTO
BUDI IRIANTI
TISNA MANSUR
DEWI BUDHI EKASARI
YANUARITA EVAFANI MU
YESSICA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
MANDEX
MANDEX
HSBTLC
BNIJBX
PMTBPL
PMTBPL
PMCSHP
PMCSHP
MANDEX
MANDEX
HSBTLC
HSBTLC
CIGLPN
CIGLPN
NIAPMD
BNIJBT
MANDEX
BNIJBT
NIAPMD
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
140,000.00
0.00
0.00
0.00
0.00
116,667.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
350,000.00
140,000.00
0.00
0.00
0.00
0.00
140,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
30,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
200,000,000.00
6,500,000.00
5,000,000.00
75,000,000.00
75,000,000.00
200,000,000.00
100,000,000.00
30,000,000.00
20,000,000.00
500,000,000.00
500,000,000.00
300,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
500,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
500,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
140,000.00
0.00
0.00
0.00
0.00
116,667.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
140,000.00
0.00
0.00
0.00
0.00
116,667.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001563511
0001567792
0001567823
0001567850.01
0001568076.01
0001568087.01
0001568649
0001569780
0001571025.01
0001571031.01
0001571071.01
0001572108
0001572617.01
0001576655.01
0001576709.01
0001577301
0001577301.01
0001578190
0001578764
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
681
IMKIN0001563511
IMKIN0001567792
IMKIN0001567823
IMKIN0001567850
IMKIN0001568076
IMKIN0001568087
IMKIN0001568649
IMKIN0001569780
IMKIN0001571025
IMKIN0001571031
IMKIN0001571071
IMKIN0001572108
IMKIN0001572617
IMKIN0001576655
IMKIN0001576709
IMKIN0001577301
IMKIN0001577301
IMKIN0001578190
IMKIN0001578764
09.03.2010
12.03.2010
15.03.2010
11.03.2010
15.03.2010
17.03.2010
17.03.2010
17.03.2010
18.03.2010
18.03.2010
19.03.2010
30.03.2010
22.03.2010
26.03.2010
23.03.2010
24.03.2010
24.03.2010
01.04.2010
02.04.2010
09.05.2012
12.03.2012
15.03.2012
11.05.2012
15.05.2012
17.03.2012
17.05.2012
17.02.2012
18.05.2012
18.03.2012
19.05.2012
30.03.2012
22.03.2012
26.04.2012
23.05.2012
24.03.2012
24.03.2012
01.05.2012
02.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
37PAGE :
I GUSTI AGUNG PUTRA
PULUNG KUSHARIADI
JOVITA IRENE TURANG
AA AHYAUDDIN DENI
MUTYA YUNI LESTARI
AGUNG BAROKAH
WILDAN DESNANDAR
KRISTIANA MUDJIATI
FARID NUR HAMZAH
UMI ENDAH SUSILOWATI
SARI RATNA FRANSISCA
HERRY LANO
ROCHIMANUL LAKSANA
ELLY PURNAWATI
PAUL H H PARDEDE
ARIS MARTONO
CELIA PRAMONO PUTRI
ANI RATMALA
HARTADI HENDRATMOKO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBT
MANTLF
MANTLF
MANDEX
MANDEX
MANDEX
PMCSHP
CIGLPN
CIGLPN
MANDEX
MANDEX
MANDEX
NIAPMK
MANDEX
MANDEX
MANDEX
PMCSHP
PMCSHP
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
0.00
91,000.00
0.00
0.00
0.00
58,333.00
142,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
91,000.00
0.00
0.00
0.00
70,000.00
142,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
75,000,000.00
20,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
75,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
2,000,000.00
100,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91,000.00
0.00
0.00
0.00
58,333.00
142,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91,000.00
0.00
0.00
0.00
58,333.00
142,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001579175
0001579348
0001579375
0001579929
0001580646
0001580646.01
0001580721
0001581871
0001581871.02
0001583075
0001584397
0001584539.01
0001584935
0001586699.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
682
683
684
685
686
687
688
689
690
691
692
693
694
695
IMKIN0001579175
IMKIN0001579348
IMKIN0001579375
IMKIN0001579929
IMKIN0001580646
IMKIN0001580646
IMKIN0001580721
IMKIN0001581871
IMKIN0001581871
IMKIN0001583075
IMKIN0001584397
IMKIN0001584539
IMKIN0001584935
IMKIN0001586699
01.04.2010
19.04.2010
01.04.2010
01.04.2010
19.04.2010
19.04.2010
02.03.2010
07.04.2010
07.04.2010
19.04.2010
07.04.2010
07.04.2010
10.04.2010
12.04.2010
01.03.2012
19.03.2012
01.05.2012
01.03.2012
19.03.2012
19.03.2012
02.05.2012
07.03.2012
07.03.2012
19.03.2012
07.03.2012
07.05.2012
10.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
38PAGE :
JENI SYAHRINA
INTEN WIDIASTARI I G
RIDAR FIRDAUS GINTIN
YOSAFAT RUMOMBE
IYOD RIDWAN
IYOD RIDWAN
GUNAWAN PONTOH
MAYA MAULIZAR AMD
WIDIASMANTO
ZAINUL ARIFIN
ROSI
ARIANA INDAWATI TIRT
CHERRIYATI
SUDIRMAN BASRI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
DANHCP
NIAPMD
NIAPMD
BNIJBX
HSBTLC
HSBTLC
NISINP
NISINP
NISINP
NISINP
BNIJBT
PMTBPL
PMTBPL
PMTBPL
PMTBPL
NIAPMK
NIAPMK
HSBTLC
HSBTLC
MANDEX
PMTBPL
PMTBPL
MANDEX
MANDEX
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632,500.00
0.00
0.00
92,000.00
1,236,000.00
2011
2012
2011
2012
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
690,000.00
0.00
0.00
1,104,000.00
1,236,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
10,000,000.00
100,000,000.00
100,000,000.00
200,000,000.00
30,000,000.00
30,000,000.00
50,000,000.00
50,000,000.00
48,000,000.00
48,000,000.00
100,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
10,000,000.00
10,000,000.00
30,000,000.00
30,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632,500.00
0.00
0.00
92,000.00
1,236,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632,500.00
0.00
0.00
92,000.00
1,236,000.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001588519.01
0001588529.01
0001588545.01
0001589179
0001589703
0001589974
0001593397.01
0001593489
0001596504
0001596665
0001596860
0001596960
0001597460
0001597772
0001597785
0001598043
0001598444.01
0001598598.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
696
697
698
699
700
701
702
703
704
705
706
707
708
709
710
711
712
713
IMKIN0001588519
IMKIN0001588529
IMKIN0001588545
IMKIN0001589179
IMKIN0001589703
IMKIN0001589974
IMKIN0001593397
IMKIN0001593489
IMKIN0001596504
IMKIN0001596665
IMKIN0001596860
IMKIN0001596960
IMKIN0001597460
IMKIN0001597772
IMKIN0001597785
IMKIN0001598043
IMKIN0001598444
IMKIN0001598598
12.04.2010
06.04.2010
12.04.2010
14.04.2010
19.04.2010
07.04.2010
13.04.2010
10.04.2010
07.04.2010
28.04.2010
16.04.2010
17.04.2010
11.06.2010
01.04.2010
01.04.2010
19.04.2010
20.04.2010
22.04.2010
12.03.2012
31.03.2012
12.05.2012
14.03.2012
19.05.2012
07.05.2012
13.03.2012
10.05.2012
07.05.2012
23.04.2012
16.05.2012
17.05.2012
11.03.2012
01.05.2012
01.03.2012
19.03.2012
20.05.2012
22.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
39PAGE :
RIA ARINDA
ERRY GARYATNO
JABMAR SIBURIAN MM D
SAHIRUN
JOICE PONTOH
DANNY ADRIANTO
HERMIN KONDO
AGUSTINA INDRAWATI A
LENA WATY
SONNY MUNANDAR
IRA SUSILO
SRI WREDININGSIH
RANTI MATURINA
BANGKIT PURNOMO
MUSROI
YUSRIDA
ICHSAN ALHADI YUSUFA
FENNIYATI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
MANDEX
MANDEX
DANHCP
DANHCP
BNIJBX
PMCSHP
MANDEX
MANDEX
PMTBPL
DANHCP
NIAPMD
PMCSHP
PMCSHP
NIAPMD
PMCSHP
PMCSHP
PMCSHP
PMTBPL
PMTBPL
MANDEX
MANDEX
0.00
0.00
0.00
632,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
258,000.00
0.00
0.00
1,402.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2012
2012
2011
2012
2012
2012
2011
2012
2012
2012
2012
2012
2012
2011
2012
2011
2012
2011
2012
2012
2012
0.00
0.00
0.00
690,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
258,000.00
0.00
0.00
5,607.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
10,000,000.00
10,000,000.00
200,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
10,000,000.00
500,000,000.00
25,000,000.00
50,000,000.00
300,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
50,000,000.00
100,000,000.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
8,010,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
258,000.00
0.00
0.00
1,402.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
258,000.00
0.00
0.00
1,402.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001599200
0001600803
0001600825
0001601891
0001601899
0001601899.02
0001602991
0001604526.01
0001604567.01
0001605454
0001606330
0001606590
0001606739
0001606945.01
0001609093.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
714
715
716
717
718
719
720
721
722
723
724
725
726
727
728
IMKIN0001599200
IMKIN0001600803
IMKIN0001600825
IMKIN0001601891
IMKIN0001601899
IMKIN0001601899
IMKIN0001602991
IMKIN0001604526
IMKIN0001604567
IMKIN0001605454
IMKIN0001606330
IMKIN0001606590
IMKIN0001606739
IMKIN0001606945
IMKIN0001609093
27.04.2010
01.05.2010
01.05.2010
01.05.2010
01.05.2010
01.05.2010
01.05.2010
05.05.2010
05.05.2010
05.05.2010
07.05.2010
08.05.2010
06.05.2010
01.05.2010
05.05.2010
27.03.2012
01.02.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
05.05.2012
05.05.2012
05.04.2012
07.03.2012
08.03.2012
06.05.2012
01.03.2012
05.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
40PAGE :
SUMARSIYAM
WARRIYODI SH
ABDUL ROUP
DONNY TRI ARFIANTO
IR E TEMMY GAWA
MARIA YOSEFINA NENG
NI KADEK WARDANI
ENDANG SRI HASTUTI
OKTIA EKA HARDIANA
FERA
I NYOMAN SURADANA
AGUS SULAEMAN
ADANG KUSNANDAR
AGUNG PUJIANTORO
MUHAMMAD SYAFRIL SAL
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
HSBTLC
HSBTLC
HSBTLC
HSBTLC
HSBTLC
HSBTLC
PMCSHP
PMCSHP
MANDEX
MANDEX
DANHCP
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
HSBTLC
CIGSRN
CIGSRN
MANDEX
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
96,667.00
640,000.00
9,000.00
2011
2012
2011
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
580,000.00
640,000.00
108,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
75,000,000.00
50,000,000.00
50,000,000.00
30,000,000.00
30,000,000.00
30,000,000.00
30,000,000.00
30,000,000.00
30,000,000.00
75,000,000.00
75,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
20,000,000.00
400,000,000.00
400,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
400,000,000.00
400,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
96,667.00
640,000.00
9,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
96,667.00
640,000.00
9,000.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001609126.01
0001609256.01
0001609274.01
0001609400.01
0001609502.01
0001610017
0001611000.01
0001611729
0001611965
0001612096
0001612172
0001612172.01
0001613517
0001613628
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
729
730
731
732
733
734
735
736
737
738
739
740
741
742
IMKIN0001609126
IMKIN0001609256
IMKIN0001609274
IMKIN0001609400
IMKIN0001609502
IMKIN0001610017
IMKIN0001611000
IMKIN0001611729
IMKIN0001611965
IMKIN0001612096
IMKIN0001612172
IMKIN0001612172
IMKIN0001613517
IMKIN0001613628
05.05.2010
11.05.2010
07.05.2010
06.05.2010
07.05.2010
12.05.2010
14.05.2010
14.05.2010
15.05.2010
17.05.2010
25.05.2010
25.05.2010
03.05.2010
12.05.2010
05.05.2012
11.03.2012
07.05.2012
06.03.2012
07.05.2012
12.03.2012
14.05.2012
14.03.2012
15.03.2012
17.03.2012
25.03.2012
25.03.2012
03.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
41PAGE :
IWAN SUHERLAN
ATIK BADIAH
WAN MUHAMAD ZAKI
MUHARILAS SUHARTININ
WAHID HIDAYAT
LEVY ASM
AMRAINI
MS KURNIAWAN
BUDI SARONO
EKO IRAWAN
TRI WAHYU
TRI WAHYU
ARSANTO NORENDRO
TITIN ZUWARNI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
HSBTLC
HSBTLC
MANDEX
HSBTLC
HSBTLC
DANHCP
DANHCP
DANHCP
DANHCP
NISINP
NISINP
NISINP
NISINP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
0.00
64,333.00
432,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2011
2012
2012
2011
2012
2012
2011
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
386,000.00
432,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
50,000,000.00
30,000,000.00
30,000,000.00
100,000,000.00
30,000,000.00
30,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
96,000,000.00
96,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
64,333.00
432,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
64,333.00
432,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001613953
0001614097
0001614162.01
0001614343.01
0001614672
0001614861
0001615400
0001615654
0001615654.02
0001615751
0001615751.02
0001616751.01
0001617581
0001619266.01
0001619285.01
0001620079
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
743
744
745
746
747
748
749
750
751
752
753
754
755
756
757
758
IMKIN0001613953
IMKIN0001614097
IMKIN0001614162
IMKIN0001614343
IMKIN0001614672
IMKIN0001614861
IMKIN0001615400
IMKIN0001615654
IMKIN0001615654
IMKIN0001615751
IMKIN0001615751
IMKIN0001616751
IMKIN0001617581
IMKIN0001619266
IMKIN0001619285
IMKIN0001620079
19.05.2010
18.05.2010
14.05.2010
12.05.2010
12.05.2010
18.05.2010
20.05.2010
19.05.2010
19.05.2010
18.05.2010
18.05.2010
21.05.2010
24.05.2010
26.05.2010
25.05.2010
01.06.2010
19.05.2012
18.03.2012
14.05.2012
12.05.2012
12.03.2012
18.03.2012
20.03.2012
19.03.2012
19.03.2012
18.05.2012
18.05.2012
21.05.2012
24.03.2012
26.05.2012
25.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
42PAGE :
M.ARCHAM UBAIDILLAH
SULMAN
TEDDY ARSONO
EDDY RIANTO
ATO SUGIARTO
ARDIANUS NENANG
ALDITYA KRISANDY
DIAN MARDIAN SANTOSO
SITI MUSYARIFAH
CHRISTIAN THOMAS E S
RICCA MARTHA RENI GE
UNTUNG ENDRO CAHYONO
DEWI OCTAVIYANTI
EDY PURNAWAN
RICKY WAHYU CANDRA
JONI HERMANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
DANHCP
DANHCP
MANDEX
MANDEX
PMTBPL
PMTBPL
DANHCP
DANHCP
PMCSHP
PMCSHP
PMTBPS
PMTBPS
PMTBPS
PMTBPS
PMTBPL
PMTBPL
MANDEX
HSBTLC
HSBTLC
MANDEX
MANDEX
MANDEX
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2012
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
2012
2011
2012
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
10,000,000.00
10,000,000.00
100,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
10,000,000.00
10,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
50,000,000.00
30,000,000.00
30,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001620773
0001621485
0001622018.01
0001622065
0001622086.01
0001625306.01
0001625644.01
0001625675.01
0001625720.01
0001625733.01
0001625833.01
0001626197
0001626914
0001626940
0001627374.01
0001628337.01
0001630984
0001632002
0001632103.01
0001632671
0001633038
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
759
760
761
762
763
764
765
766
767
768
769
770
771
772
773
774
775
776
777
778
779
IMKIN0001620773
IMKIN0001621485
IMKIN0001622018
IMKIN0001622065
IMKIN0001622086
IMKIN0001625306
IMKIN0001625644
IMKIN0001625675
IMKIN0001625720
IMKIN0001625733
IMKIN0001625833
IMKIN0001626197
IMKIN0001626914
IMKIN0001626940
IMKIN0001627374
IMKIN0001628337
IMKIN0001630984
IMKIN0001632002
IMKIN0001632103
IMKIN0001632671
IMKIN0001633038
01.06.2010
01.06.2010
01.06.2010
01.06.2010
01.06.2010
07.06.2010
02.06.2010
07.06.2010
01.06.2010
01.06.2010
04.06.2010
09.06.2010
05.06.2010
05.06.2010
07.06.2010
09.06.2010
14.06.2010
09.06.2010
10.06.2010
12.06.2010
16.06.2010
01.05.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
07.03.2012
02.03.2012
07.05.2012
01.03.2012
01.03.2012
04.03.2012
09.05.2012
05.05.2012
05.05.2012
07.02.2012
09.05.2012
14.03.2012
09.03.2012
10.03.2012
12.05.2012
16.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
43PAGE :
TITA ROSITA
WILLY SURYA
HIDAYAT SONDA
CHOLIMAH
FITRIAH
FITRI ANDAYANI
HINNANTA WIBOWO WONG
HADRANSYAH
JANGKUNG MULYONO
RULLY AKBARI PANGGAB
MUHAMAD RIDWAN
NURHIDAYAT
RUSLI
ENDANG SRI HASTUTI
ABDUL HAMID SE
FIRMAN SAGAF
NOOR LANJAR BUDIONO
HERI PUJIANTO
RONI BUDI ERWANTO
FAISAL BAHRI
SUSSY MACHTALINDA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
PMTBPL
MANDEX
DANHCP
MANDEX
HSBCPP
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
BNIJBX
DANHCP
DANHCP
CIGSRN
HSBCPP
PMTBPL
MANCLP
MANDEX
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
19,667.00
17,500.00
0.00
36,667.00
29,500.00
0.00
0.00
5,833.00
0.00
0.00
0.00
25,750.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
0.00
236,000.00
70,000.00
0.00
440,000.00
118,000.00
0.00
0.00
70,000.00
0.00
0.00
0.00
309,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
25,000,000.00
5,000,000.00
100,000,000.00
25,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
200,000,000.00
10,000,000.00
10,000,000.00
50,000,000.00
200,000,000.00
5,000,000.00
100,000,000.00
100,000,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
200,000,000.00
100,000,000.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
19,667.00
17,500.00
0.00
36,667.00
29,500.00
0.00
0.00
5,833.00
0.00
0.00
0.00
25,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
19,667.00
17,500.00
0.00
36,667.00
29,500.00
0.00
0.00
5,833.00
0.00
0.00
0.00
25,750.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001633204
0001633990
0001634597
0001634779.01
0001634901.01
0001635447
0001635997
0001636111
0001636178.01
0001636237.01
0001636301.01
0001636600
0001637202.01
0001637227
0001638554
0001638725
0001641484.01
0001641639.01
0001642561
0001642698
0001643210
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
780
781
782
783
784
785
786
787
788
789
790
791
792
793
794
795
796
797
798
799
800
IMKIN0001633204
IMKIN0001633990
IMKIN0001634597
IMKIN0001634779
IMKIN0001634901
IMKIN0001635447
IMKIN0001635997
IMKIN0001636111
IMKIN0001636178
IMKIN0001636237
IMKIN0001636301
IMKIN0001636600
IMKIN0001637202
IMKIN0001637227
IMKIN0001638554
IMKIN0001638725
IMKIN0001641484
IMKIN0001641639
IMKIN0001642561
IMKIN0001642698
IMKIN0001643210
16.06.2010
14.06.2010
19.06.2010
11.06.2010
17.06.2010
21.06.2010
18.06.2010
21.06.2010
15.06.2010
19.06.2010
18.06.2010
18.06.2010
22.06.2010
23.06.2010
17.06.2010
18.06.2010
22.06.2010
24.06.2010
01.07.2010
01.07.2010
01.07.2010
16.05.2012
14.03.2012
19.05.2012
11.02.2012
17.02.2012
21.03.2012
18.05.2012
21.05.2012
15.03.2012
19.05.2012
18.05.2012
18.03.2012
22.03.2012
23.05.2012
17.03.2012
18.05.2012
22.03.2012
25.05.2012
01.05.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
44PAGE :
FACHRURRAZI,DRS
DIAN PRAMANA PUTRA
ADITYA RIDYA IR
ERIC YUNIAR WIBOWO
RADEN DICKE HIKMAT
YUSRIZAL
SUGIYANTO KARSOKARYO
TSHIN JONG CIE
HASCARYADI DRS
IMMACULATA TRI WAHJU
AJ STEVANO
IRMA HAMDI
SISKA NOULA ANGELINA
MARYO S
NURAINI AMALIA
MUHAMMAD RUM.SH
KURDIANTO
HENNY WAHYUNI
DADDY PRAWIRAKUSUMAH
IR ARIANTO SUFAAT
KONG LAP WAI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBT
PMTBPL
BNIJBT
CIGSRN
CIGSRN
BNIJBT
DANHCP
MANTLF
MANDEX
MANDEX
MANDEX
PMTBPL
MANDEX
BNIJBT
DANHCP
CIGLPN
HSBCPP
MANDEX
PMTBPL
PMCSHP
DANHCP
0.00
0.00
28,750.00
105,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
23,333.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
345,000.00
316,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
280,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
6,500,000.00
50,000,000.00
400,000,000.00
50,000,000.00
100,000,000.00
10,000,000.00
75,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
6,500,000.00
50,000,000.00
100,000,000.00
10,000,000.00
500,000,000.00
100,000,000.00
100,000,000.00
5,000,000.00
25,000,000.00
10,000,000.00
0.00
0.00
50,000,000.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
28,750.00
105,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
23,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
28,750.00
105,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
23,333.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001643255.01
0001643344.01
0001643927
0001644338
0001646372
0001647574
0001647574.01
0001647793
0001648026.01
0001649744.01
0001649798.01
0001650234
0001651163
0001651178.01
0001653023
0001653588
0001653752
0001653756
0001655606.01
0001657824.01
0001658482.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
801
802
803
804
805
806
807
808
809
810
811
812
813
814
815
816
817
818
819
820
821
IMKIN0001643255
IMKIN0001643344
IMKIN0001643927
IMKIN0001644338
IMKIN0001646372
IMKIN0001647574
IMKIN0001647574
IMKIN0001647793
IMKIN0001648026
IMKIN0001649744
IMKIN0001649798
IMKIN0001650234
IMKIN0001651163
IMKIN0001651178
IMKIN0001653023
IMKIN0001653588
IMKIN0001653752
IMKIN0001653756
IMKIN0001655606
IMKIN0001657824
IMKIN0001658482
01.07.2010
01.07.2010
01.07.2010
01.07.2010
05.07.2010
23.07.2010
23.07.2010
08.07.2010
13.07.2010
09.07.2010
09.07.2010
02.07.2010
05.07.2010
02.07.2010
06.07.2010
14.07.2010
13.07.2010
13.07.2010
15.07.2010
19.07.2010
16.07.2010
01.03.2012
01.05.2012
01.05.2012
01.03.2012
05.03.2012
23.03.2012
23.03.2012
08.03.2012
13.03.2012
09.05.2012
09.05.2012
02.03.2012
05.03.2012
02.05.2012
06.03.2012
14.05.2012
13.03.2012
13.03.2012
15.05.2012
19.02.2012
16.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
45PAGE :
HAMZAH HUSAIN
DEWI KARTIKA SARI
TRIAS SANJAYA PUTRA
HEROLD DOLVIE ROBBY
ANDRI NOFRIAN
AAN AINAH
AAN AINAH
CHRISTIANUS D
NOVALIA INDRIASARI
MOHAMMAD ABDILAH NUR
TRISNI LOEKITAWATI
AHMAD HANDRI YUSUF
SAK PHIN
CECEP AANG HERMAWAN
SYAMSURI MUSTOFA
ENDAH BUDI KUSUMANIN
LUKAS LEKRANSY
GATOT RIADI
DR KU JANNI
A WASISTO SETIYONO
YANTI EVA ULINA BORU
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
PMCSHP
MISLPN
PMCSHP
NISINP
NISINP
DANHCP
HSBCPP
MANDEX
MANDEX
DANHCP
HSBTLC
HSBCPP
PMCSHP
PMTBPL
DANHCP
DANHCP
HSBCPP
CIGSRN
MANDEX
91,667.00
0.00
0.00
85,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,167.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
275,000.00
0.00
0.00
255,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
42,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
100,000,000.00
75,000,000.00
300,000,000.00
75,000,000.00
50,000,000.00
48,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
10,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
6,500,000.00
25,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91,667.00
0.00
0.00
85,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,167.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91,667.00
0.00
0.00
85,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,167.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001662799
0001663317
0001663367
0001663401
0001663401.02
0001663468
0001664750.01
0001665215
0001665336
0001666833.01
0001666878.01
0001666919.01
0001667027
0001667247
0001667362
0001668959
0001669038.01
0001669911
0001672967
0001673660
0001673984
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
822
823
824
825
826
827
828
829
830
831
832
833
834
835
836
837
838
839
840
841
842
IMKIN0001662799
IMKIN0001663317
IMKIN0001663367
IMKIN0001663401
IMKIN0001663401
IMKIN0001663468
IMKIN0001664750
IMKIN0001665215
IMKIN0001665336
IMKIN0001666833
IMKIN0001666878
IMKIN0001666919
IMKIN0001667027
IMKIN0001667247
IMKIN0001667362
IMKIN0001668959
IMKIN0001669038
IMKIN0001669911
IMKIN0001672967
IMKIN0001673660
IMKIN0001673984
21.07.2010
22.07.2010
22.07.2010
22.07.2010
22.07.2010
23.07.2010
22.07.2010
21.07.2010
27.07.2010
27.07.2010
28.07.2010
27.07.2010
01.08.2010
03.08.2010
01.08.2010
01.08.2010
02.08.2010
05.08.2010
09.08.2010
09.08.2010
01.08.2010
21.03.2012
22.03.2012
22.05.2012
22.03.2012
22.03.2012
23.03.2012
22.03.2012
21.03.2012
27.03.2012
27.03.2012
28.03.2012
27.03.2012
01.03.2012
03.05.2012
01.05.2012
01.03.2012
02.05.2012
05.03.2012
09.05.2012
09.05.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
46PAGE :
RUDI SETIAWAN
WAHYU IRAWAN
ZAINUDIN
KURNIAWAN SASMITHA
NI MADE MIRA DWIPAYA
RINDI HERLAN SYABAND
ETTY MIHARTI
ROSIKHUL ABROR
DARMONO
MARINGAN BANCIN STNT
MOHAMAD DAHLAN SUMAN
SUMARSINI
INAFI TAN
TEGUH BASUKI,BEC
LEO AGUSTA
SYLVIA MUSFRIANTI
IRAWATI
FERRY TOBING
SRI AGUSTINA
CAROLUS I NYOMAN MAR
DARMANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANDEX
PMTBPL
PMTBPL
HSBCPP
MANDEX
MANDEX
PMTBPS
BNIJBX
PMTBPL
HSBTLC
HSBCPP
PMCSHP
PMTBPL
BNIJBX
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
130,667.00
0.00
0.00
0.00
0.00
230,000.00
0.00
27,000.00
0.00
45,000.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
392,000.00
0.00
0.00
0.00
0.00
690,000.00
0.00
108,000.00
0.00
108,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
100,000,000.00
6,500,000.00
6,500,000.00
100,000,000.00
50,000,000.00
100,000,000.00
5,000,000.00
200,000,000.00
5,000,000.00
50,000,000.00
100,000,000.00
75,000,000.00
6,500,000.00
200,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
100,000,000.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
130,667.00
0.00
0.00
0.00
0.00
230,000.00
0.00
27,000.00
0.00
45,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
130,667.00
0.00
0.00
0.00
0.00
230,000.00
0.00
27,000.00
0.00
45,000.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001674600
0001675362
0001675969.01
0001676197
0001678690
0001679131
0001679262
0001679436.01
0001680085
0001682868
0001682945
0001682950
0001684566
0001684582
0001684610.01
0001685383
0001685767
0001685808
0001686484
0001686484.01
0001686488
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
843
844
845
846
847
848
849
850
851
852
853
854
855
856
857
858
859
860
861
862
863
IMKIN0001674600
IMKIN0001675362
IMKIN0001675969
IMKIN0001676197
IMKIN0001678690
IMKIN0001679131
IMKIN0001679262
IMKIN0001679436
IMKIN0001680085
IMKIN0001682868
IMKIN0001682945
IMKIN0001682950
IMKIN0001684566
IMKIN0001684582
IMKIN0001684610
IMKIN0001685383
IMKIN0001685767
IMKIN0001685808
IMKIN0001686484
IMKIN0001686484
IMKIN0001686488
09.08.2010
11.08.2010
03.08.2010
09.08.2010
16.08.2010
06.08.2010
03.08.2010
18.08.2010
18.08.2010
19.08.2010
21.08.2010
23.08.2010
24.08.2010
25.08.2010
25.08.2010
23.08.2010
18.08.2010
18.08.2010
13.08.2010
13.08.2010
13.08.2010
09.02.2012
11.03.2012
03.05.2012
09.03.2012
16.03.2012
06.05.2012
03.03.2012
18.02.2012
18.03.2012
19.03.2012
21.03.2012
23.05.2012
24.05.2012
25.05.2012
25.05.2012
23.03.2012
18.04.2012
18.05.2012
13.03.2012
13.03.2012
13.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
47PAGE :
ZAINUL ARIFIN
IRWAN P
POPIE WISYE MATHEOS
BAMBANG SULISTIONO
SUARTO
SITI DWI LAZUARDI
LUKMAN ARIFIN
PUJI ARIANTO
HADI SUWEKO
ELIZABETH MUNA
CINDY FLORA D
RUDY KELANA WIDJAJA
NANANG DWIRINTO
MONICA LIMANTARA
SETYO RINI UTAMI
SUGIYANTO
RINO SUDJARWO
KADEK WIWIN HENDRA W
BUDHIE KRISWANTORO
ERNAWATI ANGGA LEDA
NUNUNG
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGLPN
PMCSHP
MANDEX
DANHCP
BNIJBX
DANHCP
PMTSHI
CIGSRN
DANHCP
DANHCP
HSBTLC
HSBTLC
HSBTLC
HSBTLC
HSBCPP
DANHCP
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
175,000.00
215,625.00
0.00
0.00
0.00
0.00
0.00
89,000.00
0.00
0.00
0.00
0.00
0.00
0.00
88,500.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
350,000.00
517,500.00
0.00
0.00
0.00
0.00
0.00
178,000.00
0.00
0.00
0.00
0.00
0.00
0.00
354,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
500,000,000.00
75,000,000.00
100,000,000.00
25,000,000.00
200,000,000.00
10,000,000.00
50,000,000.00
200,000,000.00
10,000,000.00
25,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
300,000,000.00
25,000,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
500,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
175,000.00
215,625.00
0.00
0.00
0.00
0.00
0.00
89,000.00
0.00
0.00
0.00
0.00
0.00
0.00
88,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
175,000.00
215,625.00
0.00
0.00
0.00
0.00
0.00
89,000.00
0.00
0.00
0.00
0.00
0.00
0.00
88,500.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001687310.01
0001687350
0001687470.01
0001688299
0001689112
0001689950
0001689950.01
0001691761
0001692505
0001693063.01
0001693483.01
0001693678.01
0001693702.01
0001693788.01
0001694319
0001694319.01
0001694758
0001694946
0001694970
0001695778
0001696962
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
864
865
866
867
868
869
870
871
872
873
874
875
876
877
878
879
880
881
882
883
884
IMKIN0001687310
IMKIN0001687350
IMKIN0001687470
IMKIN0001688299
IMKIN0001689112
IMKIN0001689950
IMKIN0001689950
IMKIN0001691761
IMKIN0001692505
IMKIN0001693063
IMKIN0001693483
IMKIN0001693678
IMKIN0001693702
IMKIN0001693788
IMKIN0001694319
IMKIN0001694319
IMKIN0001694758
IMKIN0001694946
IMKIN0001694970
IMKIN0001695778
IMKIN0001696962
20.08.2010
23.08.2010
24.08.2010
01.09.2010
01.09.2010
02.09.2010
02.09.2010
01.09.2010
01.09.2010
03.09.2010
08.09.2010
07.09.2010
08.09.2010
02.09.2010
01.09.2010
01.09.2010
16.09.2010
07.09.2010
08.09.2010
14.09.2010
17.09.2010
20.04.2012
23.03.2012
24.02.2012
01.03.2012
01.03.2012
02.03.2012
02.03.2012
01.03.2012
01.05.2012
03.03.2012
08.03.2012
07.04.2012
08.05.2012
02.05.2012
13.05.2012
13.05.2012
16.03.2012
07.05.2012
08.05.2012
14.03.2012
17.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
48PAGE :
BUDHI SETIAWAN
HARIRSYAH
MUNSIF
SUGENG PRIYANTO
ERIS SETIAWAN BIN UM
ANDRI NOFRIAN
DEVVYCENDRAWATI
LINDA
EKA RIJANTO
DIAH IDARIYATI
EVI WAHYU LESTARI
ASEP MAHPUDIN
ABDUL RAHIM
YOKE ROSALINDA PATIA
HERI DWIASTUTI
HERI DWIASTUTI
ROSANA PATTY
ISMURYATI MARIA M
RONI ADE PUTRA
DIAN TRISNA
NOVINDRA M
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGCFY
BNIJBX
CIGSRN
BNIJBX
PMTSHI
PMTBPL
PMTBPL
DANHCP
HSBTLC
MANDEX
CIGFYY
MANDEX
MANDEX
MANDEX
NISINP
NISINP
PMTBPL
BNIJBX
BNIJBX
DANHCP
PMTBPL
48,333.00
0.00
55,000.00
192,250.00
0.00
0.00
0.00
0.00
0.00
0.00
81,000.00
0.00
26,333.00
24,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
145,000.00
0.00
110,000.00
384,500.00
0.00
0.00
0.00
0.00
0.00
0.00
162,000.00
0.00
79,000.00
72,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
200,000,000.00
200,000,000.00
150,000,000.00
25,000,000.00
6,500,000.00
6,500,000.00
10,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
50,000,000.00
48,000,000.00
6,500,000.00
150,000,000.00
200,000,000.00
10,000,000.00
5,000,000.00
100,000,000.00
0.00
100,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
48,333.00
0.00
55,000.00
192,250.00
0.00
0.00
0.00
0.00
0.00
0.00
81,000.00
0.00
26,333.00
24,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
48,333.00
0.00
55,000.00
192,250.00
0.00
0.00
0.00
0.00
0.00
0.00
81,000.00
0.00
26,333.00
24,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001697267
0001697946.01
0001698737
0001699426.01
0001700697
0001700703
0001700759
0001700850
0001700859
0001701041.01
0001702026.01
0001703358
0001703585
0001703662.01
0001704174
0001705253
0001705293.01
0001705442
0001707279
0001707279.02
0001708062
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
885
886
887
888
889
890
891
892
893
894
895
896
897
898
899
900
901
902
903
904
905
IMKIN0001697267
IMKIN0001697946
IMKIN0001698737
IMKIN0001699426
IMKIN0001700697
IMKIN0001700703
IMKIN0001700759
IMKIN0001700850
IMKIN0001700859
IMKIN0001701041
IMKIN0001702026
IMKIN0001703358
IMKIN0001703585
IMKIN0001703662
IMKIN0001704174
IMKIN0001705253
IMKIN0001705293
IMKIN0001705442
IMKIN0001707279
IMKIN0001707279
IMKIN0001708062
20.09.2010
18.09.2010
21.09.2010
20.09.2010
02.09.2010
02.09.2010
08.09.2010
20.09.2010
20.09.2010
21.09.2010
01.09.2010
24.09.2010
24.09.2010
22.09.2010
24.09.2010
04.10.2010
01.10.2010
01.10.2010
04.10.2010
04.10.2010
06.10.2010
20.05.2012
18.03.2012
02.05.2012
20.04.2012
02.03.2012
02.03.2012
08.05.2012
20.03.2012
20.05.2012
21.05.2012
01.03.2012
24.03.2012
17.02.2012
22.03.2012
24.03.2012
04.05.2012
01.03.2012
01.03.2012
04.05.2012
04.05.2012
06.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
49PAGE :
RUDI TONI LUBIS
YANNI
MADE RENANTA
FAROUQ JAMALUDDIN AR
DANAU RAYMOND SUSANT
ALI HASAN
SUDARTO
EKA SULIS ANJARWATI
MEDIANTI PURNAMASARI
FRANSISCUS XAVERIUS
TATANG ROCHMANA
YENNY
HAMSIR TALENGKA
HARDI MULYADI
REZA FAHROMI
AGUS ADI CANDRA
MARIANA
YANNY
CIPTO GHO
SULIANA
SARYONO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
MANDEX
BNIJBX
MANDEX
PMCSHP
PMCSHP
PMCSHP
PMTSHI
PMCSHP
MANDEX
MANGMK
MISLPN
DANHCP
MANDEX
PMTSHI
BNIJBX
CIGCFY
HSBTLC
PMTBPL
PMTBPL
DANHCP
0.00
0.00
0.00
29,167.00
0.00
0.00
0.00
0.00
0.00
0.00
39,500.00
175,000.00
0.00
246,500.00
0.00
0.00
102,667.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
79,000.00
350,000.00
0.00
493,000.00
0.00
0.00
176,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,600.00
0.00
0.00
0.00
0.00
6,500,000.00
50,000,000.00
150,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
75,000,000.00
100,000,000.00
100,000,000.00
500,000,000.00
25,000,000.00
200,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
30,000,000.00
6,500,000.00
6,500,000.00
25,000,000.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
500,000,000.00
0.00
100,000,000.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,267.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
0.00
0.00
0.00
0.00
0.00
0.00
39,500.00
175,000.00
0.00
246,500.00
0.00
0.00
92,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,167.00
0.00
0.00
0.00
0.00
0.00
0.00
39,500.00
175,000.00
0.00
246,500.00
0.00
0.00
92,400.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001708417.01
0001709833
0001709833.02
0001710371
0001711890.01
0001711899.01
0001711900.01
0001711904.01
0001711941.01
0001711999.01
0001712057.01
0001712058.01
0001712184.01
0001713021.01
0001714318
0001715482.01
0001715489.01
0001716318
0001716368.01
0001716373.01
0001716377.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
906
907
908
909
910
911
912
913
914
915
916
917
918
919
920
921
922
923
924
925
926
IMKIN0001708417
IMKIN0001709833
IMKIN0001709833
IMKIN0001710371
IMKIN0001711890
IMKIN0001711899
IMKIN0001711900
IMKIN0001711904
IMKIN0001711941
IMKIN0001711999
IMKIN0001712057
IMKIN0001712058
IMKIN0001712184
IMKIN0001713021
IMKIN0001714318
IMKIN0001715482
IMKIN0001715489
IMKIN0001716318
IMKIN0001716368
IMKIN0001716373
IMKIN0001716377
04.10.2010
11.10.2010
11.10.2010
01.10.2010
05.10.2010
05.10.2010
05.10.2010
05.10.2010
09.10.2010
11.10.2010
05.10.2010
05.10.2010
08.10.2010
14.10.2010
09.10.2010
19.10.2010
19.10.2010
15.10.2010
13.10.2010
14.10.2010
14.10.2010
04.05.2012
11.03.2012
11.03.2012
01.03.2012
05.03.2012
05.03.2012
05.04.2012
05.04.2012
09.03.2012
11.03.2012
05.04.2012
05.05.2012
08.03.2012
14.02.2012
09.03.2012
19.02.2012
19.02.2012
15.03.2012
13.04.2012
14.05.2012
14.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
50PAGE :
ANI RATMALA
PUTRIANI MUTIARA HIK
TEGUH TRI PRIYADI
MAYA ANDRIYANI
ADE GUNAWAN
RIFALDI PAULUS SITAN
AMRIADI
YUNITA SIRURU
TOMY EFFENDY
ANDRE OLVIJANTO PALO
RUSWANTO
SUYANTO
HASANUDDIN DEANG
JONI FAISOL
RR TITIEK INDAHH
GANDA MORAHOT PAULIN
YUDHI FARDHINI TRIZA
INDRA ALFAIRUZZABADI
EMANUEL IRAWADI ARYO
PRIANDONO DINANTYA
FERDINAND SILALAHI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
PMTBPL
PMTBPL
PMTBPL
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
MANDEX
CIGSRN
PMTBPL
CIGSRN
CIGSRN
DANHCP
MANDEX
MANDEX
MANDEX
40,208.00
0.00
0.00
0.00
26,542.00
75,250.00
0.00
36,000.00
200,667.00
0.00
0.00
29,167.00
126,000.00
158,000.00
0.00
52,667.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
96,500.00
0.00
0.00
0.00
45,500.00
129,000.00
0.00
72,000.00
344,000.00
0.00
0.00
70,000.00
216,000.00
237,000.00
0.00
79,000.00
0.00
0.00
0.00
0.00
0.00
9,650.00
0.00
0.00
0.00
4,550.00
12,900.00
0.00
7,200.00
34,400.00
0.00
0.00
7,000.00
21,600.00
23,700.00
0.00
7,900.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
50,000,000.00
200,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
300,000,000.00
6,500,000.00
200,000,000.00
50,000,000.00
25,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
0.00
0.00
0.00
50,000,000.00
100,000,000.00
0.00
100,000,000.00
200,000,000.00
0.00
0.00
100,000,000.00
100,000,000.00
300,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
4,021.00
0.00
0.00
0.00
2,654.00
7,525.00
0.00
3,600.00
20,067.00
0.00
0.00
2,917.00
12,600.00
15,800.00
0.00
5,267.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
36,187.00
0.00
0.00
0.00
23,888.00
67,725.00
0.00
32,400.00
180,600.00
0.00
0.00
26,250.00
113,400.00
142,200.00
0.00
47,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
36,187.00
0.00
0.00
0.00
23,888.00
67,725.00
0.00
32,400.00
180,600.00
0.00
0.00
26,250.00
113,400.00
142,200.00
0.00
47,400.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001716405.01
0001716436.01
0001716696
0001717544
0001717552
0001718691.01
0001718861
0001719178.01
0001720691
0001720972.01
0001720973.01
0001721148
0001721149
0001721214
0001722133.01
0001722446.01
0001722653.01
0001722665
0001722665.01
0001722714
0001722845.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
927
928
929
930
931
932
933
934
935
936
937
938
939
940
941
942
943
944
945
946
947
IMKIN0001716405
IMKIN0001716436
IMKIN0001716696
IMKIN0001717544
IMKIN0001717552
IMKIN0001718691
IMKIN0001718861
IMKIN0001719178
IMKIN0001720691
IMKIN0001720972
IMKIN0001720973
IMKIN0001721148
IMKIN0001721149
IMKIN0001721214
IMKIN0001722133
IMKIN0001722446
IMKIN0001722653
IMKIN0001722665
IMKIN0001722665
IMKIN0001722714
IMKIN0001722845
18.10.2010
12.10.2010
15.10.2010
13.10.2010
13.10.2010
19.10.2010
19.10.2010
26.10.2010
25.10.2010
26.10.2010
27.10.2010
20.10.2010
20.10.2010
21.10.2010
25.10.2010
06.10.2010
07.10.2010
01.10.2010
01.10.2010
26.10.2010
19.10.2010
18.05.2012
12.05.2012
15.03.2012
13.03.2012
13.03.2012
19.03.2012
19.02.2012
26.05.2012
25.02.2012
26.03.2012
27.03.2012
20.05.2012
20.05.2012
21.03.2012
25.05.2012
06.03.2012
07.03.2012
03.03.2012
03.03.2012
26.05.2012
19.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
51PAGE :
NOVITA LAMRIA SIMATU
DADANG SUDARSONO
DEDI FAHMI FIRMANSYA
YENTI ONGGO SAPUTRA
ABD AZIZ
ADI SUSANTO
DWI SULISTIANI
ERNI WIDAYATI
WILLY
LUCYANA MARIS
ZERI PURWOKO
SUGIANTO
FANDI FASARILLA
SLAMET WAHYUDI
ANDRI BUDIMAN
SRI ENDAH W
ROKHAYATI
CH MAYA KARTIKASARI
CH MAYA KARTIKASARI
MUHAMMAD RIFAI
SUAIB RISDA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
PMTSHI
HSBTLC
HSBTLC
HSBCPP
CIGHPL
CIGSRN
CIGLPN
HSBCPP
HSBCPP
PMTSHI
PMTSHI
PMTSHI
MANDEX
HSBCPP
HSBCPP
NISINP
NISINP
BNIJBX
MANDEX
0.00
45,000.00
0.00
0.00
0.00
203,583.00
46,667.00
91,875.00
233,333.00
75,250.00
0.00
0.00
0.00
0.00
15,000.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
108,000.00
0.00
0.00
0.00
349,000.00
70,000.00
220,500.00
350,000.00
129,000.00
0.00
0.00
0.00
0.00
36,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,800.00
0.00
0.00
0.00
34,900.00
7,000.00
22,050.00
35,000.00
12,900.00
0.00
0.00
0.00
0.00
3,600.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
400,000,000.00
50,000,000.00
500,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
48,000,000.00
200,000,000.00
50,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
100,000,000.00
100,000,000.00
50,000,000.00
500,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,500.00
0.00
0.00
0.00
20,358.00
4,667.00
9,188.00
23,333.00
7,525.00
0.00
0.00
0.00
0.00
1,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
40,500.00
0.00
0.00
0.00
183,225.00
42,000.00
82,687.00
210,000.00
67,725.00
0.00
0.00
0.00
0.00
13,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
40,500.00
0.00
0.00
0.00
183,225.00
42,000.00
82,687.00
210,000.00
67,725.00
0.00
0.00
0.00
0.00
13,500.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001722896.01
0001722942.01
0001723101.01
0001723117.01
0001724894.01
0001725020.01
0001725020.03
0001725495
0001725622.01
0001725632.01
0001725653.01
0001726512.01
0001726512.03
0001726800.01
0001726932.01
0001727060
0001727079
0001729251
0001729426.01
0001729430.01
0001729531.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
948
949
950
951
952
953
954
955
956
957
958
959
960
961
962
963
964
965
966
967
968
IMKIN0001722896
IMKIN0001722942
IMKIN0001723101
IMKIN0001723117
IMKIN0001724894
IMKIN0001725020
IMKIN0001725020
IMKIN0001725495
IMKIN0001725622
IMKIN0001725632
IMKIN0001725653
IMKIN0001726512
IMKIN0001726512
IMKIN0001726800
IMKIN0001726932
IMKIN0001727060
IMKIN0001727079
IMKIN0001729251
IMKIN0001729426
IMKIN0001729430
IMKIN0001729531
26.10.2010
27.10.2010
25.10.2010
26.10.2010
01.11.2010
02.11.2010
02.11.2010
01.11.2010
01.11.2010
01.11.2010
01.11.2010
03.11.2010
03.11.2010
02.11.2010
02.11.2010
01.11.2010
01.11.2010
02.11.2010
10.11.2010
11.11.2010
05.11.2010
26.03.2012
27.05.2012
25.05.2012
26.05.2012
01.03.2012
02.04.2012
02.04.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
03.03.2012
03.03.2012
02.05.2012
02.02.2012
01.05.2012
01.03.2012
02.05.2012
10.05.2012
11.03.2012
05.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
52PAGE :
DEDDY OKTAVIANTO
AMRAN H B
YUYUN YUNIARTI
HENDRAWAN JATI PRASE
REZA ROSSADY
H MUHAMMAD TAJUDDIN
RINI TOWIDJODJO
JULIANTI
SYAMSURIA MOKODOMPIT
SYAHRIL GUNANDAR
GAJALI RAHMA
LELY
RICKY STEVEN
BAGUS PERMADI
SOFIAN SUPRIOTO
NANCY
RUDY RUSADY
RENNY
LINA
FITRIA WIDANINGSIH
AGUS SURYANA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
MANDEX
MANDEX
PMTBPL
PMTBPL
PMTBPL
DANHCP
MANDEX
MANDEX
MANDEX
PMTBPL
PMTBPL
MANDEX
CIGSRN
HSBTLC
HSBTLC
DANHCP
HSBCPP
HSBCPP
MANDEX
0.00
35,417.00
0.00
32,917.00
3,033.00
7,318.00
5,915.00
23,333.00
460,000.00
46,667.00
49,000.00
3,033.00
3,033.00
0.00
177,750.00
0.00
0.00
0.00
0.00
0.00
19,750.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
85,000.00
0.00
79,000.00
4,550.00
12,545.00
10,140.00
35,000.00
690,000.00
70,000.00
98,000.00
4,550.00
4,550.00
0.00
237,000.00
0.00
0.00
0.00
0.00
0.00
39,500.00
0.00
8,500.00
0.00
7,900.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
100,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
50,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
50,000,000.00
300,000,000.00
50,000,000.00
50,000,000.00
25,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
0.00
100,000,000.00
0.00
100,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
50,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
6,500,000.00
6,500,000.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
3,542.00
0.00
3,292.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
31,875.00
0.00
29,625.00
3,033.00
7,318.00
5,915.00
23,333.00
460,000.00
46,667.00
49,000.00
3,033.00
3,033.00
0.00
177,750.00
0.00
0.00
0.00
0.00
0.00
19,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
31,875.00
0.00
29,625.00
3,033.00
7,318.00
5,915.00
23,333.00
460,000.00
46,667.00
49,000.00
3,033.00
3,033.00
0.00
177,750.00
0.00
0.00
0.00
0.00
0.00
19,750.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001729547.01
0001729635.01
0001729677.01
0001729852.01
0001730108.01
0001731014
0001731286
0001731381.01
0001732210.01
0001732417.01
0001732552
0001732552.01
0001734110.01
0001734115
0001734434
0001734457
0001734813
0001735578.01
0001736844.01
0001736895.01
0001736967.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
969
970
971
972
973
974
975
976
977
978
979
980
981
982
983
984
985
986
987
988
989
IMKIN0001729547
IMKIN0001729635
IMKIN0001729677
IMKIN0001729852
IMKIN0001730108
IMKIN0001731014
IMKIN0001731286
IMKIN0001731381
IMKIN0001732210
IMKIN0001732417
IMKIN0001732552
IMKIN0001732552
IMKIN0001734110
IMKIN0001734115
IMKIN0001734434
IMKIN0001734457
IMKIN0001734813
IMKIN0001735578
IMKIN0001736844
IMKIN0001736895
IMKIN0001736967
03.11.2010
11.11.2010
03.11.2010
09.11.2010
01.11.2010
11.11.2010
15.11.2010
13.11.2010
15.11.2010
15.11.2010
16.11.2010
16.11.2010
10.11.2010
10.11.2010
18.11.2010
18.11.2010
18.11.2010
10.11.2010
13.11.2010
13.11.2010
11.11.2010
03.05.2012
11.03.2012
03.05.2012
09.03.2012
01.03.2012
11.05.2012
15.03.2012
13.05.2012
15.03.2012
15.03.2012
04.03.2012
04.03.2012
10.03.2012
10.03.2012
18.05.2012
18.04.2012
18.03.2012
10.02.2012
13.03.2012
13.05.2012
11.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
53PAGE :
ADI PRAUTOMO
INTAN IDRIANSARI IDR
ELZY DRIANDRY
IMAN RANDAL TARIGAN
NOLIS NURSANTI
IRMA SARI
DEDE SULAEMAN
HERRY KURNIAWAN
SIGIT SISWOYO
LEVY ASM
REINHAD WESLY HASIHO
REINHAD WESLY HASIHO
VIKTOR MORI SEBAYANG
EFFENDI APRIYANTO
RAFDINAL
ABRIMAN
ENDAH PUSPITA RINI
VERA MARSELLY
HENDARWIN
DEWI SUKAESIH
YUSUF RIZAL
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
MANGMK
MANDEX
PMTBPL
CIGLPN
BNIJBX
PMTBPL
PMTBPL
HSBCPP
NISINP
NISINP
PMTBPL
PMTSHI
BNIJBX
BNIJBX
PMCSHP
CIGSRN
MANDEX
MANGMK
MANDEX
118,000.00
0.00
0.00
94,667.00
10,530.00
0.00
0.00
2,275.00
2,633.00
0.00
0.00
0.00
9,360.00
0.00
392,000.00
137,667.00
45,500.00
91,500.00
144,000.00
39,500.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
236,000.00
0.00
0.00
142,000.00
15,795.00
0.00
0.00
4,550.00
3,950.00
0.00
0.00
0.00
14,040.00
0.00
784,000.00
236,000.00
68,250.00
122,000.00
216,000.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
6,500,000.00
300,000,000.00
200,000,000.00
6,500,000.00
5,000,000.00
100,000,000.00
50,000,000.00
48,000,000.00
6,500,000.00
50,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
50,000,000.00
200,000,000.00
0.00
0.00
100,000,000.00
6,500,000.00
0.00
0.00
6,500,000.00
5,000,000.00
0.00
0.00
0.00
6,500,000.00
0.00
200,000,000.00
200,000,000.00
75,000,000.00
100,000,000.00
200,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
118,000.00
0.00
0.00
94,667.00
10,530.00
0.00
0.00
2,275.00
2,633.00
0.00
0.00
0.00
9,360.00
0.00
392,000.00
137,667.00
45,500.00
91,500.00
144,000.00
39,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
118,000.00
0.00
0.00
94,667.00
10,530.00
0.00
0.00
2,275.00
2,633.00
0.00
0.00
0.00
9,360.00
0.00
392,000.00
137,667.00
45,500.00
91,500.00
144,000.00
39,500.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001736988.01
0001737375.01
0001737699
0001737713
0001738679.01
0001738709.01
0001739084
0001739084.01
0001739886.01
0001740758
0001740930
0001741233.01
0001741256.01
0001741864.01
0001741864.03
0001741883
0001741981.01
0001742485.01
0001742485.03
0001742971
0001744800
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
990
991
992
993
994
995
996
997
998
999
1000
1001
1002
1003
1004
1005
1006
1007
1008
1009
1010
IMKIN0001736988
IMKIN0001737375
IMKIN0001737699
IMKIN0001737713
IMKIN0001738679
IMKIN0001738709
IMKIN0001739084
IMKIN0001739084
IMKIN0001739886
IMKIN0001740758
IMKIN0001740930
IMKIN0001741233
IMKIN0001741256
IMKIN0001741864
IMKIN0001741864
IMKIN0001741883
IMKIN0001741981
IMKIN0001742485
IMKIN0001742485
IMKIN0001742971
IMKIN0001744800
12.11.2010
19.11.2010
10.11.2010
15.11.2010
19.11.2010
20.11.2010
22.11.2010
22.11.2010
25.11.2010
19.11.2010
19.11.2010
25.11.2010
23.11.2010
01.12.2010
01.12.2010
01.12.2010
01.12.2010
02.12.2010
02.12.2010
01.12.2010
01.12.2010
12.04.2012
19.05.2012
10.03.2012
15.03.2012
19.03.2012
20.03.2012
26.05.2012
26.05.2012
25.03.2012
19.03.2012
19.05.2012
25.03.2012
23.03.2012
01.05.2012
01.05.2012
01.03.2012
01.03.2012
02.03.2012
02.03.2012
01.04.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
54PAGE :
BATU SUGIARTO
DEIVY NANGIN
GO MARTIN WIOGO
TJIU KOEI YIONG
SUPRIANTO
KARMAN SOESANTO
PANDU FEBRIARSO
PANDU FEBRIARSO
SUMARYANA
ARIAWAN SUTOMO
HENDRY GOZALI
MARSELLI N
BUDI ARIYANTO SUTRIS
MINA WIDYAWATI
TEGUH SADSETYOBUDI
BUGIANTO
CHAMDUN MAHMUDI
EDA JUBAIDA
SYAMSURI MUSTOFA
ADI PRAWITA
SUSIAWITA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
MANDEX
DANHCP
DANHCP
PMTBPL
PMTBPL
NISINP
NISINP
PMTBPL
CIGLPO
MISLPN
MANDEX
MANDEX
PMTBPL
PMTBPL
PMSSHP
PMTBPL
PMTBPL
PMTBPL
BCASHP
DANHCP
0.00
129,000.00
0.00
14,167.00
5,200.00
5,590.00
0.00
0.00
3,033.00
233,333.00
872,500.00
184,000.00
324,000.00
5,384.00
5,384.00
0.00
7,605.00
2,625.00
3,675.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
258,000.00
0.00
21,250.00
7,800.00
8,385.00
0.00
0.00
4,550.00
350,000.00
1,745,000.00
276,000.00
486,000.00
9,230.00
9,230.00
0.00
10,140.00
3,500.00
4,900.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
10,000,000.00
25,000,000.00
5,000,000.00
6,500,000.00
75,000,000.00
72,000,000.00
6,500,000.00
500,000,000.00
500,000,000.00
50,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
75,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
20,000,000.00
10,000,000.00
0.00
200,000,000.00
0.00
25,000,000.00
5,000,000.00
6,500,000.00
0.00
0.00
6,500,000.00
500,000,000.00
500,000,000.00
50,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
5,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
129,000.00
0.00
14,167.00
5,200.00
5,590.00
0.00
0.00
3,033.00
233,333.00
872,500.00
184,000.00
324,000.00
5,384.00
5,384.00
0.00
7,605.00
2,625.00
3,675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
129,000.00
0.00
14,167.00
5,200.00
5,590.00
0.00
0.00
3,033.00
233,333.00
872,500.00
184,000.00
324,000.00
5,384.00
5,384.00
0.00
7,605.00
2,625.00
3,675.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001744982.01
0001746850
0001747003
0001748688.01
0001750903.01
0001751104
0001752315
0001752431
0001752458.01
0001752542.01
0001752601.01
0001752866
0001752881.01
0001752915.01
0001753064
0001753090.01
0001753462
0001754762
0001755238
0001755282
0001755332
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1011
1012
1013
1014
1015
1016
1017
1018
1019
1020
1021
1022
1023
1024
1025
1026
1027
1028
1029
1030
1031
IMKIN0001744982
IMKIN0001746850
IMKIN0001747003
IMKIN0001748688
IMKIN0001750903
IMKIN0001751104
IMKIN0001752315
IMKIN0001752431
IMKIN0001752458
IMKIN0001752542
IMKIN0001752601
IMKIN0001752866
IMKIN0001752881
IMKIN0001752915
IMKIN0001753064
IMKIN0001753090
IMKIN0001753462
IMKIN0001754762
IMKIN0001755238
IMKIN0001755282
IMKIN0001755332
01.12.2010
06.12.2010
08.12.2010
09.12.2010
04.12.2010
10.12.2010
15.12.2010
18.12.2010
14.12.2010
01.12.2010
06.12.2010
10.12.2010
10.12.2010
11.12.2010
13.12.2010
14.12.2010
17.12.2010
21.12.2010
09.12.2010
17.12.2010
20.12.2010
01.05.2012
06.03.2012
08.03.2012
09.03.2012
04.05.2012
10.04.2012
15.05.2012
18.05.2012
14.03.2012
01.03.2012
06.05.2012
10.03.2012
10.03.2012
11.03.2012
13.03.2012
14.03.2012
17.05.2012
21.04.2012
09.03.2012
17.03.2012
20.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
55PAGE :
ENNY RUSMINAWATY RAC
MAHMUD
SUPRIADY PAKAYA
THE PAU CHING
DIAN NOVIA WARDANI
RAMLAH
MUHAMMAD ABDUH
SUGENG
DEWI MAIMUNAH
BAMBANG PURNAMA
M IQBAL SYAFEI
SORYADI
ANDI PUTRA
DEDE SUPRIADI
RULLY
ROSA ETY KARTIKAWATI
PITER
RATNA SUZANNA
SHELVY IRAWAN
ANTHON JONTAH RAYO
DRS MAD SOLEH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
DANHCP
BNIJBX
HSBCPP
PMTBPL
DANHCP
DANHCP
HSBTLC
HSBCPP
PMTBPL
PMTBPL
PMTSHI
PMTBPL
PMTBPL
PMTSHI
PMTBPL
BNIJBX
BNIJBX
DANHCP
DANHCP
HSBTLC
0.00
0.00
105,000.00
0.00
2,042.00
0.00
0.00
0.00
0.00
6,450.00
2,042.00
0.00
3,413.00
9,409.00
0.00
2,625.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
140,000.00
0.00
3,500.00
0.00
0.00
0.00
0.00
8,600.00
3,500.00
0.00
4,550.00
12,545.00
0.00
3,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
25,000,000.00
200,000,000.00
50,000,000.00
5,000,000.00
10,000,000.00
50,000,000.00
70,000,000.00
50,000,000.00
5,000,000.00
6,500,000.00
50,000,000.00
6,500,000.00
6,500,000.00
25,000,000.00
5,000,000.00
200,000,000.00
150,000,000.00
25,000,000.00
25,000,000.00
20,000,000.00
0.00
0.00
200,000,000.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
5,000,000.00
5,000,000.00
0.00
6,500,000.00
6,500,000.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
105,000.00
0.00
2,042.00
0.00
0.00
0.00
0.00
6,450.00
2,042.00
0.00
3,413.00
9,409.00
0.00
2,625.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
105,000.00
0.00
2,042.00
0.00
0.00
0.00
0.00
6,450.00
2,042.00
0.00
3,413.00
9,409.00
0.00
2,625.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001755456
0001755456.01
0001755641
0001755641.01
0001756124
0001758525.01
0001758585.01
0001758591.01
0001758828
0001759266
0001760226
0001760226.01
0001760300
0001760708
0001760735
0001761583.01
0001761598.01
0001763086
0001763282
0001763352
0001763359
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1032
1033
1034
1035
1036
1037
1038
1039
1040
1041
1042
1043
1044
1045
1046
1047
1048
1049
1050
1051
1052
IMKIN0001755456
IMKIN0001755456
IMKIN0001755641
IMKIN0001755641
IMKIN0001756124
IMKIN0001758525
IMKIN0001758585
IMKIN0001758591
IMKIN0001758828
IMKIN0001759266
IMKIN0001760226
IMKIN0001760226
IMKIN0001760300
IMKIN0001760708
IMKIN0001760735
IMKIN0001761583
IMKIN0001761598
IMKIN0001763086
IMKIN0001763282
IMKIN0001763352
IMKIN0001763359
27.12.2010
27.12.2010
27.12.2010
27.12.2010
14.12.2010
27.12.2010
21.12.2010
22.12.2010
01.01.2011
01.01.2011
13.01.2011
13.01.2011
01.01.2011
04.01.2011
03.01.2011
06.01.2011
06.01.2011
04.01.2011
06.01.2011
06.01.2011
06.01.2011
27.03.2012
27.03.2012
27.05.2012
27.05.2012
14.03.2012
27.02.2012
21.05.2012
22.03.2012
01.03.2012
01.03.2012
13.03.2012
13.03.2012
01.03.2012
04.03.2012
03.03.2012
06.03.2012
06.03.2012
04.03.2012
06.05.2012
06.03.2012
06.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
56PAGE :
ANANG SOPIAN
ANANG SOPIAN
SETYO NUGROHO
SETYO NUGROHO
MARTINAR
NURSANTI DORIANA
MUHAMMAD FARID BAAY
MICHAEL CHRISTIAN LI
DODIK GUNAWAN ST
ENDANG TARYANA
EVA NAPITUPULU
EVA NAPITUPULU
TRI ASMININGDIAH
WIDODO
HENKI GOOSA M,SE
RUDY KARTONO
ASPI ALETRI
AGUNG C WIBOWO
RHOMA DHANNIATI
UNANA TISNA JUMENA
NANCY ANGELA HENDRIK
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
NISINP
NISINP
NISINP
PMCSHP
CIGSRN
MANDEX
MANDEX
PMCSHP
DANHCP
NISINP
NISINP
DAFLPN
PMCSHP
PMCSHP
PMTBPL
PMTBPL
PMTSHI
PMTSHI
PMTSHI
PMTSHI
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,692.00
3,792.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9,230.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
72,000,000.00
50,000,000.00
48,000,000.00
25,000,000.00
100,000,000.00
50,000,000.00
100,000,000.00
75,000,000.00
10,000,000.00
75,000,000.00
72,000,000.00
500,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,692.00
3,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,692.00
3,792.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001763365
0001763636.01
0001763792.01
0001763845.01
0001764946
0001764975.01
0001764997.01
0001765079
0001765661
0001766029
0001766032
0001766085
0001766233.01
0001766858.01
0001766858.03
0001767020.01
0001767177
0001767415.01
0001767415.03
0001767575.01
0001767781.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1053
1054
1055
1056
1057
1058
1059
1060
1061
1062
1063
1064
1065
1066
1067
1068
1069
1070
1071
1072
1073
IMKIN0001763365
IMKIN0001763636
IMKIN0001763792
IMKIN0001763845
IMKIN0001764946
IMKIN0001764975
IMKIN0001764997
IMKIN0001765079
IMKIN0001765661
IMKIN0001766029
IMKIN0001766032
IMKIN0001766085
IMKIN0001766233
IMKIN0001766858
IMKIN0001766858
IMKIN0001767020
IMKIN0001767177
IMKIN0001767415
IMKIN0001767415
IMKIN0001767575
IMKIN0001767781
06.01.2011
10.01.2011
10.01.2011
10.01.2011
11.01.2011
11.01.2011
11.01.2011
07.01.2011
13.01.2011
07.01.2011
07.01.2011
07.01.2011
11.01.2011
15.01.2011
15.01.2011
15.01.2011
14.01.2011
17.01.2011
17.01.2011
17.01.2011
11.01.2011
06.03.2012
10.02.2012
10.05.2012
10.03.2012
11.03.2012
11.03.2012
11.05.2012
07.03.2012
13.05.2012
07.03.2012
07.03.2012
07.03.2012
11.03.2012
15.05.2012
15.05.2012
15.05.2012
14.03.2012
17.03.2012
17.03.2012
17.02.2012
11.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
57PAGE :
NI NYOMAN SRI APRIAW
METHA TENGGARA
ELFA WATI
YOVI CHANDRA
RONALD SITORUS
NG MIAW PHIN
DRS. AGUS PUTUT WIBI
RUSKIMAN
FAISAL BAHRI
NURFIQ DIANTO
KARTIKA SARI
ENDRA BUDI HERMANTO
PAUL ARIF BUDIMAN
WURI HANDAYANI
YUNI SETIAWAN
VIVI RYANTIE
MIRYANTI
BENNI WINTANA
CHERISTIN MEGAWATI
MARHABAN
SARALINLIA RAMLI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTSHI
CIGSRN
MANDEX
MANDEX
DANHCP
MANDEX
MANDEX
BNIJBX
PMCSHP
PMTSHI
PMTSHI
PMTSHI
CIGSRN
PMTBPL
PMTBPL
MANDEX
BNIJBX
PMTBPL
PMTBPL
CIGSRN
MANDEX
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
483,333.00
3,683.00
4,680.00
0.00
0.00
0.00
0.00
88,000.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
580,000.00
5,525.00
7,020.00
0.00
0.00
0.00
0.00
96,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
400,000,000.00
6,500,000.00
6,500,000.00
200,000,000.00
200,000,000.00
5,000,000.00
5,000,000.00
300,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
400,000,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
483,333.00
3,683.00
4,680.00
0.00
0.00
0.00
0.00
88,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
483,333.00
3,683.00
4,680.00
0.00
0.00
0.00
0.00
88,000.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001767790.01
0001768582.01
0001768609.01
0001769716
0001769771.01
0001769943
0001770440
0001770728
0001770883.01
0001771031
0001771126
0001771212.01
0001771226
0001771248
0001771269.01
0001771668
0001771668.01
0001771978.01
0001772017.01
0001772039.01
0001772127
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1074
1075
1076
1077
1078
1079
1080
1081
1082
1083
1084
1085
1086
1087
1088
1089
1090
1091
1092
1093
1094
IMKIN0001767790
IMKIN0001768582
IMKIN0001768609
IMKIN0001769716
IMKIN0001769771
IMKIN0001769943
IMKIN0001770440
IMKIN0001770728
IMKIN0001770883
IMKIN0001771031
IMKIN0001771126
IMKIN0001771212
IMKIN0001771226
IMKIN0001771248
IMKIN0001771269
IMKIN0001771668
IMKIN0001771668
IMKIN0001771978
IMKIN0001772017
IMKIN0001772039
IMKIN0001772127
13.01.2011
11.01.2011
11.01.2011
18.01.2011
19.01.2011
18.01.2011
20.01.2011
20.01.2011
12.01.2011
13.01.2011
15.01.2011
18.01.2011
18.01.2011
18.01.2011
19.01.2011
25.01.2011
25.01.2011
18.01.2011
18.01.2011
19.01.2011
21.01.2011
13.05.2012
11.05.2012
11.03.2012
18.03.2012
19.03.2012
18.02.2012
20.05.2012
20.03.2012
12.03.2012
13.03.2012
15.03.2012
18.03.2012
18.05.2012
18.03.2012
19.05.2012
25.03.2012
25.03.2012
18.05.2012
18.05.2012
19.05.2012
21.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
58PAGE :
AGUSTINUS GH TAMBUNA
DENI ANDRIANTO
DENI SUKANDI
ZULKARNAIN
MUJI LESTARI
RIA KARTIKA SARI
HENDRI KURNIAWAN
UNTUNG
FATRIA ASIA AVANTI
MUHAMMAD YASIN
WIDI NURWORO
AZIZ MUSLIM
SANJAYA
ARIS BUDIYANTO
YOVITA SARI KARTIKA
FESTIYANI
FESTIYANI
SUSY SUNARSIH
NI MADE DWI INDAH P
DIDIK NUGROHO
GIARSIH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
MANDEX
PMTBPL
PMTBPL
DANHCP
HSBCPP
CIGLPN
BNIJBX
BNIJBX
PMTBPL
PMTSHI
PMTSHI
PMTBPL
PMTSHI
PMTSHI
PMTBPL
NISINP
NISINP
MANCGP
MANDEX
MANDEX
DANHCP
0.00
0.00
0.00
0.00
0.00
269,500.00
0.00
0.00
0.00
0.00
0.00
3,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
294,000.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
5,000,000.00
5,000,000.00
25,000,000.00
50,000,000.00
500,000,000.00
200,000,000.00
200,000,000.00
5,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
50,000,000.00
50,000,000.00
5,000,000.00
50,000,000.00
48,000,000.00
35,000,000.00
200,000,000.00
200,000,000.00
25,000,000.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
269,500.00
0.00
0.00
0.00
0.00
0.00
3,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
269,500.00
0.00
0.00
0.00
0.00
0.00
3,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001772178
0001772229
0001772229.01
0001772368.01
0001772526
0001772921.01
0001773788
0001774027
0001774028
0001774525.01
0001774548.01
0001774934.01
0001774935.01
0001775459.01
0001775481.01
0001776082.01
0001777547.01
0001777664.01
0001779271
0001779272
0001779272.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1095
1096
1097
1098
1099
1100
1101
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
IMKIN0001772178
IMKIN0001772229
IMKIN0001772229
IMKIN0001772368
IMKIN0001772526
IMKIN0001772921
IMKIN0001773788
IMKIN0001774027
IMKIN0001774028
IMKIN0001774525
IMKIN0001774548
IMKIN0001774934
IMKIN0001774935
IMKIN0001775459
IMKIN0001775481
IMKIN0001776082
IMKIN0001777547
IMKIN0001777664
IMKIN0001779271
IMKIN0001779272
IMKIN0001779272
24.01.2011
26.01.2011
26.01.2011
22.01.2011
26.01.2011
24.01.2011
26.01.2011
25.01.2011
26.01.2011
01.02.2011
01.02.2011
01.02.2011
01.02.2011
02.02.2011
02.02.2011
05.02.2011
01.02.2011
05.02.2011
12.02.2011
12.02.2011
12.02.2011
24.03.2012
26.03.2012
26.03.2012
22.03.2012
26.05.2012
24.03.2012
26.03.2012
25.02.2012
26.05.2012
01.03.2012
01.05.2012
01.03.2012
01.03.2012
02.03.2012
02.05.2012
05.03.2012
01.05.2012
05.05.2012
12.03.2012
12.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
59PAGE :
MARINGAN BANCIN
DWI MERLINA
DWI MERLINA
IGHARRY SUWARTO
HERMAN L. HARTAWAN,
GALIH FAJAR ATMANEGA
YUDI HARNADI
TYAS MUNASWATI R.
DINA DAMAYANTI
SRI ENDANG ELVIANI
FANDI FASARILLA
YUDIT MELINDA TAHER
TINA AGUSTINA
LUKMANUL HAKIM
MARDIANA R. LINTANG
I WAYAN SUDANA
EKO SOEMARTONO
ELIN PARLINA
RONI ARFANTO
VERONIKA DIANA YULIA
VINCENTIUS TOMY SIDH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
HSBTLC
NISINP
NISINP
PMTBPL
BNIJBX
PMTBPL
HSBTLC
CIGLPN
CIGLPN
PMTBPL
PMTBPL
MANDEX
MANDEX
PMTBPL
PMTBPL
PMTBPL
MANDEX
MANGMK
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
46,421.00
0.00
3,792.00
0.00
0.00
0.00
0.00
3,413.00
0.00
0.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
55,705.00
0.00
4,550.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
70,000,000.00
75,000,000.00
72,000,000.00
6,500,000.00
150,000,000.00
6,500,000.00
50,000,000.00
50,000,000.00
200,000,000.00
5,000,000.00
6,500,000.00
50,000,000.00
100,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
200,000,000.00
100,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
46,421.00
0.00
3,792.00
0.00
0.00
0.00
0.00
3,413.00
0.00
0.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
46,421.00
0.00
3,792.00
0.00
0.00
0.00
0.00
3,413.00
0.00
0.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001779405
0001779753
0001780746.01
0001781487.01
0001781646
0001781677.01
0001781686.01
0001781720
0001781769.01
0001781784.01
0001781810.01
0001781835
0001781996.01
0001782151
0001782448
0001783263
0001784072.01
0001784109.01
0001784136.01
0001784150.01
0001784182.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1116
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
1135
1136
IMKIN0001779405
IMKIN0001779753
IMKIN0001780746
IMKIN0001781487
IMKIN0001781646
IMKIN0001781677
IMKIN0001781686
IMKIN0001781720
IMKIN0001781769
IMKIN0001781784
IMKIN0001781810
IMKIN0001781835
IMKIN0001781996
IMKIN0001782151
IMKIN0001782448
IMKIN0001783263
IMKIN0001784072
IMKIN0001784109
IMKIN0001784136
IMKIN0001784150
IMKIN0001784182
10.02.2011
10.02.2011
09.02.2011
17.02.2011
18.02.2011
17.02.2011
14.02.2011
01.02.2011
01.02.2011
01.02.2011
01.02.2011
02.02.2011
17.02.2011
14.02.2011
18.02.2011
21.02.2011
04.02.2011
04.02.2011
04.02.2011
04.02.2011
04.02.2011
10.05.2012
10.03.2012
09.05.2012
17.03.2012
18.05.2012
17.02.2012
14.05.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
17.03.2012
14.03.2012
18.05.2012
21.05.2012
04.03.2012
04.03.2012
04.03.2012
04.03.2012
04.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
60PAGE :
GUNADI
PURWANTI
HERIYANTO
MARIA STEFANI SEBAST
TEDDY WIRIYADI
TONY SUSANTO
HELENA
TONY SUSILO
LILIK FARID BUDIAWAN
MISILAH
MINIYATI
ROSADI
ALBERT YOSIETO
SUHERMAN
AFRIZAL
ANTHONY SENO SUBROTO
HENGKI RIYANTO
HANIF EKA PUTRA
TEGUH RIYANTO
AAN NUR ANGGONO
ISA FAHRIZAL BUSTOMI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBX
DANHCP
MANGMK
PMTBPL
BNIJBX
CIGSRN
MANDEX
PMTSHI
PMTBPL
PMTBPL
PMTBPL
PMTSHI
HSBCPP
DANHCP
BNIJBX
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,707.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,171.00
4,171.00
4,171.00
4,171.00
4,171.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,135.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
4,550.00
4,550.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
25,000,000.00
200,000,000.00
5,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
50,000,000.00
100,000,000.00
10,000,000.00
150,000,000.00
150,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,707.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,171.00
4,171.00
4,171.00
4,171.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,707.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,171.00
4,171.00
4,171.00
4,171.00
4,171.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001784503.01
0001784610.01
0001784976
0001785072
0001785202.01
0001785223.01
0001785805
0001785805.01
0001786386.01
0001786431.01
0001787462.01
0001788332.01
0001788338.01
0001788350.01
0001788357.01
0001788393
0001788404.01
0001788441.01
0001788699
0001788699.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1137
1138
1139
1140
1141
1142
1143
1144
1145
1146
1147
1148
1149
1150
1151
1152
1153
1154
1155
1156
IMKIN0001784503
IMKIN0001784610
IMKIN0001784976
IMKIN0001785072
IMKIN0001785202
IMKIN0001785223
IMKIN0001785805
IMKIN0001785805
IMKIN0001786386
IMKIN0001786431
IMKIN0001787462
IMKIN0001788332
IMKIN0001788338
IMKIN0001788350
IMKIN0001788357
IMKIN0001788393
IMKIN0001788404
IMKIN0001788441
IMKIN0001788699
IMKIN0001788699
08.02.2011
10.02.2011
22.02.2011
22.02.2011
22.02.2011
22.02.2011
16.02.2011
16.02.2011
21.02.2011
22.02.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
01.03.2011
08.05.2012
10.03.2012
22.03.2012
22.05.2012
22.03.2012
22.03.2012
16.03.2012
16.03.2012
21.05.2012
22.01.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
01.03.2012
01.03.2012
01.05.2012
01.05.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
61PAGE :
PUTU POPPY AIMY WIDY
M YOKA DESTHURAKA
ADE SUHARYANATA
INDRA A E SETIAWAN
DEDY A SUSANTO
SYIFA MUFIEDATUSSALA
INDRAWADI
YUNI RIALISA
ELLY KENDRAWATI
BAHRID BUSENG DRS H
RIZI LUQMAN HAKIM
SITI ULFAH
JULIATI
RUSMIYATI
SOLIHA
IR FENCY TEMMY GAWA
JASMINTO
AZHAR LUBIS
CATARINA TRIMURTI MU
YOSEPH MULYO SANTOSO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMCSHP
BNIJBX
HSBCPP
HSBCPP
PMTSHI
PMTSHI
CIGSRN
CIGSRN
CIGSRN
PMTBPL
MANGMK
MANGMK
MANGMK
MANGMK
HSBTLC
HSBCPP
HSBCPP
PMCSHP
PMCSHP
3,413.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,875.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
4,550.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
154,500.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
15,450.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
75,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
200,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,288.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,587.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,587.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001789051.01
0001789073.01
0001789214
0001789261
0001789626.01
0001789857
0001790011
0001790376
0001791385
0001791385.01
0001791413
0001792960
0001793067.01
0001793187.01
0001793208.01
0001793820.01
0001793846.01
0001794744.01
0001794795.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1157
1158
1159
1160
1161
1162
1163
1164
1165
1166
1167
1168
1169
1170
1171
1172
1173
1174
1175
IMKIN0001789051
IMKIN0001789073
IMKIN0001789214
IMKIN0001789261
IMKIN0001789626
IMKIN0001789857
IMKIN0001790011
IMKIN0001790376
IMKIN0001791385
IMKIN0001791385
IMKIN0001791413
IMKIN0001792960
IMKIN0001793067
IMKIN0001793187
IMKIN0001793208
IMKIN0001793820
IMKIN0001793846
IMKIN0001794744
IMKIN0001794795
03.03.2011
03.03.2011
03.03.2011
07.03.2011
04.03.2011
03.03.2011
03.03.2011
01.03.2011
11.03.2011
11.03.2011
08.03.2011
03.03.2011
09.03.2011
03.03.2011
09.03.2011
11.03.2011
01.03.2011
10.03.2011
11.03.2011
03.03.2012
03.03.2012
03.03.2012
07.05.2012
04.05.2012
03.03.2012
03.02.2012
01.03.2012
11.03.2012
11.03.2012
08.03.2012
03.02.2012
09.05.2012
03.05.2012
09.05.2012
11.03.2012
01.02.2012
10.05.2012
11.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
62PAGE :
R ADITYA NOTOSUPRAPT
ANGGA DESTRIA YUDIST
WINARNI
ALDY RIVANSYAH
YULI
ROY H
CHARLES M MAMAHIT
R ADITYA NOTOSUPRAPT
WATI SUKMAWATI
WATI SUKMAWATI
LIANAWATI SANTOSO
NI MADE RIKA HARMINI
SLAMET SANTOSO
YENNY GOZAL
VIVI NURI
JULIAN MICHO RAWUNG
FRENGKY MAMAHID ANGK
TRILINDA MARDIANA
LOMALIA SARI. B.PT
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
BNIJBX
BNIJBX
MANGMK
BNIJBX
CIGLPN
CIGLPN
PMTSHI
NISINP
NISINP
HSBTLC
CIGLPN
CIGLPN
CIGSRN
MANGMK
MANGMK
PMTBPL
CIGSRN
CIGSRN
MANGMK
MANDEX
4,550.00
0.00
0.00
0.00
40,092.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,500.00
0.00
0.00
0.00
0.00
4,550.00
115,833.00
1,552,000.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2012
2011
2012
2012
2012
4,550.00
0.00
0.00
0.00
48,110.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
210,000.00
0.00
0.00
0.00
0.00
4,550.00
1,390,000.00
1,552,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
21,000.00
0.00
0.00
0.00
0.00
0.00
139,000.00
0.00
0.00
0.00
6,500,000.00
5,000,000.00
150,000,000.00
150,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
48,000,000.00
50,000,000.00
300,000,000.00
300,000,000.00
200,000,000.00
100,000,000.00
200,000,000.00
6,500,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
0.00
0.00
0.00
56,600,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
6,500,000.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,750.00
0.00
0.00
0.00
0.00
0.00
11,583.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
40,092.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
15,750.00
0.00
0.00
0.00
0.00
4,550.00
104,250.00
1,552,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
40,092.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
15,750.00
0.00
0.00
0.00
0.00
4,550.00
104,250.00
1,552,000.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001795371
0001795425
0001795428
0001797039.01
0001797232.01
0001797242.01
0001797584
0001797646.01
0001797646.03
0001797783.01
0001797819.01
0001797867.01
0001797932.01
0001798299.01
0001798321.01
0001798350.01
0001798350.03
0001798381.01
0001798409.01
0001798457.01
0001798671.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1176
1177
1178
1179
1180
1181
1182
1183
1184
1185
1186
1187
1188
1189
1190
1191
1192
1193
1194
1195
1196
IMKIN0001795371
IMKIN0001795425
IMKIN0001795428
IMKIN0001797039
IMKIN0001797232
IMKIN0001797242
IMKIN0001797584
IMKIN0001797646
IMKIN0001797646
IMKIN0001797783
IMKIN0001797819
IMKIN0001797867
IMKIN0001797932
IMKIN0001798299
IMKIN0001798321
IMKIN0001798350
IMKIN0001798350
IMKIN0001798381
IMKIN0001798409
IMKIN0001798457
IMKIN0001798671
14.03.2011
14.03.2011
14.03.2011
21.03.2011
21.03.2011
21.03.2011
01.03.2011
02.03.2011
02.03.2011
03.03.2011
03.03.2011
03.03.2011
03.03.2011
10.03.2011
10.03.2011
10.03.2011
10.03.2011
10.03.2011
11.03.2011
11.03.2011
14.03.2011
14.03.2012
14.03.2012
14.03.2012
21.03.2012
21.05.2012
21.05.2012
01.03.2012
02.03.2012
02.03.2012
03.03.2012
03.05.2012
03.05.2012
03.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
11.03.2012
11.05.2012
14.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
63PAGE :
RUDI HARYANTO PAULUS
TAUFIK RAHMAN
SYAHRONI
IRWAN RADIAN SAPUTRA
BERNADETTE MURNIATI
RIDWAN
SIOE JOENG BOESONO
LEO PRANATA
MULIA HAYDINA
TANTOWI ABDILLAH
MARIO SYAUFI
AGUNG SETYA BUDI
DENI SUGITO
ISTINAH
ELIZABETH AUDITH RAT
AHMAD YUSUF
DINA SARI INTANIA
YUSRI AFRIANTO
DOEDY SOELISTYO
RUDIONO
JERRY JAMES SITANIAP
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
DANHCP
DANHCP
PMTBPL
HSBCPP
HSBCPP
PMTSHI
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGYSR
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
32,045.00
3,792.00
3,792.00
4,550.00
7,020.00
11,180.00
4,680.00
4,550.00
4,550.00
11,180.00
16,738.00
332,500.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
32,045.00
4,550.00
4,550.00
4,550.00
7,020.00
11,180.00
4,680.00
4,550.00
4,550.00
11,180.00
20,085.00
399,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
40,000,000.00
10,000,000.00
25,000,000.00
5,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
32,045.00
3,792.00
3,792.00
4,550.00
7,020.00
11,180.00
4,680.00
4,550.00
4,550.00
11,180.00
16,738.00
332,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
32,045.00
3,792.00
3,792.00
4,550.00
7,020.00
11,180.00
4,680.00
4,550.00
4,550.00
11,180.00
16,738.00
332,500.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001798881.01
0001800360.01
0001800363
0001800950.01
0001801174
0001801280
0001801381.01
0001801552.01
0001801929.01
0001802425.01
0001804098.01
0001804209
0001804669
0001805586
0001806171.01
0001806178.01
0001806228.01
0001806532
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1197
1198
1199
1200
1201
1202
1203
1204
1205
1206
1207
1208
1209
1210
1211
1212
1213
1214
IMKIN0001798881
IMKIN0001800360
IMKIN0001800363
IMKIN0001800950
IMKIN0001801174
IMKIN0001801280
IMKIN0001801381
IMKIN0001801552
IMKIN0001801929
IMKIN0001802425
IMKIN0001804098
IMKIN0001804209
IMKIN0001804669
IMKIN0001805586
IMKIN0001806171
IMKIN0001806178
IMKIN0001806228
IMKIN0001806532
01.03.2011
23.03.2011
24.03.2011
23.03.2011
09.03.2011
21.03.2011
02.03.2011
02.03.2011
23.03.2011
21.03.2011
01.04.2011
01.04.2011
01.04.2011
01.04.2011
04.04.2011
01.04.2011
04.04.2011
01.04.2011
01.03.2012
23.05.2012
24.05.2012
23.05.2012
09.04.2012
21.03.2012
02.03.2012
02.03.2012
23.03.2012
21.03.2012
01.04.2012
01.03.2012
01.05.2012
01.05.2012
05.05.2012
01.03.2012
04.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
64PAGE :
TRI TURI YANTO
YENNY HOO
MARYCEL ROSA NOYA
LULUK HARDONO
FREDY KUNCORO
RENI RUMENGAN`SH
RAKHMAD DEWO
SULAIMAN YUSUF
DRH HAMONG SUHARSONO
HENDRIK
BUGIANTO
MUHAMAD AFFANDI
I GEDE SUARSA
RANI KUSUMA NINGRUM
RIRISMAWATI NAINGGOL
SRI HANDAYANI
TAUFIK WALHIDAYAH
IWAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
CIGSRN
BNIJBX
PMTBPS
BCASHP
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
BNIJBX
BNIJBX
MANGMK
MANGMK
MANGMK
MANGMK
MANGMK
HSBTLC
HSBTLC
5,915.00
1,212,750.00
0.00
8,450.00
0.00
0.00
4,550.00
14,040.00
20,085.00
20,085.00
28,600.00
8,063.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2011
2012
2012
2012
2012
2011
2012
2011
2012
2011
2012
5,915.00
1,455,300.00
0.00
10,140.00
0.00
0.00
4,550.00
14,040.00
20,085.00
20,085.00
28,600.00
96,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9,675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
400,000,000.00
200,000,000.00
6,500,000.00
20,000,000.00
25,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
150,000,000.00
150,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
100,000,000.00
6,500,000.00
330,000,000.00
0.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
806.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,915.00
1,212,750.00
0.00
8,450.00
0.00
0.00
4,550.00
14,040.00
20,085.00
20,085.00
28,600.00
7,257.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,915.00
1,212,750.00
0.00
8,450.00
0.00
0.00
4,550.00
14,040.00
20,085.00
20,085.00
28,600.00
7,257.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001806637
0001806646
0001806769
0001807079
0001807079.01
0001807332.01
0001807359.01
0001807787.01
0001807787.03
0001808726.01
0001808731.01
0001808751.01
0001808762.01
0001808778
0001809019
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1215
1216
1217
1218
1219
1220
1221
1222
1223
1224
1225
1226
1227
1228
1229
IMKIN0001806637
IMKIN0001806646
IMKIN0001806769
IMKIN0001807079
IMKIN0001807079
IMKIN0001807332
IMKIN0001807359
IMKIN0001807787
IMKIN0001807787
IMKIN0001808726
IMKIN0001808731
IMKIN0001808751
IMKIN0001808762
IMKIN0001808778
IMKIN0001809019
01.04.2011
01.04.2011
06.04.2011
08.04.2011
08.04.2011
01.04.2011
01.04.2011
05.04.2011
05.04.2011
11.04.2011
08.04.2011
08.04.2011
11.04.2011
12.04.2011
11.04.2011
01.05.2012
01.03.2012
06.05.2012
08.03.2012
08.03.2012
01.03.2012
01.03.2012
05.03.2012
05.03.2012
11.05.2012
08.05.2012
08.05.2012
11.04.2012
12.03.2012
11.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
65PAGE :
AGUSTINA
SULIYANSYAH
TRI NUGROHO
ARI BUDI LESTARI
ARI BUDI LESTARI
MAULANA AGUSTIN
ABDULAH
AMIR
YURNIS
ERNI WIDAYATI
LUKMAN HAKIM
NENI KURNIANINGSIH
MATEUS FRANSIUS HARI
SRI WIDAYANTI
HERI SUSANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
DANHCP
DANHCP
PMCSHP
NISINP
NISINP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
HSBCPP
MANGMK
MANDEX
MANGMK
PMCSHP
PMCSHP
DANHCP
DANHCP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
379.00
4,550.00
292.00
0.00
379.00
4,550.00
379.00
4,550.00
0.00
718,667.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2012
2011
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
3,500.00
0.00
4,550.00
4,550.00
4,550.00
4,550.00
0.00
784,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
350.00
0.00
455.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
10,000,000.00
10,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
48,000,000.00
48,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
50,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
75,000,000.00
75,000,000.00
25,000,000.00
25,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
38.00
0.00
29.00
0.00
38.00
0.00
38.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
341.00
4,550.00
263.00
0.00
341.00
4,550.00
341.00
4,550.00
0.00
718,667.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
341.00
4,550.00
263.00
0.00
341.00
4,550.00
341.00
4,550.00
0.00
718,667.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001809810
0001810776.01
0001811505
0001811507
0001811510
0001811655
0001811735.01
0001811761.01
0001811773.01
0001812081.01
0001812088.01
0001812125.01
0001812321.01
0001812366.01
0001812417.01
0001813557
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1230
1231
1232
1233
1234
1235
1236
1237
1238
1239
1240
1241
1242
1243
1244
1245
IMKIN0001809810
IMKIN0001810776
IMKIN0001811505
IMKIN0001811507
IMKIN0001811510
IMKIN0001811655
IMKIN0001811735
IMKIN0001811761
IMKIN0001811773
IMKIN0001812081
IMKIN0001812088
IMKIN0001812125
IMKIN0001812321
IMKIN0001812366
IMKIN0001812417
IMKIN0001813557
07.04.2011
13.04.2011
19.04.2011
19.04.2011
19.04.2011
18.04.2011
18.04.2011
12.04.2011
14.04.2011
07.04.2011
07.04.2011
08.04.2011
13.04.2011
14.04.2011
15.04.2011
20.04.2011
07.05.2012
13.03.2012
19.03.2012
19.03.2012
19.05.2012
18.03.2012
18.05.2012
12.03.2012
14.05.2012
07.05.2012
07.03.2012
08.05.2012
13.03.2012
14.04.2012
15.05.2012
20.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
66PAGE :
RABIAH
MAULANA PAMUNGKAS
YUS HARUDIAN PUTRA
ILHAM BUKA
IDA AYU ARIE MAYUNI
HUSNI YUSUF
RIDWAN PERMANA
SANTI SEPTIANI
LOKITA
MILKA SARI NASUTION
ILHAM SANJAYA
YULI TRIONO
KHOIRUN
IRVAN SENO SEPTIANA
DJAP SJOEN NGO
KENIET CHAHYORINI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBX
CIGYSR
CIGYSR
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
DANHCP
DANHCP
MANUTD
MANGMK
MANGMK
MANGMK
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
BNIJBX
0.00
19,750.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,833.00
0.00
0.00
0.00
292.00
0.00
0.00
292.00
0.00
0.00
36,823.00
0.00
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2012
2011
2012
2012
2012
2011
2012
2012
2011
2012
2012
2012
2012
0.00
237,000.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
70,000.00
0.00
0.00
0.00
3,500.00
0.00
0.00
3,500.00
0.00
0.00
40,170.00
0.00
0.00
23,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,000.00
0.00
0.00
0.00
350.00
0.00
0.00
350.00
0.00
0.00
0.00
0.00
150,000,000.00
300,000,000.00
300,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
150,000,000.00
10,000,000.00
10,000,000.00
50,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
200,000,000.00
0.00
300,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
5,000,000.00
0.00
0.00
6,500,000.00
0.00
0.00
1,975.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
583.00
0.00
0.00
0.00
29.00
0.00
0.00
29.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,775.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,250.00
0.00
0.00
0.00
263.00
0.00
0.00
263.00
0.00
0.00
36,823.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
17,775.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,250.00
0.00
0.00
0.00
263.00
0.00
0.00
263.00
0.00
0.00
36,823.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001813800
0001813917.01
0001814199
0001814730
0001815153
0001815278.01
0001815303.01
0001815324.01
0001815485.01
0001815622.01
0001815649.01
0001815866
0001816054
0001816473.01
0001816652.01
0001816659.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1246
1247
1248
1249
1250
1251
1252
1253
1254
1255
1256
1257
1258
1259
1260
1261
IMKIN0001813800
IMKIN0001813917
IMKIN0001814199
IMKIN0001814730
IMKIN0001815153
IMKIN0001815278
IMKIN0001815303
IMKIN0001815324
IMKIN0001815485
IMKIN0001815622
IMKIN0001815649
IMKIN0001815866
IMKIN0001816054
IMKIN0001816473
IMKIN0001816652
IMKIN0001816659
19.04.2011
18.04.2011
21.04.2011
21.04.2011
25.04.2011
19.04.2011
19.04.2011
20.04.2011
03.05.2011
20.04.2011
25.04.2011
26.04.2011
26.04.2011
26.04.2011
28.04.2011
27.04.2011
19.03.2012
18.02.2012
21.03.2012
21.03.2012
25.05.2012
19.05.2012
19.05.2012
20.03.2012
03.06.2011
20.05.2012
25.05.2012
26.05.2012
26.02.2012
26.05.2012
28.03.2012
27.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
67PAGE :
DWI RETNO SULISTIYAN
SUMURUNG MANURUNG
EKO PRAYITNO NAEN SA
SALASIAH
NICO LEONG
YUDI ARIJANTO
FRECIYANA BOEDIJONO
RENDY ISMANSYAH
DEWA AYU MADE LILY D
YANCHE
MOCH FIRMANSYAH
MARTINA MUCHLIAT
HARTUTIK
SOEDARWANTO
KARDINAT SAPAN
EMNY JUNE C SIMATUPA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
DANHCP
CIGSRN
CIGSRN
PMCSHP
PMCSHP
DANHCP
DANHCP
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANUTV
MANUTV
HSBCPP
HSBCPP
BNIJBX
CIGLPN
CIGLPN
MANCGP
MISSRN
MISSRN
CIGSRN
0.00
0.00
88,667.00
435,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
292.00
0.00
0.00
0.00
0.00
0.00
0.00
98,333.00
129,000.00
0.00
13,167.00
162,000.00
0.00
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
2012
2011
2012
2011
0.00
0.00
532,000.00
435,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,500.00
0.00
0.00
0.00
0.00
0.00
0.00
590,000.00
129,000.00
0.00
158,000.00
162,000.00
0.00
0.00
0.00
53,200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
350.00
0.00
0.00
0.00
0.00
0.00
0.00
59,000.00
0.00
0.00
15,800.00
0.00
0.00
10,000,000.00
10,000,000.00
400,000,000.00
400,000,000.00
75,000,000.00
75,000,000.00
10,000,000.00
10,000,000.00
150,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
100,000,000.00
200,000,000.00
500,000,000.00
500,000,000.00
70,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
0.00
0.00
400,000,000.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
500,000,000.00
100,000,000.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
8,867.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29.00
0.00
0.00
0.00
0.00
0.00
0.00
9,833.00
0.00
0.00
1,317.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
79,800.00
435,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
263.00
0.00
0.00
0.00
0.00
0.00
0.00
88,500.00
129,000.00
0.00
11,850.00
162,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
79,800.00
435,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
263.00
0.00
0.00
0.00
0.00
0.00
0.00
88,500.00
129,000.00
0.00
11,850.00
162,000.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001817021
0001817021.01
0001817124
0001817124.01
0001817162.01
0001817172.01
0001817308.01
0001817530
0001817540
0001817987
0001818040
0001818526.01
0001818548
0001818606
0001818606.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1262
1263
1264
1265
1266
1267
1268
1269
1270
1271
1272
1273
1274
1275
1276
IMKIN0001817021
IMKIN0001817021
IMKIN0001817124
IMKIN0001817124
IMKIN0001817162
IMKIN0001817172
IMKIN0001817308
IMKIN0001817530
IMKIN0001817540
IMKIN0001817987
IMKIN0001818040
IMKIN0001818526
IMKIN0001818548
IMKIN0001818606
IMKIN0001818606
01.05.2011
01.05.2011
01.05.2011
01.05.2011
02.05.2011
12.05.2011
02.05.2011
02.05.2011
03.05.2011
04.05.2011
01.05.2011
01.05.2011
01.05.2011
11.05.2011
11.05.2011
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
12.05.2012
02.05.2012
02.05.2012
03.05.2012
04.03.2012
01.03.2012
01.05.2012
01.05.2012
11.03.2012
11.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
68PAGE :
IFAN FARIANDA
MUTY NUBIKASARI
DWI PRASETYO NUGROHO
PRIMA NIENDYA SUKMA
RIYONOSIDI
ALPHARD MUAMMAR
SUHARTONO
JUSTIAN SALIM
ADY MULYADY
WANDALIH TJHIN
ALOYSIUS KRISTIAWAN
DEDY SUPRIATNA
EKA NURNINGSIH
WIWIN WINARNI
WIWIN WINARNI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGSRN
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPL
PMTBPL
MANUTD
PMTBPL
BNIJBX
BNIJBX
DANHCP
DANHCP
DANHCP
DANHCP
MANDEX
HSBTLC
NISINP
NISINP
NISINP
NISINP
0.00
8,750.00
0.00
0.00
0.00
0.00
0.00
0.00
758.00
4,680.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2012
2011
2011
2012
2011
2012
2011
2012
2012
2012
2012
2012
2011
2012
2011
2012
2012
2012
2011
2012
2011
2012
0.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,680.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,250.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
50,000,000.00
5,000,000.00
150,000,000.00
200,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
50,000,000.00
20,000,000.00
50,000,000.00
50,000,000.00
48,000,000.00
48,000,000.00
0.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
875.00
0.00
0.00
0.00
0.00
0.00
0.00
76.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,875.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,680.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,875.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,680.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001818607
0001818607.01
0001819413
0001819695
0001819715
0001819726
0001820095
0001820430
0001820499.01
0001820499.03
0001820753.01
0001820855.01
0001821145
0001821158
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1277
1278
1279
1280
1281
1282
1283
1284
1285
1286
1287
1288
1289
1290
IMKIN0001818607
IMKIN0001818607
IMKIN0001819413
IMKIN0001819695
IMKIN0001819715
IMKIN0001819726
IMKIN0001820095
IMKIN0001820430
IMKIN0001820499
IMKIN0001820499
IMKIN0001820753
IMKIN0001820855
IMKIN0001821145
IMKIN0001821158
11.05.2011
11.05.2011
06.05.2011
09.05.2011
06.05.2011
06.05.2011
09.05.2011
11.05.2011
11.05.2011
11.05.2011
01.05.2011
04.05.2011
06.05.2011
09.05.2011
11.03.2012
11.03.2012
06.03.2012
09.03.2012
06.04.2012
06.05.2012
09.03.2012
11.03.2012
11.03.2012
11.03.2012
01.05.2012
04.04.2012
06.03.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
69PAGE :
MELINDA TRIYANTI
MELINDA TRIYANTI
FATRA ANGGARA
RAMADHAN MANSYUR
DEDY APRIANTO
ADE PRISKA SAMITRA
RUSTAM
NUR HASAN SIDIQ
DEDEH KURNIA
IR MIFTAHUDIN
WAN MAYA SURI
STANNY OKTAVIANI PUT
FAHMI
KARYO UTOMO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
NISINP
NISINP
NISINP
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGYSR
CIGSRN
CIGSRN
DANHCP
DANHCP
DANHCP
0.00
0.00
0.00
0.00
23,333.00
0.00
23,333.00
0.00
8,750.00
0.00
0.00
91,667.00
0.00
23,333.00
0.00
1,538.00
10,140.00
5,341.00
35,880.00
0.00
6,583.00
0.00
0.00
0.00
0.00
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2011
2012
2011
2012
2011
0.00
0.00
0.00
0.00
140,000.00
0.00
140,000.00
0.00
105,000.00
0.00
0.00
550,000.00
0.00
140,000.00
0.00
9,230.00
10,140.00
32,045.00
35,880.00
0.00
79,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,000.00
0.00
14,000.00
0.00
10,500.00
0.00
0.00
55,000.00
0.00
14,000.00
0.00
923.00
0.00
3,205.00
0.00
0.00
7,900.00
0.00
0.00
0.00
0.00
72,000,000.00
72,000,000.00
96,000,000.00
96,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
150,000,000.00
150,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
200,000,000.00
200,000,000.00
200,000,000.00
25,000,000.00
25,000,000.00
10,000,000.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
200,000,000.00
0.00
150,000,000.00
0.00
0.00
200,000,000.00
0.00
200,000,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,333.00
0.00
2,333.00
0.00
875.00
0.00
0.00
9,167.00
0.00
2,333.00
0.00
154.00
0.00
534.00
0.00
0.00
658.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
21,000.00
0.00
21,000.00
0.00
7,875.00
0.00
0.00
82,500.00
0.00
21,000.00
0.00
1,384.00
10,140.00
4,807.00
35,880.00
0.00
5,925.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
21,000.00
0.00
21,000.00
0.00
7,875.00
0.00
0.00
82,500.00
0.00
21,000.00
0.00
1,384.00
10,140.00
4,807.00
35,880.00
0.00
5,925.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001821190.01
0001821196.01
0001821268
0001821300
0001821336
0001821418
0001821483
0001821504
0001821730.01
0001821731.01
0001821773.01
0001821773.03
0001822130
0001822149
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1291
1292
1293
1294
1295
1296
1297
1298
1299
1300
1301
1302
1303
1304
IMKIN0001821190
IMKIN0001821196
IMKIN0001821268
IMKIN0001821300
IMKIN0001821336
IMKIN0001821418
IMKIN0001821483
IMKIN0001821504
IMKIN0001821730
IMKIN0001821731
IMKIN0001821773
IMKIN0001821773
IMKIN0001822130
IMKIN0001822149
19.05.2011
19.05.2011
01.05.2011
01.05.2011
01.05.2011
01.05.2011
01.05.2011
01.05.2011
02.05.2011
02.05.2011
02.05.2011
02.05.2011
12.05.2011
12.05.2011
19.05.2012
19.05.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
02.03.2012
02.05.2012
02.05.2012
12.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
70PAGE :
ADI WINARDO
SOFA HARIS
MUHAMAD ZULKARNAEN
NOVI ARIANTI
SYARIFUDDIN
WAHYUDI M
MUHAMMAD ARIS
NURRIA IHSANUDIN
ARI HENDRA ANGGARA
ANDRI RUSIYANTO
ABU SOFYAN
RADIAH
BOBBY FERRY MANALU
SUGIO WIJAYA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
MANUTV
MANUTV
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
758.00
4,550.00
758.00
4,550.00
8,385.00
4,550.00
3,542.00
0.00
17,750.00
0.00
2012
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2011
2012
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
4,550.00
4,550.00
8,385.00
4,550.00
21,250.00
0.00
106,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
455.00
0.00
0.00
0.00
2,125.00
0.00
10,650.00
0.00
10,000,000.00
100,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
25,000,000.00
25,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
25,000,000.00
0.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
76.00
0.00
76.00
0.00
0.00
0.00
354.00
0.00
1,775.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,550.00
682.00
4,550.00
8,385.00
4,550.00
3,188.00
0.00
15,975.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,550.00
682.00
4,550.00
8,385.00
4,550.00
3,188.00
0.00
15,975.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001822356.01
0001822649
0001822877.01
0001822882.01
0001822894.01
0001822912.01
0001822957.01
0001822961.01
0001822970.01
0001823023.01
0001823059.01
0001823184.01
0001823214
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1305
1306
1307
1308
1309
1310
1311
1312
1313
1314
1315
1316
1317
IMKIN0001822356
IMKIN0001822649
IMKIN0001822877
IMKIN0001822882
IMKIN0001822894
IMKIN0001822912
IMKIN0001822957
IMKIN0001822961
IMKIN0001822970
IMKIN0001823023
IMKIN0001823059
IMKIN0001823184
IMKIN0001823214
09.05.2011
10.05.2011
04.05.2011
04.05.2011
04.05.2011
04.05.2011
05.05.2011
05.05.2011
05.05.2011
06.05.2011
06.05.2011
06.05.2011
05.05.2011
09.03.2012
10.05.2012
04.03.2012
04.03.2012
04.03.2012
04.03.2012
05.03.2012
05.03.2012
05.03.2012
06.03.2012
06.03.2012
06.02.2012
05.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
71PAGE :
NAPSIRIN HADI
AZHARI
IR PIGOU TORORI DWI
AGUS SETYAWAN
H.ABDUL RAZAK
BAYU STEVIA ANANTA
ARI KURNIAWAN
AMSSAL JAYA SIANIPAR
CECEP KUSNANDAR
ICHLAS FIRMANSYAH
FANNY TROFIEN RUMOKO
WIDIO NUGRAHWATI
BAHRID BUSENG DRS H
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGSRN
CIGSRN
CIGLPN
CIGLPN
583.00
0.00
0.00
1,538.00
10,140.00
758.00
4,550.00
3,781.00
25,480.00
758.00
4,550.00
758.00
4,550.00
583.00
0.00
758.00
4,550.00
583.00
3,500.00
986.00
6,370.00
87,000.00
0.00
68,750.00
0.00
2011
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
3,500.00
0.00
0.00
9,230.00
10,140.00
4,550.00
4,550.00
22,685.00
25,480.00
4,550.00
4,550.00
4,550.00
4,550.00
3,500.00
0.00
4,550.00
4,550.00
3,500.00
3,500.00
5,915.00
6,370.00
348,000.00
0.00
275,000.00
0.00
350.00
0.00
0.00
923.00
0.00
455.00
0.00
2,269.00
0.00
455.00
0.00
455.00
0.00
350.00
0.00
455.00
0.00
350.00
0.00
592.00
0.00
34,800.00
0.00
27,500.00
0.00
5,000,000.00
5,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
5,000,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
100,000,000.00
0.00
100,000,000.00
0.00
58.00
0.00
0.00
154.00
0.00
76.00
0.00
378.00
0.00
76.00
0.00
76.00
0.00
58.00
0.00
76.00
0.00
58.00
0.00
99.00
0.00
8,700.00
0.00
6,875.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
525.00
0.00
0.00
1,384.00
10,140.00
682.00
4,550.00
3,403.00
25,480.00
682.00
4,550.00
682.00
4,550.00
525.00
0.00
682.00
4,550.00
525.00
3,500.00
887.00
6,370.00
78,300.00
0.00
61,875.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
525.00
0.00
0.00
1,384.00
10,140.00
682.00
4,550.00
3,403.00
25,480.00
682.00
4,550.00
682.00
4,550.00
525.00
0.00
682.00
4,550.00
525.00
3,500.00
887.00
6,370.00
78,300.00
0.00
61,875.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001823746
0001824947.01
0001824971.01
0001825118.01
0001825381.01
0001825393.01
0001825555
0001825748.01
0001826538.01
0001826570.01
0001826577
0001826596
0001826614
0001826629
0001826941
0001826955
0001826979
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1318
1319
1320
1321
1322
1323
1324
1325
1326
1327
1328
1329
1330
1331
1332
1333
1334
IMKIN0001823746
IMKIN0001824947
IMKIN0001824971
IMKIN0001825118
IMKIN0001825381
IMKIN0001825393
IMKIN0001825555
IMKIN0001825748
IMKIN0001826538
IMKIN0001826570
IMKIN0001826577
IMKIN0001826596
IMKIN0001826614
IMKIN0001826629
IMKIN0001826941
IMKIN0001826955
IMKIN0001826979
12.05.2011
10.05.2011
10.05.2011
12.05.2011
19.05.2011
18.05.2011
18.05.2011
18.05.2011
20.05.2011
21.05.2011
20.05.2011
20.05.2011
21.05.2011
21.05.2011
23.05.2011
23.05.2011
23.05.2011
12.03.2012
10.03.2012
10.03.2012
12.03.2012
19.05.2012
18.05.2012
18.05.2012
18.03.2012
20.04.2012
21.05.2012
20.05.2012
20.05.2012
21.05.2012
21.05.2012
23.05.2012
23.05.2012
23.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
72PAGE :
MARTHA MONIKA LINGGA
SANUDI
SUKARYO B RUSBAD
AGUS SURAHMAN
ANDRY ABADI UTAMA
KAPAITRIYA SARI NING
NUSIRWAN DALIMUNTHE
AANG JUNAEDI
ABRIMAN
TEGUH BASUKI,BEC
HENDRA SETIONO
JOHAN MAIS OLEY
AZIS PURNOMO PUTRO,S
SUHARTONO
RIRIN ANDIANI
HENDRIK L TIWOW
I WAYAN AJI SEDANA.A
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
BNIDRD
BNIDRD
BNIHLF
MISSRN
MISSRN
BNIDRD
BNIDRD
BNIDRD
BNIHLF
BNIHLF
BNIHLF
BNIHLF
BNIHLF
BNIHLF
BNIHLF
0.00
0.00
758.00
4,550.00
758.00
4,550.00
758.00
4,550.00
0.00
70,000.00
0.00
0.00
0.00
14,750.00
129,000.00
118,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
4,550.00
4,550.00
4,550.00
4,550.00
4,550.00
4,550.00
0.00
70,000.00
0.00
0.00
0.00
177,000.00
129,000.00
118,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
455.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
17,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
10,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
150,000,000.00
150,000,000.00
10,000,000.00
100,000,000.00
100,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
10,000,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
100,000,000.00
0.00
0.00
0.00
150,000,000.00
100,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
76.00
0.00
76.00
0.00
76.00
0.00
0.00
0.00
0.00
0.00
0.00
1,475.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,550.00
682.00
4,550.00
682.00
4,550.00
0.00
70,000.00
0.00
0.00
0.00
13,275.00
129,000.00
118,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
4,550.00
682.00
4,550.00
682.00
4,550.00
0.00
70,000.00
0.00
0.00
0.00
13,275.00
129,000.00
118,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001827150
0001827163
0001827175
0001827396
0001827422
0001827512.01
0001827537
0001827537.01
0001827550.01
0001827669
0001827712
0001828487
0001828817.01
0001828836.01
0001829089.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1335
1336
1337
1338
1339
1340
1341
1342
1343
1344
1345
1346
1347
1348
1349
IMKIN0001827150
IMKIN0001827163
IMKIN0001827175
IMKIN0001827396
IMKIN0001827422
IMKIN0001827512
IMKIN0001827537
IMKIN0001827537
IMKIN0001827550
IMKIN0001827669
IMKIN0001827712
IMKIN0001828487
IMKIN0001828817
IMKIN0001828836
IMKIN0001829089
24.05.2011
24.05.2011
24.05.2011
23.05.2011
20.05.2011
18.05.2011
20.05.2011
20.05.2011
20.05.2011
13.05.2011
14.05.2011
25.05.2011
23.05.2011
24.05.2011
24.05.2011
24.04.2012
24.05.2012
24.05.2012
23.03.2012
20.03.2012
18.03.2012
20.03.2012
20.03.2012
20.03.2012
13.05.2012
14.05.2012
25.05.2012
23.03.2012
24.03.2012
15.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
73PAGE :
MUHAMMAD MARMAN TUHA
LILI AYENI,SH
ARIF FARHAN BUDIYANT
HENDRA OKRIMALFI
PRANYONO
IR WALMEN SITINDAON
MIRWAN ARSYAD
SRI SETIYONINGSIH
ADRIANUS HARYO P
RULLY CAHYANI
RUDI TONI LUBIS
MUH AMIN
DJOKO WIJONO
BAGUS PRABOWO
TEVERI BENTI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
BNIHLF
BNIHLF
DANHCP
DANHCP
DANHCP
DANHCP
PMTBPL
PMTBPL
PMTSHI
PMTSHI
PMTSHI
PMTSHI
PMTBPL
PMTBPL
PMTSHI
PMTSHI
BNIHLF
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANUTV
4,375.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
4,600.00
0.00
0.00
0.00
0.00
0.00
583.00
0.00
0.00
0.00
0.00
658.00
0.00
583.00
0.00
0.00
2011
2012
2012
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2012
2012
2012
2011
2012
2011
2012
2012
52,500.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
27,600.00
0.00
0.00
0.00
0.00
0.00
3,500.00
0.00
0.00
0.00
0.00
3,950.00
0.00
3,500.00
0.00
0.00
5,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,760.00
0.00
0.00
0.00
0.00
0.00
350.00
0.00
0.00
0.00
0.00
395.00
0.00
350.00
0.00
0.00
75,000,000.00
75,000,000.00
10,000,000.00
10,000,000.00
40,000,000.00
40,000,000.00
25,000,000.00
25,000,000.00
5,000,000.00
5,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
5,000,000.00
5,000,000.00
50,000,000.00
50,000,000.00
10,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
5,000,000.00
0.00
0.00
438.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
460.00
0.00
0.00
0.00
0.00
0.00
58.00
0.00
0.00
0.00
0.00
66.00
0.00
58.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,937.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
4,140.00
0.00
0.00
0.00
0.00
0.00
525.00
0.00
0.00
0.00
0.00
592.00
0.00
525.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,937.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
4,140.00
0.00
0.00
0.00
0.00
0.00
525.00
0.00
0.00
0.00
0.00
592.00
0.00
525.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001829142.01
0001829142.03
0001829211.01
0001829810
0001829814
0001829886
0001829889.01
0001829929.01
0001829978.01
0001830019
0001833204
0001833301.01
0001833310.01
0001833337.01
0001833376.01
0001833403.01
0001833977.01
0001833977.03
0001834062.01
0001834096.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1350
1351
1352
1353
1354
1355
1356
1357
1358
1359
1360
1361
1362
1363
1364
1365
1366
1367
1368
1369
IMKIN0001829142
IMKIN0001829142
IMKIN0001829211
IMKIN0001829810
IMKIN0001829814
IMKIN0001829886
IMKIN0001829889
IMKIN0001829929
IMKIN0001829978
IMKIN0001830019
IMKIN0001833204
IMKIN0001833301
IMKIN0001833310
IMKIN0001833337
IMKIN0001833376
IMKIN0001833403
IMKIN0001833977
IMKIN0001833977
IMKIN0001834062
IMKIN0001834096
20.05.2011
20.05.2011
24.05.2011
01.06.2011
01.06.2011
01.06.2011
01.06.2011
01.06.2011
01.06.2011
01.06.2011
06.06.2011
06.06.2011
09.06.2011
01.06.2011
06.06.2011
07.06.2011
01.06.2011
01.06.2011
01.06.2011
01.06.2011
20.05.2012
20.05.2012
24.03.2012
01.05.2012
01.04.2012
01.05.2012
01.05.2012
01.05.2012
01.03.2012
01.02.2012
06.03.2012
06.03.2012
09.03.2012
01.03.2012
06.05.2012
07.05.2012
01.05.2012
01.05.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
74PAGE :
BAMBANG SADONO
SUGIARTI
SUPRATMAN
NURUL LAILATUS SA`AD
IKE AMELIA
SUTARTI
TOPAN WIBAWA
AMALIA FEBRY SADHANA
RONI WIJAYANTO
TAN TJIN TIONG
JEJE
DADANG
MIRRA HASTUTY
MURWANTO
AGOES EDY SETIAWAN
EKO SUDARMAWAN
BAHARUDIN UMASUGI
INDAH PRATIWI
IYAR WIARSIH
AKHMAD NABHANI ST
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
DANHCP
DANHCP
HSBTLC
HSBCPP
MANGMK
PMTBPL
CIGLPN
DANHCP
HSBCPP
HSBCPP
MANGMK
MANGMK
MANGMK
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
3,667.00
0.00
0.00
0.00
0.00
0.00
5,833.00
875.00
1,030,000.00
0.00
0.00
0.00
0.00
0.00
9,833.00
379.00
379.00
2,096.00
1,138.00
2012
2012
2011
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
22,000.00
0.00
0.00
0.00
0.00
0.00
70,000.00
3,500.00
3,090,000.00
0.00
0.00
0.00
0.00
0.00
118,000.00
4,550.00
4,550.00
8,385.00
4,550.00
0.00
0.00
2,200.00
0.00
0.00
0.00
0.00
0.00
7,000.00
350.00
309,000.00
0.00
0.00
0.00
0.00
0.00
11,800.00
455.00
455.00
839.00
455.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
10,000,000.00
25,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
5,000,000.00
500,000,000.00
10,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
5,000,000.00
500,000,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
367.00
0.00
0.00
0.00
0.00
0.00
583.00
88.00
103,000.00
0.00
0.00
0.00
0.00
0.00
983.00
38.00
38.00
210.00
114.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,300.00
0.00
0.00
0.00
0.00
0.00
5,250.00
787.00
927,000.00
0.00
0.00
0.00
0.00
0.00
8,850.00
341.00
341.00
1,886.00
1,024.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,300.00
0.00
0.00
0.00
0.00
0.00
5,250.00
787.00
927,000.00
0.00
0.00
0.00
0.00
0.00
8,850.00
341.00
341.00
1,886.00
1,024.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001834175.01
0001834294.01
0001834613.01
0001834613.03
0001836416
0001836537.01
0001836583.01
0001836605.01
0001836619.01
0001836664.01
0001836668.01
0001836673.01
0001836688.01
0001836735.01
0001836753
0001837157.01
0001837319
0001837983.01
0001838176
0001839569.01
0001840235.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1370
1371
1372
1373
1374
1375
1376
1377
1378
1379
1380
1381
1382
1383
1384
1385
1386
1387
1388
1389
1390
IMKIN0001834175
IMKIN0001834294
IMKIN0001834613
IMKIN0001834613
IMKIN0001836416
IMKIN0001836537
IMKIN0001836583
IMKIN0001836605
IMKIN0001836619
IMKIN0001836664
IMKIN0001836668
IMKIN0001836673
IMKIN0001836688
IMKIN0001836735
IMKIN0001836753
IMKIN0001837157
IMKIN0001837319
IMKIN0001837983
IMKIN0001838176
IMKIN0001839569
IMKIN0001840235
04.06.2011
07.06.2011
13.06.2011
13.06.2011
13.06.2011
06.06.2011
03.06.2011
09.06.2011
07.06.2011
10.06.2011
08.06.2011
10.06.2011
09.06.2011
14.06.2011
14.06.2011
16.06.2011
15.06.2011
17.06.2011
16.06.2011
22.06.2011
22.06.2011
04.05.2012
07.05.2012
13.05.2012
13.05.2012
13.03.2012
06.05.2012
03.05.2012
09.04.2012
07.03.2012
10.05.2012
08.03.2012
10.05.2012
09.03.2012
14.03.2012
14.05.2012
16.04.2012
15.03.2012
17.03.2012
16.03.2012
22.03.2012
22.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
75PAGE :
FARID KUMBORO ARIEF
ERIKA SULISTYANI
LILIS AISAH
SYAHBUDIN
YUSPIK ALWI LUBIS
MUHAMAD HANAPI
MADI SINGGIH SASMORO
MUHAMMAD ALI PURKON
KHAERUL BUDHY NAGARA
WITASARI
NENI ARIANI
NUR CHOLIS MAJID
DESIYANI PUJI WAHYUN
DHIRA ANINDYA NIRMAL
FAJAR KURNIANINGSIH
ENDANG MURTI ANDRINI
SUDRAJAT ABDUL MUNAW
YUSRIZAL, SE
DADANG SAPUTRA
RAHMAD BUDI AJI
T HENNY HANDAJANI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
DANHCP
HSBCPP
MANGMK
MANGMK
MANGMK
MANGMK
MANGMK
MANGMK
MANGMK
MANGMK
DANHCP
PMTBPL
DANHCP
BNIDRD
DANHCP
PMTBPL
HSBCPP
379.00
379.00
379.00
769.00
0.00
0.00
0.00
19,667.00
29,500.00
14,333.00
17,500.00
0.00
17,500.00
17,500.00
0.00
583.00
0.00
0.00
0.00
1,138.00
4,917.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
4,550.00
4,550.00
4,550.00
9,230.00
0.00
0.00
0.00
118,000.00
118,000.00
172,000.00
70,000.00
0.00
70,000.00
70,000.00
0.00
3,500.00
0.00
0.00
0.00
4,550.00
59,000.00
455.00
455.00
455.00
923.00
0.00
0.00
0.00
11,800.00
11,800.00
17,200.00
7,000.00
0.00
7,000.00
7,000.00
0.00
350.00
0.00
0.00
0.00
455.00
5,900.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
50,000,000.00
50,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
200,000,000.00
200,000,000.00
40,000,000.00
5,000,000.00
10,000,000.00
150,000,000.00
25,000,000.00
6,500,000.00
50,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
0.00
100,000,000.00
100,000,000.00
0.00
5,000,000.00
0.00
0.00
0.00
6,500,000.00
50,000,000.00
38.00
38.00
38.00
77.00
0.00
0.00
0.00
1,967.00
2,950.00
1,433.00
1,750.00
0.00
1,750.00
1,750.00
0.00
58.00
0.00
0.00
0.00
114.00
492.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
341.00
341.00
341.00
692.00
0.00
0.00
0.00
17,700.00
26,550.00
12,900.00
15,750.00
0.00
15,750.00
15,750.00
0.00
525.00
0.00
0.00
0.00
1,024.00
4,425.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
341.00
341.00
341.00
692.00
0.00
0.00
0.00
17,700.00
26,550.00
12,900.00
15,750.00
0.00
15,750.00
15,750.00
0.00
525.00
0.00
0.00
0.00
1,024.00
4,425.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001840313
0001840434
0001840577
0001841042.01
0001841078
0001842005.01
0001842005.03
0001842278.01
0001842716.01
0001842954
0001843018
0001843018.01
0001843250.01
0001843344.01
0001843381
0001843382
0001843485.01
0001843683
0001843683.01
0001844006
0001844108
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1391
1392
1393
1394
1395
1396
1397
1398
1399
1400
1401
1402
1403
1404
1405
1406
1407
1408
1409
1410
1411
IMKIN0001840313
IMKIN0001840434
IMKIN0001840577
IMKIN0001841042
IMKIN0001841078
IMKIN0001842005
IMKIN0001842005
IMKIN0001842278
IMKIN0001842716
IMKIN0001842954
IMKIN0001843018
IMKIN0001843018
IMKIN0001843250
IMKIN0001843344
IMKIN0001843381
IMKIN0001843382
IMKIN0001843485
IMKIN0001843683
IMKIN0001843683
IMKIN0001844006
IMKIN0001844108
17.06.2011
22.06.2011
21.06.2011
21.06.2011
10.06.2011
01.07.2011
01.07.2011
01.07.2011
01.07.2011
02.07.2011
06.07.2011
06.07.2011
04.07.2011
05.07.2011
05.07.2011
05.07.2011
05.07.2011
08.07.2011
08.07.2011
01.07.2011
04.07.2011
17.02.2012
22.03.2012
21.03.2012
21.03.2012
10.03.2012
01.03.2012
01.03.2012
01.03.2012
01.02.2012
02.05.2012
06.03.2012
06.03.2012
04.03.2012
05.03.2012
05.05.2012
05.05.2012
05.03.2012
08.03.2012
08.03.2012
01.03.2012
04.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
76PAGE :
LABUDI
YUYUN
PUTRI PRIHATINI
ANIH HADYANTI
MUHAMMAD RICKY RIVAI
ANDRI KUSNANDAR
RAHAYU INDAH HANDAYA
INDAH AGUS LESTARI
IBNU ABBAS
SUGENG WIRNALI
CASMARI
CASMARI
LUKMAN ARIFIN
AZHAR BSC
SANTOSO OEY
SANTOSO OEY
ASEP SURIANA
ARIA SRI FITRIANA
ARIA SRI FITRIANA
FRANS MARSINTA PUTRA
MUHAMAD SALADIN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGLPN
DANHCP
DANHCP
PMTBPL
PMCSHP
PMTBPL
PMTBPL
PMTBPL
CIGSRN
HSBTLC
NISINP
NISINP
PMTBPL
BNIDRD
CIGLPN
CIGLPR
PMTBPL
NISINP
NISINP
DANHCP
BNIJBX
162,000.00
0.00
0.00
3,438.00
0.00
1,517.00
1,517.00
1,167.00
258,750.00
0.00
0.00
0.00
1,517.00
115,000.00
81,000.00
202,500.00
1,167.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
486,000.00
0.00
0.00
13,750.00
0.00
4,550.00
4,550.00
3,500.00
621,000.00
0.00
0.00
0.00
4,550.00
345,000.00
486,000.00
1,215,000.00
3,500.00
0.00
0.00
0.00
0.00
48,600.00
0.00
0.00
1,375.00
0.00
455.00
455.00
350.00
62,100.00
0.00
0.00
0.00
455.00
34,500.00
48,600.00
121,500.00
350.00
0.00
0.00
0.00
0.00
500,000,000.00
25,000,000.00
25,000,000.00
5,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
100,000,000.00
50,000,000.00
72,000,000.00
96,000,000.00
6,500,000.00
50,000,000.00
500,000,000.00
500,000,000.00
5,000,000.00
72,000,000.00
96,000,000.00
10,000,000.00
200,000,000.00
200,000,000.00
0.00
0.00
5,000,000.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
100,000,000.00
0.00
0.00
0.00
6,500,000.00
50,000,000.00
200,000,000.00
500,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
16,200.00
0.00
0.00
344.00
0.00
152.00
152.00
117.00
25,875.00
0.00
0.00
0.00
152.00
11,500.00
8,100.00
20,250.00
117.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
145,800.00
0.00
0.00
3,094.00
0.00
1,365.00
1,365.00
1,050.00
232,875.00
0.00
0.00
0.00
1,365.00
103,500.00
72,900.00
182,250.00
1,050.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
145,800.00
0.00
0.00
3,094.00
0.00
1,365.00
1,365.00
1,050.00
232,875.00
0.00
0.00
0.00
1,365.00
103,500.00
72,900.00
182,250.00
1,050.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001844276
0001844545.01
0001844606
0001844611.01
0001844660
0001844845.01
0001844856.01
0001844878
0001845546.01
0001845603
0001846081
0001846410.01
0001846900.01
0001847197
0001847226
0001847239
0001847287
0001847302
0001847342
0001847342.01
0001847469
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1412
1413
1414
1415
1416
1417
1418
1419
1420
1421
1422
1423
1424
1425
1426
1427
1428
1429
1430
1431
1432
IMKIN0001844276
IMKIN0001844545
IMKIN0001844606
IMKIN0001844611
IMKIN0001844660
IMKIN0001844845
IMKIN0001844856
IMKIN0001844878
IMKIN0001845546
IMKIN0001845603
IMKIN0001846081
IMKIN0001846410
IMKIN0001846900
IMKIN0001847197
IMKIN0001847226
IMKIN0001847239
IMKIN0001847287
IMKIN0001847302
IMKIN0001847342
IMKIN0001847342
IMKIN0001847469
01.07.2011
06.07.2011
22.07.2011
07.07.2011
05.07.2011
01.07.2011
05.07.2011
05.07.2011
07.07.2011
05.07.2011
09.07.2011
11.07.2011
12.07.2011
11.07.2011
12.07.2011
12.07.2011
11.07.2011
07.07.2011
15.07.2011
15.07.2011
08.07.2011
01.05.2012
06.05.2012
22.05.2012
07.05.2012
05.05.2012
01.02.2012
05.02.2012
05.05.2012
07.04.2012
05.03.2012
09.05.2012
11.05.2012
12.03.2012
11.03.2012
12.03.2012
12.03.2012
11.03.2012
07.03.2012
15.03.2012
15.03.2012
08.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
77PAGE :
HASANUDDIN
SURI LATIFAH
TJIO WIESIONG-SUWIRY
MARYCEL ROSA NOYA
AFRIANATA
HANDI WIDIYANTO
WIWI MULYANA
R TURADJA AULIA NUG
HERI SUTIANTO
RIZAL STIONO SUTAJAY
NOVELIA ADISITA
PURMADI
SARAH LAYLA
IMAM SUTIKNO
TERIMABAIK HAREFA
ERMINA SARILANTI TAM
SOFYAN SYAHRUDY
RIANDY SETIAWAN
EDY SUHARTO
EDY SUHARTO
REZA FAHLEVI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
PMTBPL
IMCGLP
BNIDRD
BNIJBX
CIGSRN
CIGSRN
CIGLPN
HSBCPP
DANHCP
BNIJBX
BNIDRD
HSBCPP
DANHCP
DANHCP
DANHCP
DANHCP
HSBTLC
NISINP
NISINP
DANHCP
0.00
758.00
0.00
29,167.00
0.00
0.00
131,667.00
23,333.00
0.00
0.00
0.00
98,000.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
4,550.00
0.00
175,000.00
0.00
0.00
316,000.00
140,000.00
0.00
0.00
0.00
588,000.00
210,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
17,500.00
0.00
0.00
31,600.00
14,000.00
0.00
0.00
0.00
58,800.00
21,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000,000.00
5,000,000.00
100,000,000.00
250,000,000.00
200,000,000.00
100,000,000.00
400,000,000.00
500,000,000.00
50,000,000.00
10,000,000.00
200,000,000.00
150,000,000.00
300,000,000.00
10,000,000.00
25,000,000.00
50,000,000.00
10,000,000.00
30,000,000.00
50,000,000.00
48,000,000.00
10,000,000.00
0.00
5,000,000.00
0.00
250,000,000.00
0.00
0.00
400,000,000.00
200,000,000.00
0.00
0.00
0.00
150,000,000.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
76.00
0.00
2,917.00
0.00
0.00
13,167.00
2,333.00
0.00
0.00
0.00
9,800.00
7,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
0.00
26,250.00
0.00
0.00
118,500.00
21,000.00
0.00
0.00
0.00
88,200.00
63,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
682.00
0.00
26,250.00
0.00
0.00
118,500.00
21,000.00
0.00
0.00
0.00
88,200.00
63,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001848091
0001848342.01
0001848391.01
0001848503
0001848803
0001848913.01
0001849396
0001849766
0001849842
0001850116.01
0001850379
0001850606
0001850625
0001851013
0001851013.01
0001851391
0001851398
0001851415
0001851461
0001851463
0001851500
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1433
1434
1435
1436
1437
1438
1439
1440
1441
1442
1443
1444
1445
1446
1447
1448
1449
1450
1451
1452
1453
IMKIN0001848091
IMKIN0001848342
IMKIN0001848391
IMKIN0001848503
IMKIN0001848803
IMKIN0001848913
IMKIN0001849396
IMKIN0001849766
IMKIN0001849842
IMKIN0001850116
IMKIN0001850379
IMKIN0001850606
IMKIN0001850625
IMKIN0001851013
IMKIN0001851013
IMKIN0001851391
IMKIN0001851398
IMKIN0001851415
IMKIN0001851461
IMKIN0001851463
IMKIN0001851500
14.07.2011
08.07.2011
11.07.2011
05.07.2011
16.07.2011
08.07.2011
15.07.2011
18.07.2011
18.07.2011
19.07.2011
18.07.2011
18.07.2011
18.07.2011
20.07.2011
20.07.2011
19.07.2011
18.07.2011
20.07.2011
21.07.2011
21.07.2011
21.07.2011
14.03.2012
08.05.2012
11.05.2012
05.03.2012
16.03.2012
08.03.2012
15.05.2012
18.03.2012
18.03.2012
19.04.2012
18.03.2012
18.05.2012
18.03.2012
20.03.2012
20.03.2012
19.04.2012
18.02.2012
20.02.2012
21.04.2012
21.05.2012
21.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
78PAGE :
NURMA HISA DESI
YONATHAN
GINANJAR DHANU UTOMO
MUHAMAD HUSIN
LATIFAH
JENDA MALEM TARIGAN
J SOFYAN BRAHIM
ELFINA AGUSTIN VENDA
RUDYANTO TJANDRA
ANEKA ASMIN
SUDIRMAN AMIN
RUSLI RAJAB
AHMAD RIZKI
HJ. JUMIANI, SE
JUJU ANTORO
TJIE KHENG
SUNARKO
MUHAMMAD HUSNI
GHOZALI HAMZAH
I GEDE SUARSA
SYAHRIAR BENNI PUTRA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
CIGSRN
CIGSRN
PMCSHP
HSBTLC
PMTBPL
BNIJBX
PMCSHP
PMCSHP
BNIDRD
BNIJBX
DANHCP
DANHCP
PMCSHP
PMCSHP
CIGLPN
CIGLPN
CIGLPN
BNIHLF
BNIHLF
PMCSHP
0.00
13,167.00
52,667.00
0.00
0.00
7,562.00
0.00
0.00
0.00
61,625.00
0.00
0.00
0.00
0.00
0.00
172,500.00
70,833.00
81,667.00
1,750.00
0.00
32,250.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
79,000.00
316,000.00
0.00
0.00
22,685.00
0.00
0.00
0.00
246,500.00
0.00
0.00
0.00
0.00
0.00
690,000.00
170,000.00
196,000.00
7,000.00
0.00
96,750.00
0.00
7,900.00
31,600.00
0.00
0.00
2,269.00
0.00
0.00
0.00
24,650.00
0.00
0.00
0.00
0.00
0.00
69,000.00
17,000.00
19,600.00
700.00
0.00
9,675.00
75,000,000.00
200,000,000.00
400,000,000.00
75,000,000.00
50,000,000.00
6,500,000.00
200,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
200,000,000.00
25,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
100,000,000.00
500,000,000.00
500,000,000.00
10,000,000.00
10,000,000.00
75,000,000.00
0.00
100,000,000.00
400,000,000.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
200,000,000.00
200,000,000.00
10,000,000.00
0.00
75,000,000.00
0.00
1,317.00
5,267.00
0.00
0.00
756.00
0.00
0.00
0.00
6,163.00
0.00
0.00
0.00
0.00
0.00
17,250.00
7,083.00
8,167.00
175.00
0.00
3,225.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,850.00
47,400.00
0.00
0.00
6,806.00
0.00
0.00
0.00
55,462.00
0.00
0.00
0.00
0.00
0.00
155,250.00
63,750.00
73,500.00
1,575.00
0.00
29,025.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,850.00
47,400.00
0.00
0.00
6,806.00
0.00
0.00
0.00
55,462.00
0.00
0.00
0.00
0.00
0.00
155,250.00
63,750.00
73,500.00
1,575.00
0.00
29,025.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001851602.01
0001851707
0001851894.01
0001852017
0001852019
0001852112
0001852405.01
0001853084.01
0001853085.01
0001853102
0001853135.01
0001853148.01
0001853162.01
0001853178
0001853199.01
0001853200.01
0001853235.01
0001853245
0001853248
0001853443.01
0001854472.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1454
1455
1456
1457
1458
1459
1460
1461
1462
1463
1464
1465
1466
1467
1468
1469
1470
1471
1472
1473
1474
IMKIN0001851602
IMKIN0001851707
IMKIN0001851894
IMKIN0001852017
IMKIN0001852019
IMKIN0001852112
IMKIN0001852405
IMKIN0001853084
IMKIN0001853085
IMKIN0001853102
IMKIN0001853135
IMKIN0001853148
IMKIN0001853162
IMKIN0001853178
IMKIN0001853199
IMKIN0001853200
IMKIN0001853235
IMKIN0001853245
IMKIN0001853248
IMKIN0001853443
IMKIN0001854472
13.07.2011
18.07.2011
22.07.2011
20.07.2011
20.07.2011
19.07.2011
25.07.2011
22.07.2011
22.07.2011
22.07.2011
22.07.2011
22.07.2011
22.07.2011
23.07.2011
23.07.2011
23.07.2011
23.07.2011
20.07.2011
20.07.2011
26.07.2011
01.08.2011
13.03.2012
18.03.2012
22.03.2012
20.03.2012
20.03.2012
19.05.2012
25.03.2012
22.05.2012
22.03.2012
22.03.2012
22.05.2012
22.03.2012
22.05.2012
23.03.2012
23.05.2012
23.03.2012
23.03.2012
20.05.2012
20.05.2012
26.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
79PAGE :
SITI MUJILAH
PANJI SETIAWAN
ADITYA
HENDRIK SAPUTRA
YUNITA HERAWATI
AHMAD KHOLIK
VICTOR VICEROY
MULYA WARDANA
PRISKA
INDRIANI SEPTYNINGSI
KHABIBI
SARDI
YUWONO SAPUTRO
ACHMAD SYAHRIFAL
YULVITA PELITANINGSI
PAIMAN
NORA OKTASARI RASMA
KADEK WIWIN HENDRA W
MOHAMAD GUNAWAN
ISRAN NOOR
HENDRY AGUSMAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMCSHP
PMTBPL
DANHCP
DANHCP
DANHCP
PMTBPL
PMTBPL
PMTBPL
PMTSHI
PMTBPL
PMTBPL
PMTBPL
PMTSHI
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
BNIDRD
PMTBPL
2,600.00
0.00
1,517.00
0.00
0.00
0.00
1,517.00
758.00
1,167.00
11,667.00
758.00
1,517.00
583.00
0.00
758.00
8,493.00
3,217.00
8,750.00
0.00
309,000.00
3,494.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
7,800.00
0.00
4,550.00
0.00
0.00
0.00
4,550.00
4,550.00
3,500.00
35,000.00
4,550.00
4,550.00
3,500.00
0.00
4,550.00
25,480.00
9,650.00
52,500.00
0.00
927,000.00
8,385.00
780.00
0.00
455.00
0.00
0.00
0.00
455.00
455.00
350.00
3,500.00
455.00
455.00
350.00
0.00
455.00
2,548.00
965.00
5,250.00
0.00
92,700.00
839.00
5,000,000.00
75,000,000.00
6,500,000.00
25,000,000.00
10,000,000.00
10,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
75,000,000.00
75,000,000.00
150,000,000.00
6,500,000.00
5,000,000.00
0.00
6,500,000.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
50,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
75,000,000.00
0.00
150,000,000.00
6,500,000.00
260.00
0.00
152.00
0.00
0.00
0.00
152.00
76.00
117.00
1,167.00
76.00
152.00
58.00
0.00
76.00
849.00
322.00
875.00
0.00
30,900.00
350.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,340.00
0.00
1,365.00
0.00
0.00
0.00
1,365.00
682.00
1,050.00
10,500.00
682.00
1,365.00
525.00
0.00
682.00
7,644.00
2,895.00
7,875.00
0.00
278,100.00
3,144.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,340.00
0.00
1,365.00
0.00
0.00
0.00
1,365.00
682.00
1,050.00
10,500.00
682.00
1,365.00
525.00
0.00
682.00
7,644.00
2,895.00
7,875.00
0.00
278,100.00
3,144.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001854472.03
0001854583
0001855048
0001855070
0001855098
0001855315.01
0001855376
0001855750.01
0001856029
0001856274.01
0001856294.01
0001856295.01
0001856341.01
0001856381.01
0001856385.01
0001856424.01
0001856428.01
0001856511.01
0001857069
0001857090.01
0001857095.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1475
1476
1477
1478
1479
1480
1481
1482
1483
1484
1485
1486
1487
1488
1489
1490
1491
1492
1493
1494
1495
IMKIN0001854472
IMKIN0001854583
IMKIN0001855048
IMKIN0001855070
IMKIN0001855098
IMKIN0001855315
IMKIN0001855376
IMKIN0001855750
IMKIN0001856029
IMKIN0001856274
IMKIN0001856294
IMKIN0001856295
IMKIN0001856341
IMKIN0001856381
IMKIN0001856385
IMKIN0001856424
IMKIN0001856428
IMKIN0001856511
IMKIN0001857069
IMKIN0001857090
IMKIN0001857095
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
02.08.2011
02.08.2011
04.08.2011
03.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.08.2011
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
02.05.2012
04.05.2012
03.05.2012
01.12.2011
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
01.05.2012
01.03.2012
01.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
80PAGE :
IRAWATI
WISMOKO TRI ALDRI
TARYUDIN
JOKO TRI HARJANTO`SE
SYAMSUL BAHRI CHAN
CENNING AGUSTIA
RIKO RISMANTO
PITER
SUWIGNYO
LUSI FEBRIANTI
LUTFI NURCAHYO
MSYUKUR
NI KOMANG SRIANTI
SUJARNO
M. AGUS
KRISTO FURUS WIDI UT
TATOS RIDWAN A FAUZI
ROHMAT IMANUDIN BIN
ADRIANSYAH
MAYPRI ASTRI NOVIYAN
HARLIE BOY OKTAVERI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMCSHP
DANHCP
DANHCP
DANHCP
PMTBPL
PMCSHP
BNIDRD
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
CIGSRN
CIGSRN
2,925.00
24,583.00
0.00
0.00
0.00
1,896.00
0.00
64,500.00
0.00
2,400.00
1,896.00
1,458.00
1,458.00
1,896.00
1,896.00
1,896.00
2,654.00
875.00
0.00
32,917.00
79,000.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
7,020.00
59,000.00
0.00
0.00
0.00
4,550.00
0.00
258,000.00
0.00
3,600.00
4,550.00
3,500.00
3,500.00
4,550.00
4,550.00
4,550.00
6,370.00
3,500.00
0.00
79,000.00
158,000.00
702.00
5,900.00
0.00
0.00
0.00
455.00
0.00
25,800.00
0.00
360.00
455.00
350.00
350.00
455.00
455.00
455.00
637.00
350.00
0.00
7,900.00
15,800.00
6,500,000.00
50,000,000.00
25,000,000.00
25,000,000.00
25,000,000.00
6,500,000.00
75,000,000.00
150,000,000.00
200,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
75,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
50,000,000.00
0.00
0.00
0.00
6,500,000.00
0.00
150,000,000.00
0.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
0.00
100,000,000.00
200,000,000.00
293.00
2,458.00
0.00
0.00
0.00
190.00
0.00
6,450.00
0.00
240.00
190.00
146.00
146.00
190.00
190.00
190.00
265.00
88.00
0.00
3,292.00
7,900.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,632.00
22,125.00
0.00
0.00
0.00
1,706.00
0.00
58,050.00
0.00
2,160.00
1,706.00
1,312.00
1,312.00
1,706.00
1,706.00
1,706.00
2,389.00
787.00
0.00
29,625.00
71,100.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,632.00
22,125.00
0.00
0.00
0.00
1,706.00
0.00
58,050.00
0.00
2,160.00
1,706.00
1,312.00
1,312.00
1,706.00
1,706.00
1,706.00
2,389.00
787.00
0.00
29,625.00
71,100.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001857338
0001857487
0001857647.01
0001857955
0001858172
0001858185
0001858251.01
0001858301.01
0001858470.01
0001858877.01
0001858936.01
0001859100.01
0001859369
0001859512.01
0001860713.01
0001860914
0001860925.01
0001860926.01
0001861067
0001862092.01
0001862217
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1496
1497
1498
1499
1500
1501
1502
1503
1504
1505
1506
1507
1508
1509
1510
1511
1512
1513
1514
1515
1516
IMKIN0001857338
IMKIN0001857487
IMKIN0001857647
IMKIN0001857955
IMKIN0001858172
IMKIN0001858185
IMKIN0001858251
IMKIN0001858301
IMKIN0001858470
IMKIN0001858877
IMKIN0001858936
IMKIN0001859100
IMKIN0001859369
IMKIN0001859512
IMKIN0001860713
IMKIN0001860914
IMKIN0001860925
IMKIN0001860926
IMKIN0001861067
IMKIN0001862092
IMKIN0001862217
02.08.2011
06.08.2011
05.08.2011
08.08.2011
08.08.2011
08.08.2011
09.08.2011
10.08.2011
10.08.2011
05.08.2011
11.08.2011
11.08.2011
10.08.2011
12.08.2011
16.08.2011
11.08.2011
13.08.2011
12.08.2011
16.08.2011
20.08.2011
23.08.2011
02.03.2012
06.05.2012
05.03.2012
08.03.2012
08.03.2012
08.05.2012
09.03.2012
16.04.2012
10.05.2012
05.02.2012
11.03.2012
11.03.2012
10.03.2012
12.03.2012
16.05.2012
11.03.2012
13.05.2012
12.03.2012
16.05.2012
20.03.2012
23.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
81PAGE :
SOLEIL SAMOSIR
AGUNG SETYA BUDI
IR JACKY WATIMURY
EDI EKO SISWANTO
YUS AFFANDI
YAN FONTABA
HERDIANTO
LEONARD E BANAM
LIDYA IMELDA
MUKTAR SYAH
M E ALEXANDRA
RAHMA TRISTIYANTI
ABDUL GANI HANDOKO
WIWIN RAHAYU
MEISA ARDHI NUGROHO
VERONICA LOMO
FIRA MARDIANI
RUSMI
WAHYONO
RETNO ENDANG SRIHARJ
IRAWAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
DANHCP
PMCSHP
PMTBPL
PMCSHP
BNIJBX
BNIJBX
PMTBPL
BNIDRR
CIGSRN
CIGSRN
HSBCPP
PMTBPL
DANHCP
BNIDRD
BNIDRD
DANHCP
HSBCPP
HSBCPP
PMCSHP
BNIDRD
NISINP
0.00
13,125.00
1,896.00
0.00
575,000.00
0.00
1,458.00
0.00
91,500.00
158,000.00
0.00
5,227.00
0.00
32,917.00
0.00
0.00
0.00
0.00
0.00
43,750.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
52,500.00
4,550.00
0.00
1,380,000.00
0.00
3,500.00
0.00
366,000.00
316,000.00
0.00
12,545.00
0.00
79,000.00
0.00
0.00
0.00
0.00
0.00
105,000.00
0.00
0.00
5,250.00
455.00
0.00
138,000.00
0.00
350.00
0.00
36,600.00
31,600.00
0.00
1,255.00
0.00
7,900.00
0.00
0.00
0.00
0.00
0.00
10,500.00
0.00
10,000,000.00
75,000,000.00
5,000,000.00
75,000,000.00
200,000,000.00
200,000,000.00
5,000,000.00
105,000,000.00
300,000,000.00
400,000,000.00
100,000,000.00
6,500,000.00
50,000,000.00
150,000,000.00
100,000,000.00
25,000,000.00
100,000,000.00
100,000,000.00
25,000,000.00
150,000,000.00
96,000,000.00
0.00
75,000,000.00
5,000,000.00
0.00
200,000,000.00
0.00
5,000,000.00
0.00
300,000,000.00
400,000,000.00
0.00
6,500,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
150,000,000.00
0.00
0.00
1,313.00
190.00
0.00
57,500.00
0.00
146.00
0.00
9,150.00
15,800.00
0.00
523.00
0.00
3,292.00
0.00
0.00
0.00
0.00
0.00
4,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,812.00
1,706.00
0.00
517,500.00
0.00
1,312.00
0.00
82,350.00
142,200.00
0.00
4,704.00
0.00
29,625.00
0.00
0.00
0.00
0.00
0.00
39,375.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,812.00
1,706.00
0.00
517,500.00
0.00
1,312.00
0.00
82,350.00
142,200.00
0.00
4,704.00
0.00
29,625.00
0.00
0.00
0.00
0.00
0.00
39,375.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001862217.01
0001862288.01
0001862326.01
0001862442
0001863043.01
0001863612
0001863612.01
0001863632
0001863637
0001863797
0001863799
0001864529
0001864555
0001864759
0001865045.01
0001866074
0001866100
0001866117
0001866225
0001867426.01
0001868035.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1517
1518
1519
1520
1521
1522
1523
1524
1525
1526
1527
1528
1529
1530
1531
1532
1533
1534
1535
1536
1537
IMKIN0001862217
IMKIN0001862288
IMKIN0001862326
IMKIN0001862442
IMKIN0001863043
IMKIN0001863612
IMKIN0001863612
IMKIN0001863632
IMKIN0001863637
IMKIN0001863797
IMKIN0001863799
IMKIN0001864529
IMKIN0001864555
IMKIN0001864759
IMKIN0001865045
IMKIN0001866074
IMKIN0001866100
IMKIN0001866117
IMKIN0001866225
IMKIN0001867426
IMKIN0001868035
23.08.2011
09.08.2011
10.08.2011
18.08.2011
23.08.2011
15.08.2011
15.08.2011
15.08.2011
16.08.2011
24.08.2011
24.08.2011
01.09.2011
01.09.2011
01.09.2011
10.09.2011
05.09.2011
07.09.2011
05.09.2011
21.09.2011
13.09.2011
13.09.2011
23.03.2012
09.05.2012
10.03.2012
18.05.2012
23.05.2012
15.05.2012
15.05.2012
15.05.2012
16.03.2012
09.04.2012
09.05.2012
01.03.2012
01.03.2012
01.03.2012
10.05.2012
05.03.2012
07.05.2012
05.03.2012
21.03.2012
13.05.2012
13.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
82PAGE :
IRAWAN
BAMBANG AGUNG SUSILO
SAMSIR SS
MIRNA MAISARA DAULAY
MAISYE M PONTOAN
KAMARIAH
RUSLIANSYAH
EKA LINDA YANI
YOHANES CHRISTIANTO
YOLA KURNIAWAN
HANDY SUPRIJADI
BARDASAWAN SUGIRI
DODY ISKANDAR
RAMDAN
MOCHSYIHABUDIN
YOGA PAMUNGKAS HASIBUAN
USMIATI
KARTA
KHO BOK BENG
LESDINER HASIBUAN
DR GERALD TOREH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
PMTBPL
PMTBPL
DANHCP
CIGSRN
PMCSHP
PMCSHP
PMTSHI
PMTSHI
IMCGLP
IMCGLP
DANHCP
DANHCP
PMTSHI
PMTBPL
DANHCP
DANHCP
HSBTLC
IMCGLP
BNIDRD
CIGSRN
0.00
2,096.00
3,196.00
0.00
133,000.00
0.00
0.00
9,000.00
0.00
163,333.00
161,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91,000.00
86,000.00
105,333.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
8,385.00
7,670.00
0.00
532,000.00
0.00
0.00
36,000.00
0.00
490,000.00
645,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
182,000.00
258,000.00
316,000.00
0.00
839.00
767.00
0.00
53,200.00
0.00
0.00
3,600.00
0.00
49,000.00
64,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
18,200.00
25,800.00
31,600.00
72,000,000.00
6,500,000.00
6,500,000.00
25,000,000.00
400,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
500,000,000.00
500,000,000.00
25,000,000.00
25,000,000.00
25,000,000.00
5,000,000.00
10,000,000.00
10,000,000.00
30,000,000.00
500,000,000.00
150,000,000.00
400,000,000.00
0.00
6,500,000.00
6,500,000.00
0.00
400,000,000.00
0.00
0.00
50,000,000.00
0.00
500,000,000.00
500,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
150,000,000.00
400,000,000.00
0.00
210.00
320.00
0.00
13,300.00
0.00
0.00
900.00
0.00
16,333.00
16,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9,100.00
8,600.00
10,533.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,886.00
2,876.00
0.00
119,700.00
0.00
0.00
8,100.00
0.00
147,000.00
145,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
81,900.00
77,400.00
94,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,886.00
2,876.00
0.00
119,700.00
0.00
0.00
8,100.00
0.00
147,000.00
145,125.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
81,900.00
77,400.00
94,800.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001868358.01
0001868415
0001868492.01
0001868581.01
0001868582
0001869973.01
0001869973.03
0001870304.01
0001870308.01
0001871162
0001871162.01
0001871597.01
0001871603.01
0001871613.01
0001871615.01
0001871615.03
0001871649.01
0001871670.01
0001872124
0001872128
0001872341
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1538
1539
1540
1541
1542
1543
1544
1545
1546
1547
1548
1549
1550
1551
1552
1553
1554
1555
1556
1557
1558
IMKIN0001868358
IMKIN0001868415
IMKIN0001868492
IMKIN0001868581
IMKIN0001868582
IMKIN0001869973
IMKIN0001869973
IMKIN0001870304
IMKIN0001870308
IMKIN0001871162
IMKIN0001871162
IMKIN0001871597
IMKIN0001871603
IMKIN0001871613
IMKIN0001871615
IMKIN0001871615
IMKIN0001871649
IMKIN0001871670
IMKIN0001872124
IMKIN0001872128
IMKIN0001872341
15.09.2011
15.09.2011
01.09.2011
06.09.2011
01.09.2011
19.09.2011
19.09.2011
05.09.2011
06.09.2011
17.09.2011
17.09.2011
12.09.2011
12.09.2011
12.09.2011
12.09.2011
12.09.2011
12.09.2011
12.09.2011
14.09.2011
14.09.2011
22.09.2011
15.05.2012
15.05.2012
01.02.2012
06.02.2012
01.02.2012
19.03.2012
19.03.2012
05.05.2012
06.03.2012
17.03.2012
17.03.2012
12.03.2012
12.03.2012
12.03.2012
12.03.2012
12.03.2012
12.03.2012
12.03.2012
14.03.2012
14.03.2012
22.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
83PAGE :
A BUDI SURYANTO
ANTONIUS HERUJIYANTO
MUHAMMAD TAMRIN
YADI SURYADI
SABARIMAN
ELY SUSIAWATI
SIGIT PRAYITNO
IR FIRDAUS ANST
I GUSTI KADEK SUARDANA
ANA SHELA TIARA
RAYMOND ABD. RACHMAN
RISYANDY ADY SAPUTRA
CUCUP SUPRIATNA
AGUS PERMADI
DINA SARI
EDWIN SAMPEPANA
RASIMAN
DJONI LUMINTANG
ADITYO HARI NUGROHO
CUCUP SUPRIATNA
KIRANA ANGGRAHITA PRAMESTI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIDRR
BNIJBX
CIGSRN
CIGSRN
CIGLPN
PMTBPS
PMTBPS
PMTBPL
PMTBPL
BCASHP
BCASHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
64,400.00
0.00
226,333.00
310,333.00
0.00
1,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
29,625.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
193,200.00
0.00
388,000.00
532,000.00
0.00
3,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
59,250.00
0.00
19,320.00
0.00
38,800.00
53,200.00
0.00
350.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,925.00
0.00
105,000,000.00
200,000,000.00
200,000,000.00
400,000,000.00
200,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
20,000,000.00
20,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
105,000,000.00
0.00
200,000,000.00
400,000,000.00
0.00
5,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
0.00
6,440.00
0.00
22,633.00
31,033.00
0.00
175.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,963.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
57,960.00
0.00
203,700.00
279,300.00
0.00
1,575.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,662.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
57,960.00
0.00
203,700.00
279,300.00
0.00
1,575.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,662.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001872341.01
0001872341.02
0001872341.03
0001872345
0001872345.01
0001872345.02
0001872361.01
0001872447.01
0001872637.01
0001872761
0001872766.01
0001873270
0001873298.01
0001873298.03
0001873468
0001873786
0001873852
0001874135.01
0001874145.01
0001874145.03
0001874185.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1559
1560
1561
1562
1563
1564
1565
1566
1567
1568
1569
1570
1571
1572
1573
1574
1575
1576
1577
1578
1579
IMKIN0001872341
IMKIN0001872341
IMKIN0001872341
IMKIN0001872345
IMKIN0001872345
IMKIN0001872345
IMKIN0001872361
IMKIN0001872447
IMKIN0001872637
IMKIN0001872761
IMKIN0001872766
IMKIN0001873270
IMKIN0001873298
IMKIN0001873298
IMKIN0001873468
IMKIN0001873786
IMKIN0001873852
IMKIN0001874135
IMKIN0001874145
IMKIN0001874145
IMKIN0001874185
22.09.2011
22.09.2011
22.09.2011
22.09.2011
22.09.2011
22.09.2011
22.09.2011
15.09.2011
08.09.2011
21.09.2011
20.09.2011
23.09.2011
20.09.2011
20.09.2011
23.09.2011
27.09.2011
24.09.2011
01.10.2011
01.10.2011
01.10.2011
01.10.2011
22.05.2012
22.05.2012
22.05.2012
22.03.2012
22.03.2012
22.03.2012
22.04.2012
15.02.2012
08.03.2012
21.03.2012
20.05.2012
23.05.2012
20.03.2012
20.03.2012
23.05.2012
27.04.2012
24.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
84PAGE :
RACHMADI SUSILO WIDODO
SHAFIRA DERASTI ALTAFFA
WIDIASTUTI
STELA LARISA CHANDRA
WAN WAN CANDRA
YULIA
BAMBANG SANTOSO
SUKUR A M ARIF
BABUL JANNASRI HAFSA
FEBRIADHY MAULANA SAADIPUTRA
PRAHESTI RETYARSARI
SLAMET SUGIARTO
RESTU SITANGGANG
SYARIFAH HUSNA
DANTE HARTLEY BARAHAMA
AGUS SUSANTO
TITI
FEBRI TRI PUTRINI
SUNARTI
SYAHLAN JUKHRI NASUTION ST
ILHAM FITRIAN MUBAROK
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPL
CIGSRN
MANGPL
DANHCP
MANGPL
BNIJBX
PMTBPL
PMTBPL
BNIJBX
BNIJBX
HSBTLC
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
29,500.00
0.00
0.00
0.00
0.00
452,667.00
42,500.00
0.00
30,333.00
0.00
0.00
0.00
0.00
0.00
0.00
2,654.00
3,450.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
88,500.00
0.00
0.00
0.00
0.00
776,000.00
85,000.00
0.00
91,000.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
5,915.00
0.00
0.00
0.00
0.00
8,850.00
0.00
0.00
0.00
0.00
77,600.00
8,500.00
0.00
9,100.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
592.00
0.00
0.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
400,000,000.00
200,000,000.00
25,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
200,000,000.00
200,000,000.00
20,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
75,000,000.00
0.00
0.00
0.00
0.00
400,000,000.00
100,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
2,950.00
0.00
0.00
0.00
0.00
45,267.00
4,250.00
0.00
3,033.00
0.00
0.00
0.00
0.00
0.00
0.00
265.00
345.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,550.00
0.00
0.00
0.00
0.00
407,400.00
38,250.00
0.00
27,300.00
0.00
0.00
0.00
0.00
0.00
0.00
2,389.00
3,105.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,550.00
0.00
0.00
0.00
0.00
407,400.00
38,250.00
0.00
27,300.00
0.00
0.00
0.00
0.00
0.00
0.00
2,389.00
3,105.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001874185.03
0001874559.01
0001874601
0001874620.01
0001875434
0001875434.01
0001875534.01
0001875671.01
0001876710
0001876710.01
0001876712
0001876712.01
0001876768.01
0001876779.01
0001877233
0001877527
0001877571
0001878712
0001878712.01
0001878728
0001880195
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1580
1581
1582
1583
1584
1585
1586
1587
1588
1589
1590
1591
1592
1593
1594
1595
1596
1597
1598
1599
1600
IMKIN0001874185
IMKIN0001874559
IMKIN0001874601
IMKIN0001874620
IMKIN0001875434
IMKIN0001875434
IMKIN0001875534
IMKIN0001875671
IMKIN0001876710
IMKIN0001876710
IMKIN0001876712
IMKIN0001876712
IMKIN0001876768
IMKIN0001876779
IMKIN0001877233
IMKIN0001877527
IMKIN0001877571
IMKIN0001878712
IMKIN0001878712
IMKIN0001878728
IMKIN0001880195
01.10.2011
01.10.2011
01.10.2011
01.10.2011
06.10.2011
06.10.2011
04.10.2011
04.10.2011
06.10.2011
06.10.2011
10.10.2011
10.10.2011
03.10.2011
05.10.2011
07.10.2011
10.10.2011
10.10.2011
11.10.2011
11.10.2011
11.10.2011
06.10.2011
01.03.2012
01.05.2012
01.03.2012
01.05.2012
06.03.2012
06.03.2012
04.05.2012
04.05.2012
16.03.2012
16.03.2012
10.03.2012
10.03.2012
03.02.2012
05.02.2012
07.03.2012
10.03.2012
10.05.2012
11.03.2012
11.03.2012
11.03.2012
06.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
85PAGE :
TRI LESTARI SUCI SUSILOWATI
INDRA A E SETIAWAN
ALBERT ICHSAN
SETIA WIJAYA S.SOS
OCTAVIANUS MATHYS HUKOM
OCTAVIANUS MATHYS HUKOM
HASYIMS SOS
SURYADINATA
BUDY HERIYAWAN
BUDY HERIYAWAN
IRMA DIYAH
IRMA DIYAH
JAKA PURWANTO
LISNA NURINDAH SARI
RIZZALUNA
NI MADE SURYANI
ABDUL GHONI EFFENDY
MUSNI
RUSLIM BAMBANG
SETIYA BUDI
SUSANTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
BNIDRD
BNIDRD
BNIDRD
NISINP
NISINP
BNIDRD
PMTBPL
NISINP
NISINP
NISINP
NISINP
CIGSRN
CIGSRN
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
0.00
43,750.00
256,667.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
258,667.00
105,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
105,000.00
440,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
388,000.00
158,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,500.00
44,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
38,800.00
15,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
150,000,000.00
100,000,000.00
50,000,000.00
75,000,000.00
72,000,000.00
150,000,000.00
5,000,000.00
50,000,000.00
48,000,000.00
50,000,000.00
48,000,000.00
200,000,000.00
200,000,000.00
25,000,000.00
25,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
150,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,375.00
25,667.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
25,867.00
10,533.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
39,375.00
231,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
232,800.00
94,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
39,375.00
231,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
232,800.00
94,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001880628
0001881426.01
0001881466
0001881785.01
0001882000.01
0001882333
0001883249
0001884131.01
0001884138.01
0001884446
0001884741.01
0001884802.01
0001884802.03
0001884826.01
0001885183.01
0001885191
0001885596.01
0001885649.01
0001885728.01
0001885740.01
0001885765.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1601
1602
1603
1604
1605
1606
1607
1608
1609
1610
1611
1612
1613
1614
1615
1616
1617
1618
1619
1620
1621
IMKIN0001880628
IMKIN0001881426
IMKIN0001881466
IMKIN0001881785
IMKIN0001882000
IMKIN0001882333
IMKIN0001883249
IMKIN0001884131
IMKIN0001884138
IMKIN0001884446
IMKIN0001884741
IMKIN0001884802
IMKIN0001884802
IMKIN0001884826
IMKIN0001885183
IMKIN0001885191
IMKIN0001885596
IMKIN0001885649
IMKIN0001885728
IMKIN0001885740
IMKIN0001885765
14.10.2011
17.10.2011
11.10.2011
03.10.2011
18.10.2011
19.10.2011
21.10.2011
12.10.2011
12.10.2011
25.10.2011
19.10.2011
21.10.2011
21.10.2011
22.10.2011
24.10.2011
24.10.2011
01.11.2011
01.11.2011
01.11.2011
01.11.2011
01.11.2011
14.04.2012
17.05.2012
11.05.2012
03.05.2012
18.04.2012
19.04.2012
21.05.2012
12.05.2012
12.03.2012
25.03.2012
19.03.2012
21.03.2012
21.03.2012
22.03.2012
24.03.2012
24.03.2012
01.05.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
86PAGE :
HENDRA TRI LAKSONO
DAHNIAR NASUTION
SAMBAS BENNY RUMBAYAN
NURWIYANTO
AKHMAD SYAMSI
TJOA RUSLI ANGGREK
GANDY JAYA BUDIHARTO
EUIS AISYAH
JUWANTO
SATYASTA MARTUA GIDEON
HENNY TRIHERLISADI
RONDYAH
SUJANA
SULASTRI
H SANUDIN
REZA SUKENDI
MUHSIN
RIZZALUNA
PULUNG KUSHARIADI
NOFRIZA MAHAYU
EDY SETIYONO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJB3
MANGPL
BNIJBX
BNIDRD
BNIDRD
BNIJBX
BNIJBX
PMTBPL
PMTBPL
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
BNIDRD
PMTBPS
MANGPL
MANGPL
MANGPX
70,000.00
58,333.00
0.00
245,000.00
162,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,333.00
0.00
46,667.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
140,000.00
140,000.00
0.00
588,000.00
324,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,500.00
0.00
70,000.00
0.00
14,000.00
14,000.00
0.00
58,800.00
32,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
350.00
0.00
7,000.00
0.00
140,000,000.00
200,000,000.00
200,000,000.00
150,000,000.00
150,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
25,000,000.00
150,000,000.00
5,000,000.00
50,000,000.00
200,000,000.00
70,000,000.00
140,000,000.00
200,000,000.00
0.00
150,000,000.00
150,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,000,000.00
0.00
100,000,000.00
0.00
7,000.00
5,833.00
0.00
24,500.00
16,200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
233.00
0.00
4,667.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63,000.00
52,500.00
0.00
220,500.00
145,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,100.00
0.00
42,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63,000.00
52,500.00
0.00
220,500.00
145,800.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,100.00
0.00
42,000.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001886170
0001886170.01
0001886190
0001886190.01
0001886190.02
0001886482.01
0001887103.01
0001887500.01
0001888257
0001888329
0001889184
0001889187
0001889189
0001889249
0001889249.01
0001889513
0001890016.01
0001890571
0001890571.01
0001890573
0001890573.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1622
1623
1624
1625
1626
1627
1628
1629
1630
1631
1632
1633
1634
1635
1636
1637
1638
1639
1640
1641
1642
IMKIN0001886170
IMKIN0001886170
IMKIN0001886190
IMKIN0001886190
IMKIN0001886190
IMKIN0001886482
IMKIN0001887103
IMKIN0001887500
IMKIN0001888257
IMKIN0001888329
IMKIN0001889184
IMKIN0001889187
IMKIN0001889189
IMKIN0001889249
IMKIN0001889249
IMKIN0001889513
IMKIN0001890016
IMKIN0001890571
IMKIN0001890571
IMKIN0001890573
IMKIN0001890573
04.11.2011
04.11.2011
02.11.2011
02.11.2011
02.11.2011
03.11.2011
07.11.2011
01.11.2011
10.11.2011
15.11.2011
15.11.2011
15.11.2011
15.11.2011
15.11.2011
15.11.2011
09.11.2011
16.11.2011
21.11.2011
21.11.2011
21.11.2011
21.11.2011
04.03.2012
04.03.2012
02.03.2012
02.03.2012
02.03.2012
03.05.2012
07.05.2012
01.03.2012
10.02.2012
15.03.2012
15.05.2012
15.03.2012
15.05.2012
15.03.2012
15.03.2012
09.05.2012
16.04.2012
21.03.2012
21.03.2012
21.03.2012
21.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
87PAGE :
DEDI WIJAYA
DEDI WIJAYA
ANDREAS JOSEPH H
HERAWATI SUMINDRA
WILLIAM SURYA H
LINDA PERMANASARI,S SOS
WINO SUMARNO
MARSUDI
SUPRIADI
ARI SETYADI
TARA AGNESSTASHA M
MUHAMMAD HAMZAH
M IQBAL SYAFEI
CATHERINA
HENDRA KRISNANDA
ZAINAL ABIDIN
AGUS SUSANTO
YUSTINA TRUSTININGSIH
YUSTINA TRUSTININGSIH
POEDJI RAHAYU
POEDJI RAHAYU
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
NISINP
PMCSHP
PMCSHP
PMCSHP
BNIDRR
BNIDRD
PMTBPL
CIGLPN
IMCGLP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
BNIJBX
BNIDRR
NISINP
NISINP
NISINP
NISINP
0.00
0.00
0.00
0.00
0.00
0.00
162,000.00
13,067.00
24,300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
79,625.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
324,000.00
19,600.00
32,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
136,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
32,400.00
1,960.00
3,240.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13,650.00
0.00
0.00
0.00
0.00
75,000,000.00
72,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
70,000,000.00
150,000,000.00
5,000,000.00
200,000,000.00
300,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
200,000,000.00
105,000,000.00
50,000,000.00
48,000,000.00
75,000,000.00
72,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
150,000,000.00
5,000,000.00
30,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
105,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16,200.00
1,307.00
2,430.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,963.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
145,800.00
11,760.00
21,870.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
71,662.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
145,800.00
11,760.00
21,870.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
71,662.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001890650
0001892203.01
0001892211.01
0001892264.01
0001892303.01
0001892338.01
0001892378.01
0001892457.01
0001892480.01
0001892485.01
0001892492.01
0001892509.01
0001892518.01
0001892522.01
0001892522.03
0001892527.01
0001892546.01
0001892768.01
0001893492
0001893687
0001893693
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1643
1644
1645
1646
1647
1648
1649
1650
1651
1652
1653
1654
1655
1656
1657
1658
1659
1660
1661
1662
1663
IMKIN0001890650
IMKIN0001892203
IMKIN0001892211
IMKIN0001892264
IMKIN0001892303
IMKIN0001892338
IMKIN0001892378
IMKIN0001892457
IMKIN0001892480
IMKIN0001892485
IMKIN0001892492
IMKIN0001892509
IMKIN0001892518
IMKIN0001892522
IMKIN0001892522
IMKIN0001892527
IMKIN0001892546
IMKIN0001892768
IMKIN0001893492
IMKIN0001893687
IMKIN0001893693
21.11.2011
15.11.2011
15.11.2011
15.11.2011
15.11.2011
16.11.2011
16.11.2011
17.11.2011
17.11.2011
17.11.2011
17.11.2011
18.11.2011
18.11.2011
18.11.2011
18.11.2011
18.11.2011
21.11.2011
23.11.2011
24.11.2011
24.11.2011
25.11.2011
21.03.2012
15.03.2012
15.03.2012
15.03.2012
15.05.2012
16.03.2012
16.03.2012
17.03.2012
17.03.2012
17.04.2012
17.03.2012
18.03.2012
18.05.2012
18.03.2012
18.03.2012
18.05.2012
21.03.2012
23.03.2012
24.05.2012
24.05.2012
25.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
88PAGE :
MOH KHOIRI
DENI MULYANA
ADE SUSENO
DIMAS GALUH SWASANA
IMAN FIRMANSYAH
SARONI
NURMAYANNA N
RIDWAN
AHMAD EFFENDI
Muhammad SUHELMI
BONG PAP KONG (ELYAS)
ENGGAR WAHYUNINGSIH
KRESNALDY EKA PUTRA
APRIANUS ROFIQ
NIA MARYANI
ERSANTI ATMADJA
OKE NUGRAHA SE
KOESNAENY SETYAWATI
AGUST SULAIMAN S.S
ERVINA D RORING
FAUZI HASAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
HSBCPP
PMCSHP
CIGLPN
CIGLPN
154,500.00
3,033.00
3,033.00
3,033.00
2,275.00
3,033.00
3,033.00
6,760.00
3,033.00
2,730.00
21,363.00
7,453.00
2,275.00
3,033.00
3,033.00
2,275.00
3,423.00
0.00
0.00
0.00
1,158,750.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
231,750.00
4,550.00
4,550.00
4,550.00
4,550.00
4,550.00
4,550.00
10,140.00
4,550.00
4,680.00
32,045.00
11,180.00
4,550.00
4,550.00
4,550.00
4,550.00
5,135.00
0.00
0.00
0.00
1,545,000.00
23,175.00
455.00
455.00
455.00
455.00
455.00
455.00
1,014.00
455.00
468.00
3,205.00
1,118.00
455.00
455.00
455.00
455.00
514.00
0.00
0.00
0.00
154,500.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
100,000,000.00
50,000,000.00
300,000,000.00
500,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
500,000,000.00
15,450.00
303.00
303.00
303.00
228.00
303.00
303.00
676.00
303.00
273.00
2,137.00
745.00
228.00
303.00
303.00
228.00
343.00
0.00
0.00
0.00
115,875.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
139,050.00
2,730.00
2,730.00
2,730.00
2,047.00
2,730.00
2,730.00
6,084.00
2,730.00
2,457.00
19,226.00
6,708.00
2,047.00
2,730.00
2,730.00
2,047.00
3,080.00
0.00
0.00
0.00
1,042,875.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
139,050.00
2,730.00
2,730.00
2,730.00
2,047.00
2,730.00
2,730.00
6,084.00
2,730.00
2,457.00
19,226.00
6,708.00
2,047.00
2,730.00
2,730.00
2,047.00
3,080.00
0.00
0.00
0.00
1,042,875.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001894289.01
0001894321.01
0001894358.01
0001894361.01
0001894397.01
0001894596
0001894784
0001895194
0001895201.01
0001895668.01
0001895668.03
0001895674
0001895723
0001895727
0001895730
0001895734
0001895754.01
0001895782.01
0001896271.01
0001896279
0001896298
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1664
1665
1666
1667
1668
1669
1670
1671
1672
1673
1674
1675
1676
1677
1678
1679
1680
1681
1682
1683
1684
IMKIN0001894289
IMKIN0001894321
IMKIN0001894358
IMKIN0001894361
IMKIN0001894397
IMKIN0001894596
IMKIN0001894784
IMKIN0001895194
IMKIN0001895201
IMKIN0001895668
IMKIN0001895668
IMKIN0001895674
IMKIN0001895723
IMKIN0001895727
IMKIN0001895730
IMKIN0001895734
IMKIN0001895754
IMKIN0001895782
IMKIN0001896271
IMKIN0001896279
IMKIN0001896298
01.12.2011
01.12.2011
01.12.2011
01.12.2011
01.12.2011
02.12.2011
01.12.2011
01.12.2011
01.12.2011
06.12.2011
06.12.2011
06.12.2011
06.12.2011
07.12.2011
07.12.2011
06.12.2011
01.12.2011
01.12.2011
07.12.2011
08.12.2011
08.12.2011
01.05.2012
01.04.2012
01.03.2012
01.05.2012
01.05.2012
02.05.2012
01.03.2012
01.02.2012
01.02.2012
06.03.2012
06.03.2012
06.03.2012
06.05.2012
07.05.2012
07.03.2012
06.05.2012
01.05.2012
01.03.2012
07.03.2012
08.03.2012
08.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
89PAGE :
AYU PUJI ASTUTI
KAMILUS N U
ROMMY ANTONIUS
SAPTO RIANDOKO
NUNIK SRI NURHAYANI
IRFAN FANANI
PETER GOZALI
DRS FX SULISTIYONO MM
JULIA DEWI NINGSIH KAKOMORE
SUKADI
YOPI RAMADHANI
AHMAD FAUZI SH
SILVIA YUNIATI
RAYZAND LEAZ
WILHELMUS LAURENS RATELA
MELLOVA
ERNAWATI
YUDHIE EPUSDI YADHEI
PRIMATA OKTA DELA
ANGGIE KEMALA DWI PUTRI
NI NENGAH SUKERTIASIH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIDRD
BNIDRD
MANGPL
MANGPL
BNIDRD
PMCSHP
BCASHP
CIGLPN
CIGSRN
PMTBPL
PMTBPL
PMCSHP
BNIJBX
BNIJBX
BNIJBX
BNIJBX
HSBCPP
PMTBPL
PMTBPS
PMCSHP
PMCSHP
61,250.00
0.00
147,000.00
45,500.00
540,750.00
0.00
0.00
0.00
406,667.00
7,238.00
5,325.00
0.00
81,667.00
81,667.00
0.00
0.00
0.00
2,625.00
2,625.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
105,000.00
0.00
196,000.00
78,000.00
927,000.00
0.00
0.00
0.00
488,000.00
9,650.00
7,100.00
0.00
140,000.00
140,000.00
0.00
0.00
0.00
3,500.00
3,500.00
0.00
0.00
10,500.00
0.00
19,600.00
7,800.00
92,700.00
0.00
0.00
0.00
48,800.00
965.00
710.00
0.00
14,000.00
14,000.00
0.00
0.00
0.00
350.00
350.00
0.00
0.00
150,000,000.00
150,000,000.00
200,000,000.00
100,000,000.00
150,000,000.00
75,000,000.00
20,000,000.00
200,000,000.00
400,000,000.00
5,000,000.00
5,000,000.00
75,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
5,000,000.00
5,000,000.00
75,000,000.00
25,000,000.00
150,000,000.00
0.00
200,000,000.00
50,000,000.00
150,000,000.00
0.00
0.00
0.00
400,000,000.00
5,000,000.00
5,000,000.00
0.00
200,000,000.00
200,000,000.00
0.00
0.00
0.00
5,000,000.00
5,000,000.00
0.00
0.00
6,125.00
0.00
14,700.00
4,550.00
54,075.00
0.00
0.00
0.00
40,667.00
724.00
533.00
0.00
8,167.00
8,167.00
0.00
0.00
0.00
263.00
263.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
55,125.00
0.00
132,300.00
40,950.00
486,675.00
0.00
0.00
0.00
366,000.00
6,514.00
4,792.00
0.00
73,500.00
73,500.00
0.00
0.00
0.00
2,362.00
2,362.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
55,125.00
0.00
132,300.00
40,950.00
486,675.00
0.00
0.00
0.00
366,000.00
6,514.00
4,792.00
0.00
73,500.00
73,500.00
0.00
0.00
0.00
2,362.00
2,362.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001896407.01
0001896540.01
0001896599
0001896842
0001896845
0001897084
0001897084.01
0001897084.02
0001897084.03
0001897120
0001897156
0001897323.01
0001897326.01
0001897377.01
0001897377.03
0001897384.01
0001897390.01
0001897418.01
0001897452.01
0001897503.01
0001897506.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1685
1686
1687
1688
1689
1690
1691
1692
1693
1694
1695
1696
1697
1698
1699
1700
1701
1702
1703
1704
1705
IMKIN0001896407
IMKIN0001896540
IMKIN0001896599
IMKIN0001896842
IMKIN0001896845
IMKIN0001897084
IMKIN0001897084
IMKIN0001897084
IMKIN0001897084
IMKIN0001897120
IMKIN0001897156
IMKIN0001897323
IMKIN0001897326
IMKIN0001897377
IMKIN0001897377
IMKIN0001897384
IMKIN0001897390
IMKIN0001897418
IMKIN0001897452
IMKIN0001897503
IMKIN0001897506
09.12.2011
09.12.2011
02.12.2011
12.12.2011
13.12.2011
09.12.2011
09.12.2011
09.12.2011
09.12.2011
14.12.2011
12.12.2011
02.12.2011
02.12.2011
05.12.2011
05.12.2011
05.12.2011
05.12.2011
06.12.2011
06.12.2011
07.12.2011
07.12.2011
09.03.2012
09.05.2012
02.02.2012
12.05.2012
13.05.2012
09.03.2012
09.03.2012
09.03.2012
09.03.2012
14.03.2012
12.05.2012
02.03.2012
02.03.2012
05.04.2012
05.04.2012
05.03.2012
05.05.2012
06.03.2012
06.05.2012
07.03.2012
07.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
90PAGE :
DARSONO
DJOKO SUHARTO
MUHAMMAD JALIL
LESDINER HASIBUAN
YOSEP NUGROHO
DINA SARI
EDWIN SAMPEPANA
M RIFALDI
URIEL
WAHID SUHERMANTO
G. AJI SURYA WICAKSONO
TOMY HERWANTO
NANI VINOZA
AWAN RISWANDI
NENGSRI WAHYUNI
ENDANG WIYATI
HERU PRAMONO
NICHOLAS ARLIEA
DANI
A MUNIF FANDI
SUBANDI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
BNIDRD
CIGLPN
BNIJBX
BNIJBX
PMCSHP
PMCSHP
PMCSHP
PMCSHP
BNIJBX
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
3,413.00
224,292.00
131,667.00
225,167.00
81,667.00
39,375.00
39,375.00
0.00
0.00
0.00
0.00
13,406.00
30,128.00
2,633.00
2,333.00
4,144.00
4,891.00
3,413.00
2,654.00
3,413.00
4,425.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
4,550.00
384,500.00
158,000.00
386,000.00
140,000.00
52,500.00
52,500.00
0.00
0.00
0.00
0.00
17,875.00
40,170.00
3,950.00
3,500.00
5,525.00
8,385.00
4,550.00
4,550.00
4,550.00
5,900.00
455.00
38,450.00
15,800.00
38,600.00
14,000.00
5,250.00
5,250.00
0.00
0.00
0.00
0.00
1,788.00
4,017.00
395.00
350.00
553.00
839.00
455.00
455.00
455.00
590.00
6,500,000.00
50,000,000.00
500,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
200,000,000.00
25,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
50,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
341.00
22,429.00
13,167.00
22,517.00
8,167.00
3,938.00
3,938.00
0.00
0.00
0.00
0.00
1,341.00
3,013.00
263.00
233.00
415.00
489.00
341.00
265.00
341.00
443.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
201,863.00
118,500.00
202,650.00
73,500.00
35,437.00
35,437.00
0.00
0.00
0.00
0.00
12,065.00
27,115.00
2,370.00
2,100.00
3,729.00
4,402.00
3,072.00
2,389.00
3,072.00
3,982.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
201,863.00
118,500.00
202,650.00
73,500.00
35,437.00
35,437.00
0.00
0.00
0.00
0.00
12,065.00
27,115.00
2,370.00
2,100.00
3,729.00
4,402.00
3,072.00
2,389.00
3,072.00
3,982.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001897554.01
0001897576.01
0001897628.01
0001898733
0001898771
0001898788
0001898868
0001899655
0001899658
0001899662.01
0001900548
0001900823
0001900844
0001900955.01
0001901002.01
0001901011.01
0001901023.01
0001901033.01
0001901064.01
0001901072.01
0001901078.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1706
1707
1708
1709
1710
1711
1712
1713
1714
1715
1716
1717
1718
1719
1720
1721
1722
1723
1724
1725
1726
IMKIN0001897554
IMKIN0001897576
IMKIN0001897628
IMKIN0001898733
IMKIN0001898771
IMKIN0001898788
IMKIN0001898868
IMKIN0001899655
IMKIN0001899658
IMKIN0001899662
IMKIN0001900548
IMKIN0001900823
IMKIN0001900844
IMKIN0001900955
IMKIN0001901002
IMKIN0001901011
IMKIN0001901023
IMKIN0001901033
IMKIN0001901064
IMKIN0001901072
IMKIN0001901078
08.12.2011
08.12.2011
15.12.2011
15.12.2011
01.12.2011
06.12.2011
17.12.2011
20.12.2011
20.12.2011
20.12.2011
10.12.2011
01.12.2011
01.12.2011
21.12.2011
09.12.2011
09.12.2011
09.12.2011
10.12.2011
12.12.2011
12.12.2011
13.12.2011
08.03.2012
08.03.2012
15.05.2012
15.05.2012
01.03.2012
06.03.2012
17.04.2012
20.03.2012
20.05.2012
12.05.2012
10.04.2012
01.05.2012
01.03.2012
21.03.2012
09.05.2012
09.03.2012
09.03.2012
10.03.2012
12.03.2012
12.05.2012
13.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
91PAGE :
DENI KURNIAWAN
HERI FIRMANSYAH
KARUNA MURTI WIDJAJA
HASYIMS SOS
CAHYANTI PURNAMASARI
DIANA PUJI LESTARI
YANTI YANUARINI ROSNURHAYATI
TEJO AGUS WINARTO WAHYUDI
MUKHTAR M USMAN
NURHIDAYAH
LISA SUNDARI
ASNAWI
ZAMZAMI
RANI KARTIKA SARI
PURKON
DAYENI AMD
RINA EFENDI
HERI HANDAYANI
EKO SUPRIJANTO
SULASTRI
EMMANUEL VIALLRESA SUSILO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
CIGSRN
BNIJBX
PMCSHP
PMCSHP
BNIJBX
BNIJB3
BNIJBX
MANGPL
BCASHP
BNIJBX
BNIJBX
HSBCPP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
2,625.00
2,625.00
257,250.00
270,375.00
0.00
0.00
0.00
0.00
212,625.00
92,167.00
0.00
0.00
0.00
59,250.00
7,318.00
4,778.00
3,413.00
3,851.00
3,851.00
2,042.00
2,042.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
3,500.00
3,500.00
441,000.00
463,500.00
0.00
0.00
0.00
0.00
364,500.00
158,000.00
0.00
0.00
0.00
79,000.00
12,545.00
6,370.00
4,550.00
5,135.00
5,135.00
3,500.00
3,500.00
350.00
350.00
44,100.00
46,350.00
0.00
0.00
0.00
0.00
36,450.00
15,800.00
0.00
0.00
0.00
7,900.00
1,255.00
637.00
455.00
514.00
514.00
350.00
350.00
5,000,000.00
5,000,000.00
200,000,000.00
150,000,000.00
75,000,000.00
75,000,000.00
200,000,000.00
140,000,000.00
150,000,000.00
200,000,000.00
20,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
100,000,000.00
150,000,000.00
0.00
0.00
0.00
0.00
150,000,000.00
200,000,000.00
0.00
0.00
0.00
100,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
263.00
263.00
25,725.00
27,038.00
0.00
0.00
0.00
0.00
21,263.00
9,217.00
0.00
0.00
0.00
5,925.00
732.00
478.00
341.00
386.00
386.00
204.00
204.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,362.00
2,362.00
231,525.00
243,337.00
0.00
0.00
0.00
0.00
191,362.00
82,950.00
0.00
0.00
0.00
53,325.00
6,586.00
4,300.00
3,072.00
3,465.00
3,465.00
1,838.00
1,838.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,362.00
2,362.00
231,525.00
243,337.00
0.00
0.00
0.00
0.00
191,362.00
82,950.00
0.00
0.00
0.00
53,325.00
6,586.00
4,300.00
3,072.00
3,465.00
3,465.00
1,838.00
1,838.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001901092.01
0001901106.01
0001901107.01
0001901151.01
0001901157.01
0001901176.01
0001901187.01
0001901213.01
0001901224.01
0001901227.01
0001901306.01
0001901319
0001901324
0001901348.01
0001901366.01
0001901369.01
0001901372.01
0001901638.01
0001901638.03
0001902204.01
0001902558
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1727
1728
1729
1730
1731
1732
1733
1734
1735
1736
1737
1738
1739
1740
1741
1742
1743
1744
1745
1746
1747
IMKIN0001901092
IMKIN0001901106
IMKIN0001901107
IMKIN0001901151
IMKIN0001901157
IMKIN0001901176
IMKIN0001901187
IMKIN0001901213
IMKIN0001901224
IMKIN0001901227
IMKIN0001901306
IMKIN0001901319
IMKIN0001901324
IMKIN0001901348
IMKIN0001901366
IMKIN0001901369
IMKIN0001901372
IMKIN0001901638
IMKIN0001901638
IMKIN0001902204
IMKIN0001902558
13.12.2011
13.12.2011
14.12.2011
14.12.2011
14.12.2011
15.12.2011
15.12.2011
15.12.2011
16.12.2011
16.12.2011
21.12.2011
12.12.2011
13.12.2011
20.12.2011
19.12.2011
20.12.2011
20.12.2011
20.12.2011
20.12.2011
23.12.2011
23.12.2011
13.05.2012
13.03.2012
14.03.2012
14.03.2012
14.03.2012
15.03.2012
15.03.2012
15.03.2012
16.03.2012
16.03.2012
21.05.2012
12.03.2012
13.03.2012
20.03.2012
19.05.2012
20.02.2012
20.02.2012
20.03.2012
20.03.2012
23.05.2012
23.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
92PAGE :
NURLIYANINGSIH
ARLAND A
ERIKA YUTIASARI
I KETUT WANA
HADIANSYAH
MUDJIJONO
ABDUL AZIS
NUNUNG MUJIATMI
EDI SANTOSO
WINDI SEJATI
NUR WIDAYAT
DANU BRATA
RIMA
NANI NARGIATI
BROTO WIKANTO
RUDY
PURWANTO
MOCH RIZKI ARIEFIADI
RD RATNA M NURANTI
EMI SULASMI
CARMO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
CIGSRN
CIGSRN
CIGSRN
CIGSRN
PMTBPL
PMTBPL
BNIDRR
BNIJBX
2,042.00
2,625.00
2,625.00
3,510.00
2,625.00
23,175.00
3,413.00
16,500.00
19,110.00
3,413.00
2,042.00
0.00
0.00
0.00
101,500.00
65,833.00
0.00
5,325.00
5,325.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
3,500.00
3,500.00
3,500.00
4,680.00
3,500.00
30,900.00
4,550.00
22,000.00
25,480.00
4,550.00
3,500.00
0.00
0.00
0.00
174,000.00
79,000.00
0.00
7,100.00
7,100.00
0.00
0.00
350.00
350.00
350.00
468.00
350.00
3,090.00
455.00
2,200.00
2,548.00
455.00
350.00
0.00
0.00
0.00
17,400.00
7,900.00
0.00
710.00
710.00
0.00
0.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
50,000,000.00
200,000,000.00
50,000,000.00
5,000,000.00
5,000,000.00
70,000,000.00
200,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
0.00
0.00
0.00
50,000,000.00
100,000,000.00
0.00
5,000,000.00
5,000,000.00
0.00
0.00
204.00
263.00
263.00
351.00
263.00
2,318.00
341.00
1,650.00
1,911.00
341.00
204.00
0.00
0.00
0.00
10,150.00
6,583.00
0.00
533.00
533.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,838.00
2,362.00
2,362.00
3,159.00
2,362.00
20,857.00
3,072.00
14,850.00
17,199.00
3,072.00
1,838.00
0.00
0.00
0.00
91,350.00
59,250.00
0.00
4,792.00
4,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,838.00
2,362.00
2,362.00
3,159.00
2,362.00
20,857.00
3,072.00
14,850.00
17,199.00
3,072.00
1,838.00
0.00
0.00
0.00
91,350.00
59,250.00
0.00
4,792.00
4,792.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001902605.01
0001902608.01
0001902913
0001902937.01
0001902939.01
0001902942
0001902942.01
0001903097
0001903160
0001903455
0001903509
0001903536
0001903555
0001903563
0001903570
0001903570.01
0001903589
0001903598
0001903696.01
0001903850.01
0001903911
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1748
1749
1750
1751
1752
1753
1754
1755
1756
1757
1758
1759
1760
1761
1762
1763
1764
1765
1766
1767
1768
IMKIN0001902605
IMKIN0001902608
IMKIN0001902913
IMKIN0001902937
IMKIN0001902939
IMKIN0001902942
IMKIN0001902942
IMKIN0001903097
IMKIN0001903160
IMKIN0001903455
IMKIN0001903509
IMKIN0001903536
IMKIN0001903555
IMKIN0001903563
IMKIN0001903570
IMKIN0001903570
IMKIN0001903589
IMKIN0001903598
IMKIN0001903696
IMKIN0001903850
IMKIN0001903911
23.12.2011
23.12.2011
23.12.2011
20.12.2011
23.12.2011
23.12.2011
23.12.2011
01.12.2011
27.12.2011
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
23.02.2012
23.05.2012
23.05.2012
20.02.2012
23.02.2012
02.03.2012
02.03.2012
01.05.2012
27.05.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
01.03.2012
01.05.2012
01.05.2012
01.03.2012
01.05.2012
01.03.2012
01.02.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
93PAGE :
ITA CAMELIA
SONNY SALFIDI
ARIEF WAHYUDI
YENNY SOFIA
FRANSISKUS SURYO WINAHYU
RINA
RINA
DEWI SURYANINGSIH
YANI SRI MULYANI
SOFYAN
DIAN INDRIYANTO
MIMIN AMINAH
SUTAN BATARA PUTRA PANE
ZULKANI
MUSTAQIM KARIM
SITI HARDIANTI PUTRI
DEWI SULISTIANA
IMAM BHAKTIAR NUGROHO
DEDI SUTISNA
ILHAM NUSANTARA
M. RASYA RAMADHANI RR
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGSRN
CIGSRN
BNIJBX
CIGSRN
CIGSRN
NISINP
NISINP
PMCSHP
BNIJB3
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPL
CIGSRN
PMCSHP
0.00
0.00
0.00
443,333.00
263,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
532,000.00
316,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
53,200.00
31,600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
50,000,000.00
150,000,000.00
400,000,000.00
400,000,000.00
50,000,000.00
48,000,000.00
75,000,000.00
105,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
100,000,000.00
75,000,000.00
0.00
0.00
0.00
400,000,000.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
44,333.00
26,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
399,000.00
237,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
399,000.00
237,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001903911.01
0001903911.02
0001903941
0001904051
0001904249.01
0001904268
0001904276
0001904830
0001904830.01
0001904867.01
0001904869.01
0001904908.01
0001904913.01
0001904941.01
0001904957.01
0001904960.01
0001904979.01
0001904996.01
0001905037.01
0001905037.03
0001905039.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1769
1770
1771
1772
1773
1774
1775
1776
1777
1778
1779
1780
1781
1782
1783
1784
1785
1786
1787
1788
1789
IMKIN0001903911
IMKIN0001903911
IMKIN0001903941
IMKIN0001904051
IMKIN0001904249
IMKIN0001904268
IMKIN0001904276
IMKIN0001904830
IMKIN0001904830
IMKIN0001904867
IMKIN0001904869
IMKIN0001904908
IMKIN0001904913
IMKIN0001904941
IMKIN0001904957
IMKIN0001904960
IMKIN0001904979
IMKIN0001904996
IMKIN0001905037
IMKIN0001905037
IMKIN0001905039
01.01.2012
01.01.2012
02.01.2012
01.01.2012
04.01.2012
01.01.2012
01.01.2012
05.01.2012
05.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.03.2012
01.03.2012
02.03.2012
01.04.2012
04.05.2012
01.03.2012
01.05.2012
23.03.2012
23.03.2012
01.03.2012
01.03.2012
01.05.2012
01.05.2012
01.04.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
94PAGE :
M. REHAN RAMATULLAH RR
RUSLI
MOCH ERWIN
RUSLI
RUSMANA
ASEP SUTISNA
AHMAD JAENUDIN
M DAHLAN
M DAHLAN
ANDRIYANA
FAJAR TRIYONO SUWANDI
MAHENDRA ARDIYANTO
SUNARTI
PESTA PARHUSIP
JOKO KUNCORO WIBISONO
NURDIN
HERCULES SIAHAAN
MUHAMAD FAHRUROJI
HJ. ICOH
OTO HAMBALI
WENI FIRDANINGSIH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
BCASHP
BNIDRR
PMCSHP
PMCSHP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,792.00
4,604.00
3,033.00
26,780.00
3,851.00
4,929.00
3,792.00
3,792.00
3,792.00
29,900.00
29,900.00
3,792.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
5,525.00
4,550.00
40,170.00
5,135.00
5,915.00
4,550.00
4,550.00
4,550.00
35,880.00
35,880.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
553.00
455.00
4,017.00
514.00
592.00
455.00
455.00
455.00
3,588.00
3,588.00
455.00
75,000,000.00
75,000,000.00
75,000,000.00
20,000,000.00
70,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
72,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
379.00
461.00
303.00
2,678.00
386.00
493.00
379.00
379.00
379.00
2,990.00
2,990.00
379.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
4,143.00
2,730.00
24,102.00
3,465.00
4,436.00
3,413.00
3,413.00
3,413.00
26,910.00
26,910.00
3,413.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
4,143.00
2,730.00
24,102.00
3,465.00
4,436.00
3,413.00
3,413.00
3,413.00
26,910.00
26,910.00
3,413.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001905044.01
0001905073.01
0001905121.01
0001905157.01
0001905181.01
0001905205.01
0001905226.01
0001905227.01
0001905228.01
0001905239
0001905242.01
0001905245.01
0001905260.01
0001905265.01
0001905277.01
0001905280.01
0001905284.01
0001905285.01
0001905317
0001905384.01
0001905402.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1790
1791
1792
1793
1794
1795
1796
1797
1798
1799
1800
1801
1802
1803
1804
1805
1806
1807
1808
1809
1810
IMKIN0001905044
IMKIN0001905073
IMKIN0001905121
IMKIN0001905157
IMKIN0001905181
IMKIN0001905205
IMKIN0001905226
IMKIN0001905227
IMKIN0001905228
IMKIN0001905239
IMKIN0001905242
IMKIN0001905245
IMKIN0001905260
IMKIN0001905265
IMKIN0001905277
IMKIN0001905280
IMKIN0001905284
IMKIN0001905285
IMKIN0001905317
IMKIN0001905384
IMKIN0001905402
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
02.01.2012
01.01.2012
02.01.2012
02.01.2012
01.01.2012
02.01.2012
01.01.2012
06.01.2012
03.01.2012
03.01.2012
04.01.2012
04.01.2012
04.01.2012
06.01.2012
06.01.2012
07.01.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
01.03.2012
02.02.2012
01.02.2012
02.02.2012
02.02.2012
01.02.2012
02.02.2012
01.02.2012
06.02.2012
03.02.2012
03.05.2012
04.02.2012
04.02.2012
04.02.2012
06.03.2012
06.05.2012
07.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
95PAGE :
UTINAH
GUNAWAN ABDUL GOFUR
RAHIM SAID
TJUN SEN
NUR SAMIAJI
YOGA RIANDA
OKTAVIANA ULI SIMATUPANG
MUSIDUL FAHMI
RUSDI
ABDUL RASYID SPD
TRIWAHYUNINGRUM
AGUS PERMANA S
JOHN DAVIDSON PANDIE
NIDIAWATI
BAMBANG IRWANSYAH
EFRAIM ARIESANDY
WIWIN WARNADHY
SUGENG SARYONO
YENI NURAINI
MELANTON SILITONGA
LUH AYU MATRAM MINI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGLPN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
PMCSHP
BNIDRD
BNIDRD
0.00
3,792.00
0.00
3,423.00
4,929.00
1,001,000.00
0.00
72,417.00
0.00
0.00
0.00
0.00
132,917.00
0.00
210,667.00
0.00
0.00
217,250.00
0.00
460,000.00
23,333.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
4,550.00
0.00
5,135.00
5,915.00
1,092,000.00
0.00
79,000.00
0.00
0.00
0.00
0.00
145,000.00
0.00
316,000.00
0.00
0.00
237,000.00
0.00
690,000.00
35,000.00
0.00
455.00
0.00
514.00
592.00
109,200.00
0.00
7,900.00
0.00
0.00
0.00
0.00
14,500.00
0.00
31,600.00
0.00
0.00
23,700.00
0.00
69,000.00
3,500.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
400,000,000.00
200,000,000.00
300,000,000.00
200,000,000.00
300,000,000.00
50,000,000.00
200,000,000.00
300,000,000.00
200,000,000.00
400,000,000.00
200,000,000.00
200,000,000.00
400,000,000.00
75,000,000.00
150,000,000.00
150,000,000.00
0.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
400,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
400,000,000.00
0.00
0.00
300,000,000.00
0.00
100,000,000.00
50,000,000.00
0.00
379.00
0.00
343.00
493.00
100,100.00
0.00
7,242.00
0.00
0.00
0.00
0.00
13,292.00
0.00
21,067.00
0.00
0.00
21,725.00
0.00
46,000.00
2,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
0.00
3,080.00
4,436.00
900,900.00
0.00
65,175.00
0.00
0.00
0.00
0.00
119,625.00
0.00
189,600.00
0.00
0.00
195,525.00
0.00
414,000.00
21,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,413.00
0.00
3,080.00
4,436.00
900,900.00
0.00
65,175.00
0.00
0.00
0.00
0.00
119,625.00
0.00
189,600.00
0.00
0.00
195,525.00
0.00
414,000.00
21,000.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001905453
0001905696.01
0001905704.01
0001905838
0001906016.01
0001906021.01
0001906028.01
0001906030.01
0001906031.01
0001906049
0001906684
0001906781.01
0001906781.03
0001906873.01
0001907194
0001907251
0001907590.01
0001907593.01
0001907596.01
0001907598.01
0001907608.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1811
1812
1813
1814
1815
1816
1817
1818
1819
1820
1821
1822
1823
1824
1825
1826
1827
1828
1829
1830
1831
IMKIN0001905453
IMKIN0001905696
IMKIN0001905704
IMKIN0001905838
IMKIN0001906016
IMKIN0001906021
IMKIN0001906028
IMKIN0001906030
IMKIN0001906031
IMKIN0001906049
IMKIN0001906684
IMKIN0001906781
IMKIN0001906781
IMKIN0001906873
IMKIN0001907194
IMKIN0001907251
IMKIN0001907590
IMKIN0001907593
IMKIN0001907596
IMKIN0001907598
IMKIN0001907608
09.01.2012
11.01.2012
11.01.2012
11.01.2012
06.01.2012
09.01.2012
10.01.2012
09.01.2012
09.01.2012
04.01.2012
12.01.2012
12.01.2012
12.01.2012
13.01.2012
16.01.2012
12.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
01.01.2012
09.05.2012
11.04.2012
11.03.2012
11.03.2012
06.01.2012
09.02.2012
10.02.2012
09.05.2012
09.02.2012
04.05.2012
12.03.2012
12.03.2012
12.03.2012
13.03.2012
16.03.2012
12.04.2012
01.03.2012
01.05.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
96PAGE :
YAFET CAWENDY
BAGUS PERMANA PUTRA
ADE ISKANDARSYAH
SUDARSONO
YUANY PRASETYA
R ALEX J SETIJOBUDI
JUMARI SIDIK
AGUS PRATIKNO
SITTI ARA USMAN
ROISAH
SRI MARYANI
INDRA NALDO
RINI RISWANI
NURDIAH KRISNO WULAN
SUKRIANI
SUPANDI
ARMAN ARDIANTO
NIRWANSYAH
ZULKIFLI
SOFHIA APRILLIA
MAULIDDIN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMTBPL
PMTBPL
PMCSHP
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
BNIJBX
PMCSHP
PMTBPS
PMTBPS
PMTBPL
BNIJBX
BNIJBX
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
3,413.00
3,792.00
0.00
0.00
0.00
365,750.00
118,667.00
0.00
0.00
0.00
3,792.00
3,792.00
16,738.00
0.00
0.00
5,308.00
4,247.00
3,792.00
3,792.00
6,988.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
4,550.00
4,550.00
0.00
0.00
0.00
399,000.00
178,000.00
0.00
0.00
0.00
4,550.00
4,550.00
20,085.00
0.00
0.00
6,370.00
6,370.00
4,550.00
4,550.00
8,385.00
0.00
455.00
455.00
0.00
0.00
0.00
39,900.00
17,800.00
0.00
0.00
0.00
455.00
455.00
2,009.00
0.00
0.00
637.00
637.00
455.00
455.00
839.00
75,000,000.00
6,500,000.00
6,500,000.00
25,000,000.00
50,000,000.00
100,000,000.00
400,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
150,000,000.00
200,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
300,000,000.00
200,000,000.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
341.00
379.00
0.00
0.00
0.00
36,575.00
11,867.00
0.00
0.00
0.00
379.00
379.00
1,674.00
0.00
0.00
531.00
425.00
379.00
379.00
699.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
3,413.00
0.00
0.00
0.00
329,175.00
106,800.00
0.00
0.00
0.00
3,413.00
3,413.00
15,064.00
0.00
0.00
4,777.00
3,822.00
3,413.00
3,413.00
6,289.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
3,413.00
0.00
0.00
0.00
329,175.00
106,800.00
0.00
0.00
0.00
3,413.00
3,413.00
15,064.00
0.00
0.00
4,777.00
3,822.00
3,413.00
3,413.00
6,289.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001907610.01
0001907657.01
0001907671.01
0001907702.01
0001907706.01
0001907751.01
0001907752.01
0001907766.01
0001907768.01
0001907804.01
0001907819.01
0001907831.01
0001907844.01
0001907889.01
0001907891.01
0001907900.01
0001907926.01
0001908071.01
0001908087.01
0001908113.01
0001908114.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1832
1833
1834
1835
1836
1837
1838
1839
1840
1841
1842
1843
1844
1845
1846
1847
1848
1849
1850
1851
1852
IMKIN0001907610
IMKIN0001907657
IMKIN0001907671
IMKIN0001907702
IMKIN0001907706
IMKIN0001907751
IMKIN0001907752
IMKIN0001907766
IMKIN0001907768
IMKIN0001907804
IMKIN0001907819
IMKIN0001907831
IMKIN0001907844
IMKIN0001907889
IMKIN0001907891
IMKIN0001907900
IMKIN0001907926
IMKIN0001908071
IMKIN0001908087
IMKIN0001908113
IMKIN0001908114
01.01.2012
01.01.2012
01.01.2012
02.01.2012
02.01.2012
02.01.2012
02.01.2012
02.01.2012
02.01.2012
03.01.2012
03.01.2012
03.01.2012
04.01.2012
04.01.2012
04.01.2012
04.01.2012
05.01.2012
07.01.2012
07.01.2012
09.01.2012
09.01.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
02.05.2012
02.03.2012
02.03.2012
02.03.2012
02.03.2012
03.03.2012
03.03.2012
03.03.2012
04.03.2012
04.05.2012
04.03.2012
04.03.2012
05.05.2012
07.03.2012
07.03.2012
09.05.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
97PAGE :
HARYANTO
MINKHATUL MAULA
PEPEN EFENDI B TARYA
KARNODO B RUSLANI
FUAD PRIANTO
ASEP HANDRIAN WINATA
DIAN NOVIANTO
I MADE SUMERTA
MUHAMAD FITRI PERDANA
ARISTO EDITA
IWAN SETIAWAN
ANDI SANINDA
EKA PUTRI HELDAWATI
YADI HARYADI
WALUYO
SURIYADI GINTING
ALIBI APRIATIN
HERIYADI
ANJAR FEBRIANTO
RIDHO ARIFIN
BAMBANG TRI ATMOKO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
4,604.00
3,792.00
4,929.00
3,792.00
0.00
3,792.00
4,279.00
0.00
3,792.00
0.00
0.00
0.00
0.00
5,590.00
3,792.00
4,279.00
3,033.00
3,900.00
3,792.00
3,033.00
6,988.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
5,525.00
4,550.00
5,915.00
4,550.00
0.00
4,550.00
5,135.00
0.00
4,550.00
0.00
0.00
0.00
0.00
8,385.00
4,550.00
5,135.00
4,550.00
4,680.00
4,550.00
4,550.00
8,385.00
553.00
455.00
592.00
455.00
0.00
455.00
514.00
0.00
455.00
0.00
0.00
0.00
0.00
839.00
455.00
514.00
455.00
468.00
455.00
455.00
839.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
461.00
379.00
493.00
379.00
0.00
379.00
428.00
0.00
379.00
0.00
0.00
0.00
0.00
559.00
379.00
428.00
303.00
390.00
379.00
303.00
699.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,143.00
3,413.00
4,436.00
3,413.00
0.00
3,413.00
3,851.00
0.00
3,413.00
0.00
0.00
0.00
0.00
5,031.00
3,413.00
3,851.00
2,730.00
3,510.00
3,413.00
2,730.00
6,289.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,143.00
3,413.00
4,436.00
3,413.00
0.00
3,413.00
3,851.00
0.00
3,413.00
0.00
0.00
0.00
0.00
5,031.00
3,413.00
3,851.00
2,730.00
3,510.00
3,413.00
2,730.00
6,289.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001908115.01
0001908178.01
0001908178.03
0001908190.01
0001908191.01
0001908196.01
0001909316.01
0001909482.01
0001909492.01
0001909570.01
0001909571.01
0001909575.01
0001909590.01
0001909601
0001909688.01
0001909714.01
0001909718.01
0001909720.01
0001909788
0001909788.01
0001909788.02
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1853
1854
1855
1856
1857
1858
1859
1860
1861
1862
1863
1864
1865
1866
1867
1868
1869
1870
1871
1872
1873
IMKIN0001908115
IMKIN0001908178
IMKIN0001908178
IMKIN0001908190
IMKIN0001908191
IMKIN0001908196
IMKIN0001909316
IMKIN0001909482
IMKIN0001909492
IMKIN0001909570
IMKIN0001909571
IMKIN0001909575
IMKIN0001909590
IMKIN0001909601
IMKIN0001909688
IMKIN0001909714
IMKIN0001909718
IMKIN0001909720
IMKIN0001909788
IMKIN0001909788
IMKIN0001909788
09.01.2012
10.01.2012
10.01.2012
10.01.2012
10.01.2012
10.01.2012
17.01.2012
11.01.2012
11.01.2012
13.01.2012
13.01.2012
14.01.2012
14.01.2012
11.01.2012
12.01.2012
01.01.2012
02.01.2012
04.01.2012
17.01.2012
17.01.2012
17.01.2012
09.03.2012
10.05.2012
10.05.2012
10.03.2012
10.05.2012
10.04.2012
17.03.2012
11.05.2012
11.05.2012
13.03.2012
13.03.2012
14.03.2012
14.03.2012
11.05.2012
12.05.2012
01.02.2012
02.02.2012
04.02.2012
17.03.2012
17.03.2012
17.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
98PAGE :
DHARMA PUSPA SUTANTO
HARIADI
SITI NURHAYATI
HJ HUSNIAH
ELI HARDIANI
I WAYAN DARMANA
DODI PRASETYO
HARYANTO
TINTON HARIBOWO
NUNNY NOOR SADIAH
YUSMAR KALDERA
MOHAMMAD HUSEN SUHARDI
SYAMSYUAR NASUTION
BENI RIYANTO
DWI KUSWINDARYATI
LORENA
ABDILLAH HAMDI (2N1BT3)
DRS ADRIANTO M HUM
AMBRIN ILAM
IKRAM MULHAQ
SITI MEILIYA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMTBPL
CIGSRN
CIGSRN
CIGSRN
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
0.00
15,064.00
3,792.00
0.00
0.00
0.00
0.00
0.00
10,454.00
0.00
0.00
0.00
365,750.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
20,085.00
4,550.00
0.00
0.00
0.00
0.00
0.00
12,545.00
0.00
0.00
0.00
399,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2,009.00
455.00
0.00
0.00
0.00
0.00
0.00
1,255.00
0.00
0.00
0.00
39,900.00
0.00
0.00
0.00
0.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
75,000,000.00
5,000,000.00
200,000,000.00
400,000,000.00
100,000,000.00
25,000,000.00
25,000,000.00
25,000,000.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,507.00
379.00
0.00
0.00
0.00
0.00
0.00
1,046.00
0.00
0.00
0.00
36,575.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13,557.00
3,413.00
0.00
0.00
0.00
0.00
0.00
9,408.00
0.00
0.00
0.00
329,175.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13,557.00
3,413.00
0.00
0.00
0.00
0.00
0.00
9,408.00
0.00
0.00
0.00
329,175.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001909788.03
0001910120.01
0001910138.01
0001910159.01
0001910192.01
0001910193.01
0001910502
0001910502.01
0001910508
0001910508.01
0001911100.01
0001911109.01
0001911111.01
0001911126.01
0001911213.01
0001911213.03
0001911224.01
0001911235.01
0001911249.01
0001911250.01
0001911267
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1874
1875
1876
1877
1878
1879
1880
1881
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
1893
1894
IMKIN0001909788
IMKIN0001910120
IMKIN0001910138
IMKIN0001910159
IMKIN0001910192
IMKIN0001910193
IMKIN0001910502
IMKIN0001910502
IMKIN0001910508
IMKIN0001910508
IMKIN0001911100
IMKIN0001911109
IMKIN0001911111
IMKIN0001911126
IMKIN0001911213
IMKIN0001911213
IMKIN0001911224
IMKIN0001911235
IMKIN0001911249
IMKIN0001911250
IMKIN0001911267
17.01.2012
12.01.2012
16.01.2012
16.01.2012
18.01.2012
19.01.2012
24.01.2012
24.01.2012
24.01.2012
24.01.2012
16.01.2012
16.01.2012
16.01.2012
16.01.2012
20.01.2012
20.01.2012
21.01.2012
21.01.2012
21.01.2012
21.01.2012
24.01.2012
17.03.2012
12.02.2012
16.02.2012
16.05.2012
18.01.2012
19.02.2012
24.03.2012
24.03.2012
24.05.2012
24.05.2012
16.03.2012
16.05.2012
16.03.2012
16.03.2012
20.03.2012
20.03.2012
21.04.2012
21.05.2012
21.04.2012
21.03.2012
24.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
99PAGE :
YANTI ALI
SUMARNI
ASEP JULI
RAUF ASRI BATUBARA
ALLEN FERRY HUKOM
YONA YOAN SAHETAPY
IKA SOPHIA
IKA SOPHIA
INAH
INAH
ERIK SULAEMAN
APRIYANTO
SUMARNO
APRIANY
AGUNG NUGROHO
ERVITA NURUL CHAMIDAH
SRI ROZIATY BINTI MUMOD ALI
SARI PUJIANTI
PUTU FEBY CORYKA
YANTI HERAWATI
HARI PRABOWO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
CIGSRN
CIGSRN
CIGSRN
CIGSRN
CIGSRN
NISINP
NISINP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGLPN
0.00
0.00
217,250.00
204,000.00
0.00
280,500.00
0.00
0.00
0.00
0.00
0.00
0.00
3,900.00
0.00
3,792.00
3,792.00
7,605.00
0.00
3,413.00
3,900.00
252,083.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
237,000.00
306,000.00
0.00
306,000.00
0.00
0.00
0.00
0.00
0.00
0.00
4,680.00
0.00
4,550.00
4,550.00
10,140.00
0.00
4,550.00
4,680.00
275,000.00
0.00
0.00
23,700.00
30,600.00
0.00
30,600.00
0.00
0.00
0.00
0.00
0.00
0.00
468.00
0.00
455.00
455.00
1,014.00
0.00
455.00
468.00
27,500.00
25,000,000.00
100,000,000.00
400,000,000.00
400,000,000.00
100,000,000.00
400,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
300,000,000.00
0.00
0.00
300,000,000.00
300,000,000.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
100,000,000.00
0.00
0.00
21,725.00
20,400.00
0.00
28,050.00
0.00
0.00
0.00
0.00
0.00
0.00
390.00
0.00
379.00
379.00
761.00
0.00
341.00
390.00
25,208.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
195,525.00
183,600.00
0.00
252,450.00
0.00
0.00
0.00
0.00
0.00
0.00
3,510.00
0.00
3,413.00
3,413.00
6,844.00
0.00
3,072.00
3,510.00
226,875.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
195,525.00
183,600.00
0.00
252,450.00
0.00
0.00
0.00
0.00
0.00
0.00
3,510.00
0.00
3,413.00
3,413.00
6,844.00
0.00
3,072.00
3,510.00
226,875.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001911267.01
0001911580.01
0001912385
0001912392
0001912407
0001912484
0001912484.01
0001912825.01
0001912826.01
0001912835.01
0001912839.01
0001912868.01
0001912872.01
0001912890.01
0001912975
0001913105.01
0001913118.01
0001913123.01
0001913126.01
0001913130.01
0001913151
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
IMKIN0001911267
IMKIN0001911580
IMKIN0001912385
IMKIN0001912392
IMKIN0001912407
IMKIN0001912484
IMKIN0001912484
IMKIN0001912825
IMKIN0001912826
IMKIN0001912835
IMKIN0001912839
IMKIN0001912868
IMKIN0001912872
IMKIN0001912890
IMKIN0001912975
IMKIN0001913105
IMKIN0001913118
IMKIN0001913123
IMKIN0001913126
IMKIN0001913130
IMKIN0001913151
24.01.2012
21.01.2012
16.01.2012
19.01.2012
20.01.2012
24.01.2012
24.01.2012
24.01.2012
24.01.2012
24.01.2012
24.01.2012
19.01.2012
20.01.2012
26.01.2012
26.01.2012
26.01.2012
26.01.2012
26.01.2012
26.01.2012
26.01.2012
05.01.2012
24.02.2012
21.03.2012
16.03.2012
19.05.2012
20.03.2012
24.03.2012
24.03.2012
24.05.2012
24.03.2012
24.03.2012
24.03.2012
19.02.2012
20.02.2012
26.02.2012
26.05.2012
26.03.2012
26.03.2012
26.03.2012
26.03.2012
26.03.2012
05.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
100PAGE :
YENI SURYANI
ROSIANA
ABDUL MUFIK IKROMI
SILVA LEWAN
BOBY MONAREH
ADHAGIA ASY SYAMS
SUTIAH
DEDI HARIADI
DHEDY ALAMSYAH LESSY
SOLEH RIDWAN
HENDRA WIJAYANTO
EDRIZON EFFENDI SE
SUTEJA I WAYAN
GUSTINA
TINTON HARIBOWO
DEPI
AGUSTINA QQ M CHANDRA WIJAYA
SUROJI
SUKARSIH QQ HANI LUTFIAH PUTRI
FITRAWATI
CUCUP SUPRIATNA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGLPN
PMTBPS
PMCSHP
PMCSHP
BNIJBX
PMCSHP
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGSRN
CIGSRN
CIGSRN
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
49,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
365,750.00
0.00
0.00
3,792.00
3,792.00
4,279.00
9,317.00
3,900.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
54,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
399,000.00
0.00
0.00
4,550.00
4,550.00
5,135.00
11,180.00
4,680.00
0.00
5,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
39,900.00
0.00
0.00
455.00
455.00
514.00
1,118.00
468.00
0.00
300,000,000.00
5,000,000.00
25,000,000.00
75,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
200,000,000.00
400,000,000.00
100,000,000.00
25,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
4,950.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
36,575.00
0.00
0.00
379.00
379.00
428.00
932.00
390.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
44,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
329,175.00
0.00
0.00
3,413.00
3,413.00
3,851.00
8,385.00
3,510.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
44,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
329,175.00
0.00
0.00
3,413.00
3,413.00
3,851.00
8,385.00
3,510.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001913155
0001913158
0001913232
0001913242
0001913248
0001913267
0001913294
0001913299
0001913300
0001913313
0001913315
0001913316
0001913321
0001913324
0001913326
0001913330
0001913330.01
0001913339
0001913341
0001913348
0001913352
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
IMKIN0001913155
IMKIN0001913158
IMKIN0001913232
IMKIN0001913242
IMKIN0001913248
IMKIN0001913267
IMKIN0001913294
IMKIN0001913299
IMKIN0001913300
IMKIN0001913313
IMKIN0001913315
IMKIN0001913316
IMKIN0001913321
IMKIN0001913324
IMKIN0001913326
IMKIN0001913330
IMKIN0001913330
IMKIN0001913339
IMKIN0001913341
IMKIN0001913348
IMKIN0001913352
05.01.2012
06.01.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
05.03.2012
06.05.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
101PAGE :
SUSANTY
KHUMAIROH
EDY MASYKUR
RIYONOSIDI
AGUNG WIBOWO
PARTONO
ATI ISAMAWATI
MUHAMAD YUNUS
BUDIAMAN
INGGIT PRIMA AGUSTIN
WIWIK SRIHARTINI
IR JACKY WATIMURY
NUR BADRI ANWAR
AKHMAD NABHANI ST
ALI MUTAQIN
MELAHANI SE
MUSLIM
ADRI ABRAR
NI KADEK MULIANI ARDANA
ADHI FAJAR DARMAMUKTI
SATIMAN
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
148,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
162,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
16,200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
25,000,000.00
75,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,850.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
133,650.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
133,650.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001913367
0001913367.01
0001913369
0001913502.01
0001913522.01
0001913662
0001913662.01
0001914207
0001914267
0001914268.01
0001914288.01
0001914290
0001914309
0001914340
0001914345
0001914719
0001914737
0001914781
0001914792
0001914800
0001914806
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
IMKIN0001913367
IMKIN0001913367
IMKIN0001913369
IMKIN0001913502
IMKIN0001913522
IMKIN0001913662
IMKIN0001913662
IMKIN0001914207
IMKIN0001914267
IMKIN0001914268
IMKIN0001914288
IMKIN0001914290
IMKIN0001914309
IMKIN0001914340
IMKIN0001914345
IMKIN0001914719
IMKIN0001914737
IMKIN0001914781
IMKIN0001914792
IMKIN0001914800
IMKIN0001914806
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
03.02.2012
03.02.2012
01.02.2012
02.02.2012
01.02.2012
01.02.2012
01.02.2012
02.02.2012
02.02.2012
02.02.2012
02.02.2012
03.02.2012
03.02.2012
03.02.2012
04.02.2012
04.02.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
03.03.2012
03.03.2012
01.03.2012
02.02.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
02.03.2012
02.03.2012
02.03.2012
03.03.2012
03.03.2012
03.03.2012
04.03.2012
04.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
102PAGE :
CITRA PERMATA DEWI
DODY HARYAWAN
TAUFIQURRAHMAN
SIDIK SARYATNO
INDRA PARINDRIANTO
PURWATI NINGRUM
PURWATI NINGRUM
MAHIAR
TOTO PRIYANTO
LORAWATI LOWIS
AHMAD RUKONI
GHOVINDARE SUKMA
ADE ANDRIAN
SYAMSUDDIN
NI LUH HENDRAYANI
I WAYAN SUARDANA
YOGI SYARIF HIDAYAT
LILLAH SEPTI SARI
TAPIP GUNTUR
EXBAR DEPI SUGARA
LAKSITA WENING KUSUMA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMTBPS
PMTBPS
NISINP
NISINP
PMCSHP
BNIJBX
PMTBPL
PMTBPS
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
8,461.00
0.00
0.00
0.00
0.00
0.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
9,230.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
923.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
6,500,000.00
72,000,000.00
96,000,000.00
75,000,000.00
200,000,000.00
5,000,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
846.00
0.00
0.00
0.00
0.00
0.00
417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,615.00
0.00
0.00
0.00
0.00
0.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,615.00
0.00
0.00
0.00
0.00
0.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001914808
0001914818
0001914956
0001914956.01
0001914956.02
0001914956.03
0001914983
0001915090
0001915095
0001915181
0001915181.01
0001915201.01
0001915214.01
0001915223.01
0001915231.01
0001915247.01
0001915256.01
0001915269.01
0001915276.01
0001915281.01
0001915309.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
IMKIN0001914808
IMKIN0001914818
IMKIN0001914956
IMKIN0001914956
IMKIN0001914956
IMKIN0001914956
IMKIN0001914983
IMKIN0001915090
IMKIN0001915095
IMKIN0001915181
IMKIN0001915181
IMKIN0001915201
IMKIN0001915214
IMKIN0001915223
IMKIN0001915231
IMKIN0001915247
IMKIN0001915256
IMKIN0001915269
IMKIN0001915276
IMKIN0001915281
IMKIN0001915309
04.02.2012
03.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
04.02.2012
06.02.2012
06.02.2012
09.02.2012
09.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
01.02.2012
04.03.2012
03.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
04.03.2012
06.03.2012
06.03.2012
09.03.2012
09.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.05.2012
01.03.2012
01.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
103PAGE :
NURMIATI
DIAN HARVEBY ZEN
HALIMAH SADIYAH
IRVAN MAULANA
KURNIA MULYANI
RAHMAT
CIEN YE
ANDHINA PUTRI HERIYANTI
SURATNO
SASTRIYANI
SASTRIYANI
SUHERYANTI
NUR ARIFIN
AGUSTINA VIVIN
DENNIS S S PURBA QQ GITA P
VIDI HANDOKO
SANUSI KARTAJAYA
NI KETUT TRESNADEWI
YONATAN
VIVIN NUR INDAH SARI
SUMIYATI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,171.00
4,171.00
9,295.00
4,171.00
23,357.00
4,144.00
4,171.00
4,171.00
23,357.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
10,140.00
4,550.00
25,480.00
5,525.00
4,550.00
4,550.00
25,480.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
455.00
1,014.00
455.00
2,548.00
553.00
455.00
455.00
2,548.00
25,000,000.00
50,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
72,000,000.00
96,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
417.00
417.00
930.00
417.00
2,336.00
415.00
417.00
417.00
2,336.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
3,754.00
8,365.00
3,754.00
21,021.00
3,729.00
3,754.00
3,754.00
21,021.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
3,754.00
8,365.00
3,754.00
21,021.00
3,729.00
3,754.00
3,754.00
21,021.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001915521
0001915526
0001915564
0001915564.01
0001915679
0001915680
0001915681
0001915681.01
0001915682
0001916001.01
0001916329
0001916331
0001916331.01
0001916352.01
0001916356.01
0001916359.01
0001916360.01
0001916519
0001916524
0001916524.01
0001916701.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
IMKIN0001915521
IMKIN0001915526
IMKIN0001915564
IMKIN0001915564
IMKIN0001915679
IMKIN0001915680
IMKIN0001915681
IMKIN0001915681
IMKIN0001915682
IMKIN0001916001
IMKIN0001916329
IMKIN0001916331
IMKIN0001916331
IMKIN0001916352
IMKIN0001916356
IMKIN0001916359
IMKIN0001916360
IMKIN0001916519
IMKIN0001916524
IMKIN0001916524
IMKIN0001916701
01.02.2012
02.02.2012
09.02.2012
09.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
08.02.2012
08.02.2012
08.02.2012
08.02.2012
08.02.2012
08.02.2012
08.02.2012
09.02.2012
09.02.2012
09.02.2012
09.02.2012
01.03.2012
02.02.2012
09.03.2012
09.03.2012
07.03.2012
07.03.2012
07.03.2012
07.03.2012
07.03.2012
07.05.2012
10.04.2012
08.02.2012
08.02.2012
08.05.2012
08.03.2012
08.05.2012
08.03.2012
09.03.2012
09.03.2012
09.03.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
104PAGE :
FATTURAKHMAN RIZKY I
HEDI GUNAWAN
NGAKAN KETUT SINARBUDI
NGAKAN KETUT SINARBUDI
SUHARYADI
MEI NOVELINA HUTAURUK
DEBI DESIANA PRADIPTA
RANGGA PRADIPTA
MAHRUF
AGATHA FELISA
DEWI LANNY POSASI
AFANDY GUNAWAN
SARINAH
NI KETUT YANI PRATIWI MARYANA
RAHMADONI
SUGENG SUGIYONO
MARTONO
SIGIT WAHYU IRAWAN
EUIS ATIKA
SUMARGONO
BAKRI POMPIDO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
NISINP
NISINP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
HSBCPP
PMCSHP
PMCSHP
PMCSHP
BNIDRR
MANGPL
MANGPL
MANGPL
PMCSHP
PMCSHP
PMCSHP
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
128,333.00
0.00
0.00
0.00
0.00
0.00
10,248.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
140,000.00
0.00
0.00
0.00
0.00
0.00
11,180.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,000.00
0.00
0.00
0.00
0.00
0.00
1,118.00
75,000,000.00
75,000,000.00
50,000,000.00
48,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
100,000,000.00
75,000,000.00
25,000,000.00
25,000,000.00
105,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
12,833.00
0.00
0.00
0.00
0.00
0.00
1,025.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
115,500.00
0.00
0.00
0.00
0.00
0.00
9,223.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
115,500.00
0.00
0.00
0.00
0.00
0.00
9,223.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001916701.03
0001916704.01
0001916704.03
0001916715.01
0001916716.01
0001916716.03
0001916843
0001916843.01
0001916869.01
0001916983.01
0001916985.01
0001916985.03
0001916993.01
0001916997.01
0001917009.01
0001917009.03
0001917019.01
0001917021
0001917093.01
0001917098.01
0001917119
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
IMKIN0001916701
IMKIN0001916704
IMKIN0001916704
IMKIN0001916715
IMKIN0001916716
IMKIN0001916716
IMKIN0001916843
IMKIN0001916843
IMKIN0001916869
IMKIN0001916983
IMKIN0001916985
IMKIN0001916985
IMKIN0001916993
IMKIN0001916997
IMKIN0001917009
IMKIN0001917009
IMKIN0001917019
IMKIN0001917021
IMKIN0001917093
IMKIN0001917098
IMKIN0001917119
09.02.2012
09.02.2012
09.02.2012
09.02.2012
09.02.2012
09.02.2012
15.02.2012
15.02.2012
09.02.2012
10.02.2012
10.02.2012
10.02.2012
10.02.2012
10.02.2012
10.02.2012
10.02.2012
11.02.2012
11.02.2012
10.02.2012
09.02.2012
13.02.2012
09.03.2012
09.03.2012
09.03.2012
09.03.2012
09.03.2012
09.03.2012
15.03.2012
15.03.2012
09.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
11.03.2012
11.03.2012
10.04.2012
09.03.2012
13.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
105PAGE :
HILMAWATI
MASROH
TEUKU MUTTAQIN
HASRUL
NOVI ARIANTI
WIRA ROSANDI
DOVI KORNIAWAN
DOVI KORNIAWAN
ADRI ABRAR
YULIYONO
ETI SETIAWATI
MOHAMMAD THARIQ D
RADITYA EKA PRASETIA
SURYA JAYA
IMRON FAISAL
WINDY HERNITA
TEDY RUSMANA
DASRI PURWANTO
CAESAR PANDU P
IRVAN FAUZI
JOKO PRIYADI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
NISINP
NISINP
PMTBPS
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
HSBCPP
PMTBPS
PMCSHP
4,707.00
5,422.00
8,461.00
4,171.00
4,171.00
4,171.00
0.00
0.00
4,171.00
4,171.00
8,461.00
7,031.00
4,171.00
4,171.00
5,065.00
4,290.00
4,171.00
0.00
0.00
4,171.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
5,135.00
5,915.00
9,230.00
4,550.00
4,550.00
4,550.00
0.00
0.00
4,550.00
4,550.00
9,230.00
7,670.00
4,550.00
4,550.00
5,525.00
4,680.00
4,550.00
0.00
0.00
4,550.00
0.00
514.00
592.00
923.00
455.00
455.00
455.00
0.00
0.00
455.00
455.00
923.00
767.00
455.00
455.00
553.00
468.00
455.00
0.00
0.00
455.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
72,000,000.00
96,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
200,000,000.00
6,500,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
0.00
471.00
543.00
846.00
417.00
417.00
417.00
0.00
0.00
417.00
417.00
846.00
703.00
417.00
417.00
507.00
429.00
417.00
0.00
0.00
417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,236.00
4,879.00
7,615.00
3,754.00
3,754.00
3,754.00
0.00
0.00
3,754.00
3,754.00
7,615.00
6,328.00
3,754.00
3,754.00
4,558.00
3,861.00
3,754.00
0.00
0.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,236.00
4,879.00
7,615.00
3,754.00
3,754.00
3,754.00
0.00
0.00
3,754.00
3,754.00
7,615.00
6,328.00
3,754.00
3,754.00
4,558.00
3,861.00
3,754.00
0.00
0.00
3,754.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001917132.01
0001917205.01
0001917778.01
0001917781.01
0001917781.03
0001917790
0001917790.01
0001917792.01
0001917792.03
0001917811.01
0001917811.03
0001918405.01
0001918412
0001918602.01
0001918602.03
0001918617.01
0001918623.01
0001918623.03
0001918627.01
0001918627.03
0001918717.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
IMKIN0001917132
IMKIN0001917205
IMKIN0001917778
IMKIN0001917781
IMKIN0001917781
IMKIN0001917790
IMKIN0001917790
IMKIN0001917792
IMKIN0001917792
IMKIN0001917811
IMKIN0001917811
IMKIN0001918405
IMKIN0001918412
IMKIN0001918602
IMKIN0001918602
IMKIN0001918617
IMKIN0001918623
IMKIN0001918623
IMKIN0001918627
IMKIN0001918627
IMKIN0001918717
13.02.2012
14.02.2012
14.02.2012
14.02.2012
14.02.2012
14.02.2012
14.02.2012
14.02.2012
14.02.2012
15.02.2012
15.02.2012
14.02.2012
14.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
07.02.2012
09.02.2012
13.03.2012
14.03.2012
14.03.2012
14.03.2012
14.03.2012
14.03.2012
14.03.2012
14.03.2012
14.03.2012
15.03.2012
15.03.2012
14.03.2012
14.03.2012
07.03.2012
07.03.2012
07.04.2012
07.03.2012
07.03.2012
07.03.2012
07.03.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
106PAGE :
ASMAT
DIDI SUPRIHADI
HENDRO SUSILO
ANDRA MEGA PUTRA LENGKEI
WIWI SULISTYOWATI LENGKEI
DWI HARIATI
NUR HARIANTO
M. WAHYU SOEGITO
NANCY ANGELA HENDRIKS
I GEDE OKA WINAYA
NI KETUT PURNAMA WATI
MOCHAMMAD USMAN
SYARIFAH MAIRIZA
MAMAN BIN H MISIN
NITA
EKO BUDIONO
ANAS
RASYIDHA
KUNTJORO
SRI SUSILOWATI DEWI
RHIMO BUDI SANTOSO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPS
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
MANGPL
HSBTLC
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
16,385.00
4,171.00
4,171.00
4,171.00
4,171.00
0.00
0.00
6,435.00
4,171.00
4,290.00
4,707.00
198,000.00
0.00
4,171.00
4,171.00
3,792.00
0.00
0.00
0.00
0.00
4,171.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
17,875.00
4,550.00
4,550.00
4,550.00
4,550.00
0.00
0.00
7,020.00
4,550.00
4,680.00
5,135.00
216,000.00
0.00
4,550.00
4,550.00
4,550.00
0.00
0.00
0.00
0.00
4,550.00
1,788.00
455.00
455.00
455.00
455.00
0.00
0.00
702.00
455.00
468.00
514.00
21,600.00
0.00
455.00
455.00
455.00
0.00
0.00
0.00
0.00
455.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
200,000,000.00
20,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
200,000,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
1,639.00
417.00
417.00
417.00
417.00
0.00
0.00
644.00
417.00
429.00
471.00
19,800.00
0.00
417.00
417.00
379.00
0.00
0.00
0.00
0.00
417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,746.00
3,754.00
3,754.00
3,754.00
3,754.00
0.00
0.00
5,791.00
3,754.00
3,861.00
4,236.00
178,200.00
0.00
3,754.00
3,754.00
3,413.00
0.00
0.00
0.00
0.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
14,746.00
3,754.00
3,754.00
3,754.00
3,754.00
0.00
0.00
5,791.00
3,754.00
3,861.00
4,236.00
178,200.00
0.00
3,754.00
3,754.00
3,413.00
0.00
0.00
0.00
0.00
3,754.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001918719.01
0001918760.01
0001918772.01
0001918790.01
0001918808.01
0001918815.01
0001918824.01
0001918832.01
0001918834.01
0001918845.01
0001918851.01
0001919286
0001919286.01
0001919288
0001919288.01
0001919621.01
0001919621.03
0001919633.01
0001919640
0001919642.01
0001919754.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
IMKIN0001918719
IMKIN0001918760
IMKIN0001918772
IMKIN0001918790
IMKIN0001918808
IMKIN0001918815
IMKIN0001918824
IMKIN0001918832
IMKIN0001918834
IMKIN0001918845
IMKIN0001918851
IMKIN0001919286
IMKIN0001919286
IMKIN0001919288
IMKIN0001919288
IMKIN0001919621
IMKIN0001919621
IMKIN0001919633
IMKIN0001919640
IMKIN0001919642
IMKIN0001919754
09.02.2012
10.02.2012
10.02.2012
10.02.2012
10.02.2012
11.02.2012
11.02.2012
11.02.2012
11.02.2012
11.02.2012
11.02.2012
17.02.2012
17.02.2012
17.02.2012
17.02.2012
16.02.2012
16.02.2012
16.02.2012
16.02.2012
16.02.2012
17.02.2012
09.05.2012
10.03.2012
10.03.2012
10.03.2012
10.03.2012
11.03.2012
11.03.2012
11.03.2012
11.05.2012
11.03.2012
11.03.2012
17.03.2012
17.03.2012
17.05.2012
17.05.2012
16.03.2012
16.03.2012
16.05.2012
16.05.2012
16.05.2012
17.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
107PAGE :
NORCHOLIFAH
RITA ERNAWATI SIANTURI
SOPANDI
HENI MEDAWATI
SUPRINGGO
CHOIRIYAH
CHRISTYA FERONIATEE
BURHANUDIN
CUCUP B KATMA
PINAN
MASLINA
MALEMTA SIHOTANG
MALEMTA SIHOTANG
SURYAWAN,I KOMANG
SURYAWAN,I KOMANG
ABDUL PASIANGAN
LIFTA LISU KARAMPOAN
ELLY NOVI ASTUTI
MARIATIE
GERRIT STEFANUS PATTIWAEL .
FARIDAH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
NISINP
NISINP
NISINP
NISINP
PMTBPL
PMTBPL
HSBCPP
BNIJBX
BNIDRD
PMTBPL
3,413.00
4,171.00
4,171.00
0.00
0.00
4,171.00
5,839.00
4,171.00
3,510.00
5,065.00
4,171.00
0.00
0.00
0.00
0.00
12,870.00
4,171.00
0.00
0.00
0.00
8,461.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
4,550.00
4,550.00
4,550.00
0.00
0.00
4,550.00
6,370.00
4,550.00
4,680.00
5,525.00
4,550.00
0.00
0.00
0.00
0.00
14,040.00
4,550.00
0.00
0.00
0.00
9,230.00
455.00
455.00
455.00
0.00
0.00
455.00
637.00
455.00
468.00
553.00
455.00
0.00
0.00
0.00
0.00
1,404.00
455.00
0.00
0.00
0.00
923.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
50,000,000.00
48,000,000.00
75,000,000.00
72,000,000.00
6,500,000.00
6,500,000.00
100,000,000.00
150,000,000.00
150,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
6,500,000.00
341.00
417.00
417.00
0.00
0.00
417.00
584.00
417.00
351.00
507.00
417.00
0.00
0.00
0.00
0.00
1,287.00
417.00
0.00
0.00
0.00
846.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
3,754.00
3,754.00
0.00
0.00
3,754.00
5,255.00
3,754.00
3,159.00
4,558.00
3,754.00
0.00
0.00
0.00
0.00
11,583.00
3,754.00
0.00
0.00
0.00
7,615.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,072.00
3,754.00
3,754.00
0.00
0.00
3,754.00
5,255.00
3,754.00
3,159.00
4,558.00
3,754.00
0.00
0.00
0.00
0.00
11,583.00
3,754.00
0.00
0.00
0.00
7,615.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001919828.01
0001919832.01
0001919835
0001919856
0001919877
0001919877.01
0001919877.02
0001919902
0001919904
0001919913
0001919914
0001919970.01
0001919981.01
0001920003
0001920017
0001920022
0001920039.01
0001920222.01
0001920223.01
0001920647
0001920647.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
2075
2076
2077
2078
2079
2080
2081
2082
2083
IMKIN0001919828
IMKIN0001919832
IMKIN0001919835
IMKIN0001919856
IMKIN0001919877
IMKIN0001919877
IMKIN0001919877
IMKIN0001919902
IMKIN0001919904
IMKIN0001919913
IMKIN0001919914
IMKIN0001919970
IMKIN0001919981
IMKIN0001920003
IMKIN0001920017
IMKIN0001920022
IMKIN0001920039
IMKIN0001920222
IMKIN0001920223
IMKIN0001920647
IMKIN0001920647
18.02.2012
18.02.2012
20.02.2012
20.02.2012
13.02.2012
13.02.2012
13.02.2012
16.02.2012
17.02.2012
17.02.2012
17.02.2012
17.02.2012
18.02.2012
03.02.2012
08.02.2012
10.02.2012
18.02.2012
21.02.2012
21.02.2012
22.02.2012
22.02.2012
18.03.2012
18.04.2012
20.03.2012
20.03.2012
13.03.2012
13.03.2012
13.03.2012
16.04.2012
17.02.2012
17.04.2012
17.03.2012
17.05.2012
18.03.2012
03.03.2012
08.03.2012
10.03.2012
18.05.2012
21.03.2012
21.03.2012
22.03.2012
22.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
108PAGE :
PUJI WALUYO
GEDE MAHENDRA JAYA
KARNILA WATI
AHMAD ARIP ERWANSYAH
AGUSTINUS KURNIAWAN
ANGELINE EKA FENTIE
LINA SAPTAWATI
LIE KIEM LIAM/R. SUMADI, BA
PANCE PERNANDO
HJ.ANDI MASJARNI P.M.
ABDUL KHALIM ROMADHON
IGA AGUNG UTAMI Y
YUDI MUDJIONO
HANDYAS ARIF SAPUTRA
ERLY DAMAYANTI
HENNY NOVITASARI
HELIANA NOVIANTI
REY RIZKY RAMADANI
DICKY ARNANDA
I KETUT MAHATMA ADITYA S
I KOMANG SENTANU ADI P
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
BCASHP
BCASHP
BCASHP
BCASHP
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
4,171.00
4,929.00
0.00
0.00
107,250.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,707.00
0.00
0.00
0.00
0.00
4,290.00
6,435.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
4,550.00
5,915.00
0.00
0.00
117,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,135.00
0.00
0.00
0.00
0.00
4,680.00
7,020.00
0.00
0.00
455.00
592.00
0.00
0.00
11,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
514.00
0.00
0.00
0.00
0.00
468.00
702.00
0.00
0.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
20,000,000.00
10,000,000.00
20,000,000.00
20,000,000.00
5,000,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
0.00
0.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
417.00
493.00
0.00
0.00
10,725.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
471.00
0.00
0.00
0.00
0.00
429.00
644.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
4,436.00
0.00
0.00
96,525.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,236.00
0.00
0.00
0.00
0.00
3,861.00
5,791.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
4,436.00
0.00
0.00
96,525.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,236.00
0.00
0.00
0.00
0.00
3,861.00
5,791.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001920647.02
0001920647.03
0001920647.04
0001920647.05
0001920649.01
0001921016.01
0001921031.01
0001921032.01
0001921300
0001921541
0001921542
0001921688
0001921698
0001921707
0001921721
0001921721.01
0001921758.01
0001921784.01
0001921794.01
0001921813.01
0001921813.03
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2084
2085
2086
2087
2088
2089
2090
2091
2092
2093
2094
2095
2096
2097
2098
2099
2100
2101
2102
2103
2104
IMKIN0001920647
IMKIN0001920647
IMKIN0001920647
IMKIN0001920647
IMKIN0001920649
IMKIN0001921016
IMKIN0001921031
IMKIN0001921032
IMKIN0001921300
IMKIN0001921541
IMKIN0001921542
IMKIN0001921688
IMKIN0001921698
IMKIN0001921707
IMKIN0001921721
IMKIN0001921721
IMKIN0001921758
IMKIN0001921784
IMKIN0001921794
IMKIN0001921813
IMKIN0001921813
22.02.2012
22.02.2012
22.02.2012
22.02.2012
22.02.2012
22.02.2012
23.02.2012
23.02.2012
23.02.2012
23.02.2012
17.02.2012
09.02.2012
08.02.2012
21.02.2012
23.02.2012
23.02.2012
13.02.2012
13.02.2012
14.02.2012
14.02.2012
14.02.2012
22.03.2012
22.03.2012
22.03.2012
22.03.2012
22.03.2012
22.03.2012
23.03.2012
23.03.2012
23.04.2012
23.05.2012
17.05.2012
09.03.2012
08.05.2012
21.03.2012
27.03.2012
27.03.2012
13.03.2012
13.03.2012
14.03.2012
14.03.2012
14.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
109PAGE :
I NENGAH DANU
NI KADEK KRISNA P DEWI
NI PUTU SARAS P DEWI
NI WAYAN SUWATRI
I NENGAH DANU
TRIE LESTARI
ZAENI
ZULIYATNO
AGUS NURAJI
BAYU WICAKSANA SATRIEYA
ERLENI
CENDY WIJAYA
MAHMUD YANI
SYLVIA YOLANDA
A N NURAEN
A N NURAEN
SRI NURJIWATI
SUPRIATINI
DWI BUDIAWAN ASMARA
HANHAN SUBHANUDIN
MERY SEBASTIANI AD
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPS
PMTBPL
PMTBPL
PMTBPL
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
HSBTLC
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
0.00
0.00
0.00
0.00
9,295.00
4,171.00
5,839.00
4,171.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9,295.00
5,065.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
10,140.00
4,550.00
6,370.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,140.00
5,525.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,014.00
455.00
637.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,014.00
553.00
0.00
0.00
0.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
150,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
30,000,000.00
50,000,000.00
48,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
5,000,000.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
930.00
417.00
584.00
417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
930.00
507.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,365.00
3,754.00
5,255.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,365.00
4,558.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,365.00
3,754.00
5,255.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,365.00
4,558.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001921856.01
0001921862.01
0001921869.01
0001921873.01
0001921878.01
0001921892.01
0001921896.01
0001921902.01
0001921913.01
0001921919.01
0001921929.01
0001921929.03
0001921953.01
0001921971.01
0001921983.01
0001922015.01
0001922021.01
0001922046.01
0001922062
0001922062.01
0001922064
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2105
2106
2107
2108
2109
2110
2111
2112
2113
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
IMKIN0001921856
IMKIN0001921862
IMKIN0001921869
IMKIN0001921873
IMKIN0001921878
IMKIN0001921892
IMKIN0001921896
IMKIN0001921902
IMKIN0001921913
IMKIN0001921919
IMKIN0001921929
IMKIN0001921929
IMKIN0001921953
IMKIN0001921971
IMKIN0001921983
IMKIN0001922015
IMKIN0001922021
IMKIN0001922046
IMKIN0001922062
IMKIN0001922062
IMKIN0001922064
14.02.2012
15.02.2012
15.02.2012
15.02.2012
15.02.2012
15.02.2012
15.02.2012
15.02.2012
16.02.2012
16.02.2012
16.02.2012
16.02.2012
20.02.2012
20.02.2012
20.02.2012
21.02.2012
21.02.2012
22.02.2012
13.02.2012
13.02.2012
14.02.2012
14.05.2012
15.03.2012
15.03.2012
15.03.2012
15.03.2012
15.03.2012
15.03.2012
15.03.2012
16.03.2012
16.03.2012
16.03.2012
16.03.2012
20.04.2012
20.03.2012
20.05.2012
21.03.2012
21.05.2012
22.03.2012
13.03.2012
13.03.2012
14.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
110PAGE :
HADIJAH
DJUMASNA
SURATNO
LUKI FAISAL ADITIA SUSANTO
TANU SRIWIDJAJA THIO
MUJAROAH
HENDRIK NAPITUPULU
DWI SUWARSIH
DIAN RETNO MURTI NINGRUM
YULI TRI MARYANI
MUKARROMAH
MULYADI
MUHAMAD SOLIHIN
RAHMAT MINARTO
RL FRANSISKA NATALIA
HANIEL ONESIMUS LARAT
DENI STEPANUS AMD
SRI REDJEKI
SARI RUHENI ASIH
YOSSY ELHAM KHUSJANA B R
ILHAMSYAH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
0.00
5,065.00
4,171.00
0.00
5,839.00
0.00
0.00
4,171.00
4,171.00
4,171.00
0.00
0.00
3,792.00
4,171.00
0.00
5,065.00
6,289.00
23,357.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
5,525.00
4,550.00
0.00
6,370.00
0.00
0.00
4,550.00
4,550.00
4,550.00
0.00
0.00
4,550.00
4,550.00
0.00
5,525.00
8,385.00
25,480.00
0.00
0.00
0.00
0.00
553.00
455.00
0.00
637.00
0.00
0.00
455.00
455.00
455.00
0.00
0.00
455.00
455.00
0.00
553.00
839.00
2,548.00
0.00
0.00
0.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
507.00
417.00
0.00
584.00
0.00
0.00
417.00
417.00
417.00
0.00
0.00
379.00
417.00
0.00
507.00
629.00
2,336.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,558.00
3,754.00
0.00
5,255.00
0.00
0.00
3,754.00
3,754.00
3,754.00
0.00
0.00
3,413.00
3,754.00
0.00
4,558.00
5,660.00
21,021.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,558.00
3,754.00
0.00
5,255.00
0.00
0.00
3,754.00
3,754.00
3,754.00
0.00
0.00
3,413.00
3,754.00
0.00
4,558.00
5,660.00
21,021.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001922077
0001922078
0001922168
0001922250
0001922436
0001922531
0001922575
0001922681
0001922696
0001922699
0001922713
0001922720
0001922776
0001922780
0001922780.01
0001922946
0001922953
0001922953.01
0001922953.02
0001922953.03
0001922997.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2126
2127
2128
2129
2130
2131
2132
2133
2134
2135
2136
2137
2138
2139
2140
2141
2142
2143
2144
2145
2146
IMKIN0001922077
IMKIN0001922078
IMKIN0001922168
IMKIN0001922250
IMKIN0001922436
IMKIN0001922531
IMKIN0001922575
IMKIN0001922681
IMKIN0001922696
IMKIN0001922699
IMKIN0001922713
IMKIN0001922720
IMKIN0001922776
IMKIN0001922780
IMKIN0001922780
IMKIN0001922946
IMKIN0001922953
IMKIN0001922953
IMKIN0001922953
IMKIN0001922953
IMKIN0001922997
22.02.2012
22.02.2012
10.02.2012
17.02.2012
22.02.2012
20.02.2012
21.02.2012
16.02.2012
07.02.2012
20.02.2012
14.02.2012
08.02.2012
22.02.2012
24.02.2012
24.02.2012
24.02.2012
24.02.2012
24.02.2012
24.02.2012
24.02.2012
25.02.2012
22.05.2012
22.03.2012
10.05.2012
17.05.2012
22.05.2012
20.05.2012
21.05.2012
16.05.2012
07.05.2012
20.05.2012
14.05.2012
08.05.2012
22.03.2012
27.05.2012
27.05.2012
24.03.2012
24.03.2012
24.03.2012
24.03.2012
24.03.2012
25.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
111PAGE :
MOKHAMAD SAHLAN
EDWARD TAUFIQ RACHMAN A.
ALICE INDRA
NAZARULLAH JAMALUDDIN
DIAN PUTRA PERDANA
PURNAMA ADHIPUTRA
YULIANTI LIU
NORFAN A
ANEKE SONDAKH
T FUAD BEY
RAUDAH FITRIANA
TARMIZI
YATI ROSYATI
YENI FATMAWATI H
YENI FATMAWATI H
KHAMIM
DENI MUHARAM
ICA APRILIANA
KADARISMAN
MUSRIFAH
AMAT USUF
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBX
BNIJBA
BNIJBX
BNIJBX
PMCSHP
NISINP
NISINP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,171.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
75,000,000.00
75,000,000.00
150,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
105,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
50,000,000.00
48,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
417.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001923014.01
0001923015.01
0001923025.01
0001923031.01
0001923154
0001923173
0001923606
0001923656.01
0001923671
0001923682.01
0001924051
0001924055
0001924385
0001924388
0001924517
0001924537
0001924566
0001924573
0001925019
0001925132.01
0001925189
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2147
2148
2149
2150
2151
2152
2153
2154
2155
2156
2157
2158
2159
2160
2161
2162
2163
2164
2165
2166
2167
IMKIN0001923014
IMKIN0001923015
IMKIN0001923025
IMKIN0001923031
IMKIN0001923154
IMKIN0001923173
IMKIN0001923606
IMKIN0001923656
IMKIN0001923671
IMKIN0001923682
IMKIN0001924051
IMKIN0001924055
IMKIN0001924385
IMKIN0001924388
IMKIN0001924517
IMKIN0001924537
IMKIN0001924566
IMKIN0001924573
IMKIN0001925019
IMKIN0001925132
IMKIN0001925189
24.02.2012
25.02.2012
24.02.2012
24.02.2012
23.02.2012
24.02.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
02.03.2012
06.03.2012
07.03.2012
01.03.2012
24.05.2012
25.05.2012
24.04.2012
24.04.2012
23.03.2012
24.05.2012
01.05.2012
01.05.2012
01.03.2012
01.03.2012
01.04.2012
01.03.2012
01.05.2012
01.03.2012
01.05.2012
01.03.2012
02.05.2012
02.05.2012
06.05.2012
07.03.2012
01.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
112PAGE :
AGNI SAPTARINI
RIZALDY PUTRA
JUSTIAN SALIM .
YUDO ADRY RUMAYAR
MUBARAK YASIR ANDI M.
ARIMBI MASNUN BASRI
NANDANG HERMANSYAH
MULIYONO
HELMI NUR EFENDI
ZESAR KAEMONG
MARYONO
LIM HIE KIONG
TEGUH AGUNG SAPUTRO
ADITYO HARYONUGROHO
HENDRA
ILYAS MAARIF
EUIS AISYAH
YUSUP MAULANA
BAMBANG AGUNG SUSILO
I GEDE SUARSA
IRVAN MULYANA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIDRD
BNIDRD
BNIDRD
BNIDRD
PMCSHP
BNIJBA
PMCSHP
BNIDRD
BNIJBX
BNIDRD
BCASHP
BCASHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMCSHP
BNIDRD
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
58,333.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
70,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
25,000,000.00
140,000,000.00
25,000,000.00
150,000,000.00
200,000,000.00
50,000,000.00
20,000,000.00
20,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
150,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
52,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001925193
0001925750.01
0001926216.01
0001926277.01
0001926369.01
0001926375.01
0001926416.01
0001926563
0001926825
0001926843.01
0001926891.01
0001927436
0001927436.01
0001927438
0001927438.01
0001927445
0001927445.01
0001927455
0001927455.01
0001927457
0001927457.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2168
2169
2170
2171
2172
2173
2174
2175
2176
2177
2178
2179
2180
2181
2182
2183
2184
2185
2186
2187
2188
IMKIN0001925193
IMKIN0001925750
IMKIN0001926216
IMKIN0001926277
IMKIN0001926369
IMKIN0001926375
IMKIN0001926416
IMKIN0001926563
IMKIN0001926825
IMKIN0001926843
IMKIN0001926891
IMKIN0001927436
IMKIN0001927436
IMKIN0001927438
IMKIN0001927438
IMKIN0001927445
IMKIN0001927445
IMKIN0001927455
IMKIN0001927455
IMKIN0001927457
IMKIN0001927457
01.03.2012
07.03.2012
01.03.2012
01.03.2012
01.03.2012
02.03.2012
05.03.2012
03.03.2012
09.03.2012
10.03.2012
01.03.2012
12.03.2012
12.03.2012
01.03.2012
01.03.2012
12.03.2012
12.03.2012
07.03.2012
07.03.2012
12.03.2012
12.03.2012
01.03.2012
07.03.2012
01.05.2012
01.05.2012
01.04.2012
02.05.2012
05.05.2012
03.05.2012
09.05.2012
10.03.2012
01.05.2012
12.03.2012
12.03.2012
01.03.2012
01.03.2012
12.03.2012
12.03.2012
07.03.2012
07.03.2012
12.03.2012
12.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
113PAGE :
IG DAVID VIRGIAWAN
RITA ZAHARA DRA
NENO
ELPRANDO TANJUNG
RUMINI
HENDRO SAPUTRO
RIRIN DEWI ARDIANTI
BUDI DJAUHARI T
WAHONO
DIPI
NANY
SATRIYO HERU IRAWAN
SATRIYO HERU IRAWAN
SITI AMINAH
SITI AMINAH
IRWANTO
IRWANTO
WARTINI
WARTINI
SUMARNO
SUMARNO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
BNIDRR
PMTBPL
PMTBPL
PMTBPL
PMTBPL
CIGSRN
BNIJBX
PMCSHP
PMTBPL
HSBCPP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
0.00
49,800.00
3,792.00
3,792.00
0.00
0.00
263,333.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
49,800.00
4,550.00
4,550.00
0.00
0.00
316,000.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,980.00
455.00
455.00
0.00
0.00
31,600.00
0.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
105,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
400,000,000.00
200,000,000.00
75,000,000.00
6,500,000.00
50,000,000.00
50,000,000.00
48,000,000.00
72,000,000.00
96,000,000.00
72,000,000.00
96,000,000.00
75,000,000.00
72,000,000.00
50,000,000.00
48,000,000.00
0.00
10,000,000.00
6,500,000.00
6,500,000.00
0.00
0.00
400,000,000.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,980.00
379.00
379.00
0.00
0.00
26,333.00
0.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
44,820.00
3,413.00
3,413.00
0.00
0.00
237,000.00
0.00
0.00
4,095.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
44,820.00
3,413.00
3,413.00
0.00
0.00
237,000.00
0.00
0.00
4,095.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001927462
0001927462.01
0001928314
0001928314.01
0001928332
0001928400
0001928400.01
0001928789
0001928789.01
0001928790
0001928790.01
0001928791
0001928791.01
0001928792
0001928792.01
0001928961
0001928961.01
0001929075
0001929305.01
0001929340.01
0001929451.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2189
2190
2191
2192
2193
2194
2195
2196
2197
2198
2199
2200
2201
2202
2203
2204
2205
2206
2207
2208
2209
IMKIN0001927462
IMKIN0001927462
IMKIN0001928314
IMKIN0001928314
IMKIN0001928332
IMKIN0001928400
IMKIN0001928400
IMKIN0001928789
IMKIN0001928789
IMKIN0001928790
IMKIN0001928790
IMKIN0001928791
IMKIN0001928791
IMKIN0001928792
IMKIN0001928792
IMKIN0001928961
IMKIN0001928961
IMKIN0001929075
IMKIN0001929305
IMKIN0001929340
IMKIN0001929451
08.03.2012
08.03.2012
09.03.2012
09.03.2012
05.03.2012
13.03.2012
13.03.2012
16.03.2012
16.03.2012
16.03.2012
16.03.2012
12.03.2012
12.03.2012
16.03.2012
16.03.2012
16.03.2012
16.03.2012
20.03.2012
08.03.2012
08.03.2012
09.03.2012
08.03.2012
08.03.2012
09.03.2012
09.03.2012
05.05.2012
13.03.2012
13.03.2012
03.04.2012
03.04.2012
16.03.2012
16.03.2012
12.03.2012
12.03.2012
16.03.2012
16.03.2012
16.03.2012
16.03.2012
20.03.2012
08.03.2012
21.05.2012
09.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
114PAGE :
WIHARTA
WIHARTA
ATIK WULANDARI
ATIK WULANDARI
ANDRI GUNAWAN
SUYATNO
SUYATNO
MINARNO
MINARNO
ROHADI ADENAN
ROHADI ADENAN
MUSLIM
MUSLIM
WAHYU HANDOKO
WAHYU HANDOKO
EDDY FIRNANDA
EDDY FIRNANDA
DYANE SUBEKTI
SUPRANOWO
AGUS BUDIARTO
ADE INDRAYANI UDJUDEDA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
NISINP
NISINP
NISINP
PMCSHP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
IMCGLP
PMTBPL
PMTBPL
CIGSRN
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
267,000.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
267,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,700.00
50,000,000.00
48,000,000.00
72,000,000.00
96,000,000.00
25,000,000.00
50,000,000.00
48,000,000.00
75,000,000.00
72,000,000.00
72,000,000.00
96,000,000.00
72,000,000.00
96,000,000.00
72,000,000.00
96,000,000.00
75,000,000.00
72,000,000.00
500,000,000.00
5,000,000.00
5,000,000.00
400,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
300,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
26,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
240,300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
240,300.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001929452.01
0001930575
0001930575.01
0001930579
0001930579.01
0001930584
0001930584.01
0001930586
0001930586.01
0001931652
0001931652.01
0001931805.01
0001931905.01
0001931995.01
0001932072
0001932363
0001932383
0001932518
0001932518.01
0001932714
0001932714.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2210
2211
2212
2213
2214
2215
2216
2217
2218
2219
2220
2221
2222
2223
2224
2225
2226
2227
2228
2229
2230
IMKIN0001929452
IMKIN0001930575
IMKIN0001930575
IMKIN0001930579
IMKIN0001930579
IMKIN0001930584
IMKIN0001930584
IMKIN0001930586
IMKIN0001930586
IMKIN0001931652
IMKIN0001931652
IMKIN0001931805
IMKIN0001931905
IMKIN0001931995
IMKIN0001932072
IMKIN0001932363
IMKIN0001932383
IMKIN0001932518
IMKIN0001932518
IMKIN0001932714
IMKIN0001932714
09.03.2012
20.03.2012
20.03.2012
16.03.2012
16.03.2012
22.03.2012
22.03.2012
19.03.2012
19.03.2012
12.03.2012
12.03.2012
14.03.2012
15.03.2012
15.03.2012
17.03.2012
21.03.2012
21.03.2012
21.03.2012
21.03.2012
27.03.2012
27.03.2012
01.05.2012
20.03.2012
20.03.2012
03.04.2012
03.04.2012
22.03.2012
22.03.2012
19.03.2012
19.03.2012
12.03.2012
12.03.2012
14.03.2012
15.03.2012
15.05.2012
17.05.2012
21.03.2012
21.05.2012
26.04.2012
26.04.2012
27.03.2012
27.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
115PAGE :
ROSYIDAH RAHMAH
ASEP SHOLIHIN
ASEP SHOLIHIN
ALI IMRON SUSANTO
ALI IMRON SUSANTO
DINAR JANUARINI
DINAR JANUARINI
T SUWARTONO
T SUWARTONO
AMIRUDDIN HIDAYAT
AMIRUDDIN HIDAYAT
TUSYADI
LUH GDE EKA WISMITA
HERAWATI
MUKTI BIANTI
SYAMSUL BAHRI
GREGORIUS YORA LAKSO SETIYONO
AGUS SUPRIANTO
AGUS SUPRIANTO
BISUK SHINDORO HADIARTO
BISUK SHINDORO HADIARTO
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
CIGSRN
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMCSHP
BNIJBX
BNIJBX
NISINP
NISINP
NISINP
NISINP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
3,792.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
4,550.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
455.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
200,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
50,000,000.00
48,000,000.00
50,000,000.00
48,000,000.00
72,000,000.00
96,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
75,000,000.00
200,000,000.00
200,000,000.00
72,000,000.00
96,000,000.00
50,000,000.00
48,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
455.00
379.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
4,095.00
3,413.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
4,095.00
3,413.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001932718
0001932718.01
0001932817
0001932921
0001932933
0001933032
0001933064
0001933111
0001933464.01
0001933466.01
0001934105
0001934105.01
0001934519
0001934519.01
0001934572.01
0001934574.01
0001934584.01
0001934591.01
0001934601.01
0001934613
0001934613.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2231
2232
2233
2234
2235
2236
2237
2238
2239
2240
2241
2242
2243
2244
2245
2246
2247
2248
2249
2250
2251
IMKIN0001932718
IMKIN0001932718
IMKIN0001932817
IMKIN0001932921
IMKIN0001932933
IMKIN0001933032
IMKIN0001933064
IMKIN0001933111
IMKIN0001933464
IMKIN0001933466
IMKIN0001934105
IMKIN0001934105
IMKIN0001934519
IMKIN0001934519
IMKIN0001934572
IMKIN0001934574
IMKIN0001934584
IMKIN0001934591
IMKIN0001934601
IMKIN0001934613
IMKIN0001934613
27.03.2012
27.03.2012
26.03.2012
05.03.2012
05.03.2012
01.04.2012
01.04.2012
01.04.2012
03.04.2012
03.04.2012
09.04.2012
09.04.2012
01.04.2012
01.04.2012
04.04.2012
04.04.2012
04.04.2012
04.04.2012
05.04.2012
04.04.2012
04.04.2012
03.04.2012
03.04.2012
26.03.2012
05.05.2012
05.03.2012
01.04.2012
01.04.2012
01.04.2012
03.04.2012
03.04.2012
09.04.2012
09.04.2012
02.05.2012
02.05.2012
04.04.2012
04.04.2012
04.05.2012
04.04.2012
05.04.2012
03.05.2012
03.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
116PAGE :
DIDIK PRASETYO HADI
DIDIK PRASETYO HADI
HAMIDAHTUR RAHMI
ERWINA IRIANI MAWUNTU
ZULYADI
JUNAIDI
MARTINI
ARIEF RAHMAN SYAHPUTRA N SH
NENNI NURAENI
SISKA AMELIA
LISTRI NURJANAH
LISTRI NURJANAH
YUSUF ISNAINI
YUSUF ISNAINI
AGUSRIZAL SE
ARISWANA
EVI JULINDA SINULINGGA
TJHEN HONG FONG
DJONI HERU WIBOWO
RITA DEAR MARIANI MANURUNG
RITA DEAR MARIANI MANURUNG
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
NISINP
BNIJBX
BNIJBX
BNIJBX
PMCSHP
PMCSHP
PMCSHP
BNIDRD
BNIDRD
NISINP
NISINP
NISINP
NISINP
BNIDRD
BNIDRD
BNIDRD
BNIDRD
BNIDRD
NISINP
NISINP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
118,000.00
0.00
64,167.00
77,000.00
275,000.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
118,000.00
0.00
70,000.00
77,000.00
275,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,800.00
0.00
7,000.00
7,700.00
27,500.00
0.00
0.00
75,000,000.00
72,000,000.00
200,000,000.00
150,000,000.00
200,000,000.00
75,000,000.00
75,000,000.00
75,000,000.00
50,000,000.00
150,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
75,000,000.00
72,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
100,000,000.00
110,000,000.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,800.00
0.00
6,417.00
7,700.00
27,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
106,200.00
0.00
57,750.00
69,300.00
247,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
106,200.00
0.00
57,750.00
69,300.00
247,500.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001935643
0001935649.01
0001935667
0001935667.01
0001935674
0001935674.01
0001936078
0001936091
0001936515
0001936599
0001936841
0001936841.01
0001936849
0001936849.01
0001936859
0001936859.01
0001936860
0001936860.01
0001936865
0001936865.01
0001936866
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2252
2253
2254
2255
2256
2257
2258
2259
2260
2261
2262
2263
2264
2265
2266
2267
2268
2269
2270
2271
2272
IMKIN0001935643
IMKIN0001935649
IMKIN0001935667
IMKIN0001935667
IMKIN0001935674
IMKIN0001935674
IMKIN0001936078
IMKIN0001936091
IMKIN0001936515
IMKIN0001936599
IMKIN0001936841
IMKIN0001936841
IMKIN0001936849
IMKIN0001936849
IMKIN0001936859
IMKIN0001936859
IMKIN0001936860
IMKIN0001936860
IMKIN0001936865
IMKIN0001936865
IMKIN0001936866
05.04.2012
05.04.2012
27.04.2012
27.04.2012
11.04.2012
11.04.2012
10.04.2012
10.04.2012
04.04.2012
07.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
05.04.2012
05.04.2012
27.04.2012
27.04.2012
11.04.2012
11.04.2012
10.04.2012
10.04.2012
04.04.2012
07.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
13.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
117PAGE :
NOR KOMALA DEWI
NURHAYATI
FREDY BALAPADANG
FREDY BALAPADANG
NOVI DIANA
NOVI DIANA
GUNAWAN AGUS PRIYANTO
AWAN RISWANDI
AKHMAD BASUKI
INDAYANI
KASLAN EFENRI SIMANJUNTAK
KASLAN EFENRI SIMANJUNTAK
AMINUDDIN
AMINUDDIN
M. RIDHO PURNOMO
M. RIDHO PURNOMO
SALMAN AL FARISI
SALMAN AL FARISI
SAEPUL HUSNA
SAEPUL HUSNA
SEPTI SETYIO HADI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBX
BNIDRD
NISINP
NISINP
NISINP
NISINP
PMCSHP
PMCSHP
BNIJBX
BNIJBX
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
150,000,000.00
150,000,000.00
50,000,000.00
48,000,000.00
72,000,000.00
96,000,000.00
25,000,000.00
75,000,000.00
200,000,000.00
200,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
75,000,000.00
72,000,000.00
72,000,000.00
96,000,000.00
72,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001936866.01
0001937008.01
0001937175.01
0001937201.01
0001937241.01
0001937273.01
0001937275.01
0001937277.01
0001937284.01
0001937286.01
0001937308.01
0001937490
0001937679
0001937760.01
0001937762.01
0001937763.01
0001937990
0001938212.01
0001939034
0001939497
0001939840
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2273
2274
2275
2276
2277
2278
2279
2280
2281
2282
2283
2284
2285
2286
2287
2288
2289
2290
2291
2292
2293
IMKIN0001936866
IMKIN0001937008
IMKIN0001937175
IMKIN0001937201
IMKIN0001937241
IMKIN0001937273
IMKIN0001937275
IMKIN0001937277
IMKIN0001937284
IMKIN0001937286
IMKIN0001937308
IMKIN0001937490
IMKIN0001937679
IMKIN0001937760
IMKIN0001937762
IMKIN0001937763
IMKIN0001937990
IMKIN0001938212
IMKIN0001939034
IMKIN0001939497
IMKIN0001939840
13.04.2012
04.04.2012
07.04.2012
07.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
09.04.2012
11.04.2012
11.04.2012
12.04.2012
12.04.2012
10.04.2012
14.04.2012
18.04.2012
19.04.2012
13.04.2012
13.04.2012
04.05.2012
07.04.2012
07.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
01.04.2012
09.04.2012
11.04.2012
11.04.2012
12.04.2012
12.04.2012
10.04.2012
14.04.2012
18.04.2012
19.04.2012
13.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
118PAGE :
SEPTI SETYIO HADI
WITRI YANTI
INDRA SAPUTRA
NOVIANTI
LESTARI WIDAYATI
RIWANTI
RIKA A GULTOM
FUTU WIJAYA PUJI PUTRA
HAIDER
YULIANTI HIDAYAT
EKA ROSADI
CHRESOLITA WIBAWA
PRASETYANI SUCI PURBO PUTRI
SUEB
MOCHAMAD SYAFI I
ABD FATTAH
JUSNIAR RUMADIANTO
DIRHAMSYAH RIVAI
ZULKARNAIN
LIBERT BUTAR BUTAR
AGUNG RAHADI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
BNIJBX
PMCSHP
BNIDRD
BNIDRD
BNIDRD
BNIJBX
BNIDRD
BNIJBX
BNIJBX
BNIJBX
0.00
4,171.00
0.00
7,670.00
0.00
5,525.00
28,600.00
4,550.00
0.00
25,480.00
0.00
0.00
0.00
0.00
0.00
85,000.00
0.00
156,000.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
4,550.00
0.00
7,670.00
0.00
5,525.00
28,600.00
4,550.00
0.00
25,480.00
0.00
0.00
0.00
0.00
0.00
85,000.00
0.00
156,000.00
0.00
0.00
0.00
0.00
455.00
0.00
767.00
0.00
553.00
2,860.00
455.00
0.00
2,548.00
0.00
0.00
0.00
0.00
0.00
8,500.00
0.00
15,600.00
0.00
0.00
0.00
96,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
5,000,000.00
150,000,000.00
75,000,000.00
150,000,000.00
50,000,000.00
150,000,000.00
200,000,000.00
150,000,000.00
150,000,000.00
200,000,000.00
200,000,000.00
0.00
6,500,000.00
0.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
417.00
0.00
767.00
0.00
553.00
2,860.00
455.00
0.00
2,548.00
0.00
0.00
0.00
0.00
0.00
8,500.00
0.00
15,600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
0.00
6,903.00
0.00
4,972.00
25,740.00
4,095.00
0.00
22,932.00
0.00
0.00
0.00
0.00
0.00
76,500.00
0.00
140,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,754.00
0.00
6,903.00
0.00
4,972.00
25,740.00
4,095.00
0.00
22,932.00
0.00
0.00
0.00
0.00
0.00
76,500.00
0.00
140,400.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001939971
0001940059
0001940075
0001940075.01
0001940076
0001940076.01
0001940082
0001940082.01
0001940093
0001940093.01
0001940115.01
0001940135.01
0001940230.01
0001940245.01
0001940311.01
0001940340.01
0001940351.01
0001940362.01
0001940371
0001940374
0001940377
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2294
2295
2296
2297
2298
2299
2300
2301
2302
2303
2304
2305
2306
2307
2308
2309
2310
2311
2312
2313
2314
IMKIN0001939971
IMKIN0001940059
IMKIN0001940075
IMKIN0001940075
IMKIN0001940076
IMKIN0001940076
IMKIN0001940082
IMKIN0001940082
IMKIN0001940093
IMKIN0001940093
IMKIN0001940115
IMKIN0001940135
IMKIN0001940230
IMKIN0001940245
IMKIN0001940311
IMKIN0001940340
IMKIN0001940351
IMKIN0001940362
IMKIN0001940371
IMKIN0001940374
IMKIN0001940377
12.04.2012
18.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
27.04.2012
27.04.2012
09.04.2012
09.04.2012
12.04.2012
13.04.2012
14.04.2012
14.04.2012
14.04.2012
14.04.2012
09.04.2012
10.04.2012
10.04.2012
12.04.2012
18.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
24.04.2012
27.04.2012
27.04.2012
09.04.2012
09.04.2012
12.04.2012
13.04.2012
14.04.2012
14.04.2012
14.04.2012
14.04.2012
09.04.2012
10.04.2012
10.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
119PAGE :
AKHMAD SUSANTO
M IAN NURDIANSYAH
RUPIYANTO
RUPIYANTO
SOPINAH
SOPINAH
NURMELIA IHYANDA
NURMELIA IHYANDA
IMAN SANTOSA
IMAN SANTOSA
KYLIE ICAVIA
OKTAVIANI FRIDAYANTI SPT
RAMDAN FIRMANSYAH
NANANG GUSMAN FACHRUROZI
MAMAT
NI LUH PUTU YULIANTINI
NI NENGAH SATRIANI
ABDUL ROHMAN
FELEX BILLI PRADETA
ARIF RACHMAN
TJIOE SUNARTI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
BNIJBX
HSBTLC
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
NISINP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
4,550.00
4,550.00
5,135.00
4,550.00
0.00
4,550.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
4,550.00
4,550.00
5,135.00
4,550.00
0.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
455.00
455.00
514.00
455.00
0.00
455.00
0.00
0.00
0.00
200,000,000.00
100,000,000.00
75,000,000.00
72,000,000.00
50,000,000.00
48,000,000.00
72,000,000.00
96,000,000.00
72,000,000.00
96,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
5,000,000.00
6,500,000.00
75,000,000.00
75,000,000.00
75,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
6,500,000.00
6,500,000.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
455.00
455.00
514.00
455.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
0.00
4,095.00
4,095.00
4,621.00
4,095.00
0.00
4,095.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
0.00
4,095.00
4,095.00
4,621.00
4,095.00
0.00
4,095.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001940383
0001940498
0001940520
0001940725
0001940792
0001940812.01
0001940897.01
0001940945
0001940969
0001940977
0001941176.01
0001941204.01
0001941211.01
0001941215.01
0001941217.01
0001941230.01
0001941257.01
0001941309.01
0001941316.01
0001941329
0001941338
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2315
2316
2317
2318
2319
2320
2321
2322
2323
2324
2325
2326
2327
2328
2329
2330
2331
2332
2333
2334
2335
IMKIN0001940383
IMKIN0001940498
IMKIN0001940520
IMKIN0001940725
IMKIN0001940792
IMKIN0001940812
IMKIN0001940897
IMKIN0001940945
IMKIN0001940969
IMKIN0001940977
IMKIN0001941176
IMKIN0001941204
IMKIN0001941211
IMKIN0001941215
IMKIN0001941217
IMKIN0001941230
IMKIN0001941257
IMKIN0001941309
IMKIN0001941316
IMKIN0001941329
IMKIN0001941338
12.04.2012
16.04.2012
18.04.2012
12.04.2012
11.04.2012
12.04.2012
23.04.2012
19.04.2012
20.04.2012
20.04.2012
16.04.2012
16.04.2012
16.04.2012
16.04.2012
16.04.2012
17.04.2012
17.04.2012
20.04.2012
20.04.2012
16.04.2012
17.04.2012
12.04.2012
16.04.2012
18.04.2012
12.04.2012
11.04.2012
12.04.2012
23.04.2012
19.04.2012
20.04.2012
20.04.2012
16.04.2012
16.04.2012
16.04.2012
16.04.2012
10.05.2012
17.04.2012
17.04.2012
20.04.2012
20.04.2012
16.04.2012
17.04.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
120PAGE :
BAYU SRILANTO
YANTY
DEWI RAHAYU
YOGIE PRABOWO
WARDI
NENG IDA
WULANDARI
HARTO SUBROTO YUWONO
MELAWATI
MARIANA
UMAN WIBOWO
ROEKIMAN
SRIYONO
ELI PANGESTINING WIDHIASIH SE
RAHMAT HIDAYAT
IRWAN SETIAWAN
RIO GUNAWAN PRATAMA
GIYATMI
ARTA JAYA
EUIS ERMAYANI
RADIH KUSWARA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
BNIJBX
BNIJBX
BNIJBX
PMCSHP
PMTBPL
PMTBPL
BCASHP
BCASHP
BCASHP
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMTBPL
PMCSHP
PMCSHP
0.00
0.00
0.00
0.00
0.00
0.00
6,370.00
0.00
0.00
0.00
0.00
44,850.00
0.00
4,550.00
0.00
4,550.00
4,550.00
0.00
0.00
0.00
0.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
6,370.00
0.00
0.00
0.00
0.00
44,850.00
0.00
4,550.00
0.00
4,550.00
4,550.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
637.00
0.00
0.00
0.00
0.00
4,485.00
0.00
455.00
0.00
455.00
455.00
0.00
0.00
0.00
0.00
50,000,000.00
200,000,000.00
200,000,000.00
200,000,000.00
50,000,000.00
5,000,000.00
6,500,000.00
20,000,000.00
20,000,000.00
10,000,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
5,000,000.00
6,500,000.00
6,500,000.00
5,000,000.00
5,000,000.00
50,000,000.00
25,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
6,500,000.00
0.00
6,500,000.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
637.00
0.00
0.00
0.00
0.00
4,485.00
0.00
455.00
0.00
455.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,733.00
0.00
0.00
0.00
0.00
40,365.00
0.00
4,095.00
0.00
4,095.00
4,095.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,733.00
0.00
0.00
0.00
0.00
40,365.00
0.00
4,095.00
0.00
4,095.00
4,095.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0001941339
0001941343
0001941346
0001941350
0001941535.01
0001941629
0001941677
0001941721
0001941721.01
0001941816
0001941816.01
0001942130
0001942401.01
0001942411.01
0001942523
0001942534
0001943517.01
0001947357
0001951053
0001951053.01
0001951184.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2336
2337
2338
2339
2340
2341
2342
2343
2344
2345
2346
2347
2348
2349
2350
2351
2352
2353
2354
2355
2356
IMKIN0001941339
IMKIN0001941343
IMKIN0001941346
IMKIN0001941350
IMKIN0001941535
IMKIN0001941629
IMKIN0001941677
IMKIN0001941721
IMKIN0001941721
IMKIN0001941816
IMKIN0001941816
IMKIN0001942130
IMKIN0001942401
IMKIN0001942411
IMKIN0001942523
IMKIN0001942534
IMKIN0001943517
IMKIN0001947357
IMKIN0001951053
IMKIN0001951053
IMKIN0001951184
17.04.2012
19.04.2012
19.04.2012
20.04.2012
18.04.2012
24.04.2012
24.04.2012
26.04.2012
26.04.2012
27.04.2012
27.04.2012
26.04.2012
23.04.2012
23.04.2012
24.04.2012
25.04.2012
01.05.2012
12.05.2012
16.05.2012
16.05.2012
23.05.2012
17.04.2012
19.04.2012
19.04.2012
20.04.2012
18.04.2012
24.04.2012
24.04.2012
26.04.2012
26.04.2012
27.04.2012
27.04.2012
26.04.2012
23.04.2012
23.04.2012
24.04.2012
25.04.2012
01.05.2012
12.05.2012
16.05.2012
16.05.2012
23.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
121PAGE :
RENDY EKA SAPUTRA
SYAMSUL ANAM
JOKO SURYANTO
ARI YANTY
NENI SRIHAYATIN
HERMANSES WP BA
ERYANTI .
SITI ANISAH
SITI ANISAH
SUPRIYO
SUPRIYO
ZAENAL ABIDIN
HERYANTO
KOMANG ANTARA
YANNA
WATUNI
KUKUH PRABOWO
SATRIA SATYAWAN
SRI HANDAYANI
SRI HANDAYANI
HALIM
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
PMCSHP
PMCSHP
PMCSHP
PMCSHP
PMTBPL
PMCSHP
BNIJBX
NISINP
NISINP
NISINP
NISINP
BNIJBX
PMTBPL
PMTBPL
PMCSHP
PMCSHP
PMTBPL
PMCSHP
NISINP
NISINP
PMTBPL
0.00
0.00
0.00
0.00
6,370.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
4,550.00
0.00
0.00
0.00
4,550.00
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
6,370.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,550.00
0.00
0.00
4,550.00
0.00
0.00
0.00
4,550.00
0.00
0.00
0.00
0.00
637.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
0.00
455.00
0.00
0.00
0.00
455.00
75,000,000.00
75,000,000.00
25,000,000.00
75,000,000.00
6,500,000.00
75,000,000.00
200,000,000.00
50,000,000.00
48,000,000.00
50,000,000.00
48,000,000.00
200,000,000.00
5,000,000.00
6,500,000.00
75,000,000.00
50,000,000.00
6,500,000.00
25,000,000.00
72,000,000.00
96,000,000.00
6,500,000.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
6,500,000.00
0.00
0.00
0.00
0.00
637.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
455.00
0.00
0.00
455.00
0.00
0.00
0.00
455.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,733.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
0.00
0.00
4,095.00
0.00
0.00
0.00
4,095.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,733.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4,095.00
0.00
0.00
4,095.00
0.00
0.00
0.00
4,095.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
000000179Z
000001006Z
000002481V
0000000920
0000004580
0000005530.01
0000014230
0000001900.01
0000005610
0000010030
0000011310
0000015710.01
0000051350.01
0000076080
0000102330
0000138830
0000157210
0000000240
0000000240.02
000000031Y
0000000750
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2357
2358
2359
2360
2361
2362
2363
2364
2365
2366
2367
2368
2369
2370
2371
2372
2373
2374
2375
2376
2377
LE0000179Z
LE0001006Z
LE0002481V
MU00000920
MU00004580
MU00005530
MU00014230
NA00001900
NA00005610
NA00010030
NA00011310
NA00015710
NA00051350
NA00076080
NA00102330
NA00138830
NA00157210
NF00000240
NF00000240
NF0000031Y
NF00000750
02.03.2011
01.07.2011
28.12.2011
24.04.2012
26.03.2012
11.04.2012
24.04.2012
03.07.2008
18.06.2008
05.06.2008
11.08.2008
25.07.2008
06.01.2009
19.09.2008
26.11.2008
18.03.2010
28.04.2010
25.11.2010
25.11.2010
22.11.2011
11.01.2011
29.05.2012
08.05.2012
08.05.2012
16.05.2012
02.05.2012
09.05.2012
28.05.2012
14.05.2012
02.05.2012
04.05.2012
21.05.2012
25.05.2012
21.05.2012
01.05.2012
26.05.2012
23.05.2012
28.05.2012
04.05.2012
04.05.2012
16.05.2012
02.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
122PAGE :
EDI SAPARUDIN.SE. .
DEWI TIRTA AYUMAS .
FRANKY RGOSAL .
YOSEFA SULAIMAN
DANIEL ADI SAPUTRO
NERIA OLEANDA
REZA ADAM FERDIAN
SRI INDAH APRILYANTI
YULIANTO INDRAPRAJA
OH CORRIE DELAIS HAL
ANGGANANTYO
NENENG SUSANTI
ANESTYA RISKINA
HJ TATI KRISTIANTI
AISYAH
WAHYU KRISTI UNTARI
HENDRY ZAPUTRA TEDJA
. GUNAWAN
ENY HERAWATI
ENDANG MELATI .
TAN GIOK MIE
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
LBCA1
LBCA1
LBCA1
UBMU11
UBMU1
UBMU11
UBMU11
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
UBNG2
LDRNF
LDRNF
LDRNF
LDRNF
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
467,833.00
0.00
0.00
2012
2011
2011
2012
2012
2012
2012
2011
2011
2011
2011
2011
2012
2011
2011
2012
2012
2011
2011
2011
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
802,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
200,000,000.00
200,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
100,000,000.00
30,000,000.00
48,000,000.00
30,000,000.00
36,000,000.00
36,000,000.00
60,000,000.00
50,000,000.00
36,000,000.00
36,000,000.00
36,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
467,833.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
467,833.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000001580
0000004060.01
0000004240.01
000000444Z
000000574Z
000000578Z
000000706Z
0000006740
0000006700
0000024460
0000024670
0000001134
0000001138
0000003046.01
0000003877
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2378
2379
2380
2381
2382
2383
2384
2385
2386
2387
2388
2389
2390
2391
2392
NF00001580
NF00004060
NF00004240
NF0000444Z
NF0000574Z
NF0000578Z
NF0000706Z
PA00006740
SP00006700
SP00024460
SP00024670
TTMIN0000001134
TTMIN0000001138
TTMIN0000003046
TTMIN0000003877
24.02.2011
22.02.2012
27.03.2012
29.11.2010
16.03.2011
16.03.2011
28.11.2011
30.08.2010
24.09.2008
17.06.2010
05.11.2010
21.03.2006
19.03.2006
03.04.2006
21.03.2006
11.05.2012
22.05.2012
21.05.2012
07.05.2012
15.05.2012
01.05.2012
04.05.2012
14.05.2012
24.05.2012
15.05.2012
05.05.2012
21.02.2012
19.02.2012
03.02.2012
21.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
123PAGE :
TJENTIS MELIAWATI
. ROOSVITANINGSIH
. A. D. M. MANURUNG / BR SITUMORANG
BASRUDDIN .
HENRY TJONDRO HARTON
JOHN WAHA .
JULIA INAWATI .
. SETIAWAN
LINA YULIANTI YULIAN
SURYA YUNINGSIH
SRI KALINAWATI
SOPHIA LOREN
SUSILOWATI
IR. HARDJANTO
COK GDE KAMINATA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
LDRNF
LDRNF
LDRNF
LDRNF
LDRNF
LDRNF
LDRNF
UBPM1
USCB1
USCB1
USCB1
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2012
2011
2012
2012
2011
2011
2011
2011
2011
2011
2011
2012
2012
2011
2011
2012
2012
2011
2012
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
75,000,000.00
50,000,000.00
50,000,000.00
50,000,000.00
100,000,000.00
50,000,000.00
75,000,000.00
108,000,000.00
60,000,000.00
60,000,000.00
60,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
0.00
0.00
18,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000003892
0000004383
0000004858.01
0000006748
0000011115.01
0000011854.01
0000011862.01
0000012010.01
0000012077.01
0000012964.01
0000013574.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2393
2394
2395
2396
2397
2398
2399
2400
2401
2402
2403
TTMIN0000003892
TTMIN0000004383
TTMIN0000004858
TTMIN0000006748
TTMIN0000011115
TTMIN0000011854
TTMIN0000011862
TTMIN0000012010
TTMIN0000012077
TTMIN0000012964
TTMIN0000013574
18.03.2006
26.03.2006
22.05.2006
01.08.2007
20.04.2006
09.05.2006
13.05.2006
30.03.2006
11.04.2006
06.08.2006
10.04.2006
18.02.2012
26.02.2012
22.02.2012
01.02.2012
20.02.2012
09.02.2012
13.02.2012
29.02.2012
11.02.2012
06.02.2012
10.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
124PAGE :
DRS. BAMBANG P. SUMO
ARIFIN
EKO PURWANTO
NANA SURYANA
DRS. SUKAMTO YACOBUS
TITIN PATIMAH
ENGKOS KOSWARA
SAHIDIN
SRI KUSMIATI
GANI AHMAD RUKMANA
ERLIN ESTININGTYAS
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2012
2011
2011
2012
2012
2011
2011
2012
2012
2011
2012
2011
2011
2012
2011
2012
2011
2012
2011
2012
2011
2012
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
18,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,500,000.00
7,500,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
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0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000013666.01
0000013943.01
0000014106.01
0000014256.01
0000014613.01
0000014783.01
0000014901.01
0000017031.01
0000017707.01
0000018327.01
0000018856.01
0000019248.01
0000019692.01
0000021125.01
0000022025.01
0000022084.01
0000022554.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2404
2405
2406
2407
2408
2409
2410
2411
2412
2413
2414
2415
2416
2417
2418
2419
2420
TTMIN0000013666
TTMIN0000013943
TTMIN0000014106
TTMIN0000014256
TTMIN0000014613
TTMIN0000014783
TTMIN0000014901
TTMIN0000017031
TTMIN0000017707
TTMIN0000018327
TTMIN0000018856
TTMIN0000019248
TTMIN0000019692
TTMIN0000021125
TTMIN0000022025
TTMIN0000022084
TTMIN0000022554
26.04.2006
11.04.2006
12.05.2006
12.08.2006
02.07.2006
09.05.2006
10.04.2006
02.08.2006
29.04.2006
17.07.2006
11.08.2006
13.08.2006
16.05.2006
06.05.2006
28.05.2006
11.06.2006
07.08.2006
26.02.2012
11.02.2012
12.02.2012
12.02.2012
02.02.2012
09.05.2012
10.05.2012
02.02.2012
29.02.2012
17.02.2012
11.02.2012
13.02.2012
16.05.2012
06.02.2012
28.05.2012
11.05.2012
07.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
125PAGE :
HERAWAN HARYANTO
EMI ARIANI
LILY WIDJAYA HARSONO
DEDI SUJADI
TJOE SIN MEI
FAUZIA ABDURACHMAN
ANIK UMI NURAINI
SUWARNO DURMAN
HELMAWATI
IGN. DJOKO SADHONO
HERDIANSYAH
MOHAMAD LUTFI
TOTO SUTJIPTO
POPON SUTIHATTY
TATANG SUKARNA
NENY MULYANI
TRIYANA ANDI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,545.00
0.00
2012
2011
2012
2011
2012
2011
2012
2011
2011
2012
2012
2011
2011
2012
2011
2011
2011
2012
2011
2012
2012
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
18,540.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,545.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,545.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000023736.01
0000023961.01
0000024814.01
0000026673.01
0000026680.01
0000027453
0000027744.01
0000027844.01
0000027939.01
0000028900.01
0000029079.01
0000029235.01
0000030178.01
0000030610.01
0000030800.01
0000030880.01
0000031545.01
0000033469.01
0000033844.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2421
2422
2423
2424
2425
2426
2427
2428
2429
2430
2431
2432
2433
2434
2435
2436
2437
2438
2439
TTMIN0000023736
TTMIN0000023961
TTMIN0000024814
TTMIN0000026673
TTMIN0000026680
TTMIN0000027453
TTMIN0000027744
TTMIN0000027844
TTMIN0000027939
TTMIN0000028900
TTMIN0000029079
TTMIN0000029235
TTMIN0000030178
TTMIN0000030610
TTMIN0000030800
TTMIN0000030880
TTMIN0000031545
TTMIN0000033469
TTMIN0000033844
10.02.2007
19.09.2006
09.05.2006
23.01.2007
01.02.2007
12.08.2007
01.11.2006
11.07.2006
03.08.2006
03.06.2006
20.07.2006
21.06.2006
19.06.2006
17.05.2006
12.06.2006
03.09.2006
30.07.2006
02.01.2007
15.03.2007
10.02.2012
19.05.2012
09.02.2012
23.02.2012
01.02.2012
12.05.2012
01.02.2012
11.02.2012
03.05.2012
03.02.2012
20.02.2012
21.05.2012
19.02.2012
17.02.2012
12.02.2012
03.02.2012
29.02.2012
02.05.2012
15.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
126PAGE :
MARIA BLANDINA SHA H
INDRAWATI HANDOKO
AHMAD MULYADI
TRESYA MARINA
SITI JUMHANAH
DIAN MELINDA KRISTIA
FAJAR RINA MARYANTI
EKO YULIARTANTO
IRAWAN HARTANTO
SRI WAHYUNI S
CECEP KURNIAWAN RS
ALI SURYONO
SUMNARDI
TRUBUS HARYANTO
AGUSTINA MARGI RAHAY
ANIS FITRIANINGSIH
INASTUTI KARDJUI
LIM FIE LIEN
A HAMIDZAM
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2011
2012
2012
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2012
2011
2011
2011
2012
2011
2012
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0.00
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3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
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PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
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0000034844.01
0000035296.01
0000035423.01
0000035432.01
0000036044.01
0000036156.01
0000037297.01
0000037653.01
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0000038546.01
0000041735.01
0000042747.01
0000044223.01
0000045979.01
0000047258.01
0000047451.01
0000048505.01
0000048917.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2440
2441
2442
2443
2444
2445
2446
2447
2448
2449
2450
2451
2452
2453
2454
2455
2456
2457
2458
2459
TTMIN0000034586
TTMIN0000034844
TTMIN0000035296
TTMIN0000035423
TTMIN0000035432
TTMIN0000036044
TTMIN0000036156
TTMIN0000037297
TTMIN0000037653
TTMIN0000037879
TTMIN0000038012
TTMIN0000038546
TTMIN0000041735
TTMIN0000042747
TTMIN0000044223
TTMIN0000045979
TTMIN0000047258
TTMIN0000047451
TTMIN0000048505
TTMIN0000048917
27.09.2006
14.09.2006
01.11.2006
23.09.2006
11.09.2006
16.10.2006
25.08.2006
13.01.2007
10.09.2006
23.05.2007
11.09.2006
01.11.2006
01.11.2006
02.11.2006
03.08.2006
09.08.2006
05.10.2006
22.08.2006
01.12.2006
01.12.2006
27.02.2012
14.02.2012
01.02.2012
23.02.2012
11.02.2012
16.02.2012
25.02.2012
13.04.2012
10.02.2012
23.02.2012
11.02.2012
01.04.2012
01.02.2012
02.02.2012
03.02.2012
09.02.2012
05.02.2012
22.02.2012
01.02.2012
01.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
127PAGE :
AGUSTINA
ASMONO
MOCH FATCHURAHMAN
SUNARDI .DRS
CAKRUM
SONHAJI SURYO LAKSMO
ENDAH SHITA LAKSMI
A RAHMAN
WAHYUDI JULIANTO
LUCIA HENDRAWATI
IVAN HASUDUNGAN PARD
S. TRISNU WIJAYA LUK
KUSMIATI
JANI SUMARJAN I.A. H
ADI DHARMA
ANTONIUS SUTOPO SE
FX. SUPARJO
MUJIHARTO
MUKHLIS S.SPD
NINING RUKMINI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBNKB
GEBBKB
GEBNKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
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0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2012
2011
2011
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
0.00
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0.00
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3,000,000.00
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0.00
0.00
0.00
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3,000,000.00
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PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000049831.01
0000050544.01
0000050983.01
0000051077.01
0000051231.01
0000052230.01
0000052241.01
0000054217.01
0000054434.01
0000056233.01
0000056630.01
0000057171.01
0000060091.01
0000061062.01
0000061915.01
0000062058.01
0000066158.01
0000066749.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2460
2461
2462
2463
2464
2465
2466
2467
2468
2469
2470
2471
2472
2473
2474
2475
2476
2477
TTMIN0000049831
TTMIN0000050544
TTMIN0000050983
TTMIN0000051077
TTMIN0000051231
TTMIN0000052230
TTMIN0000052241
TTMIN0000054217
TTMIN0000054434
TTMIN0000056233
TTMIN0000056630
TTMIN0000057171
TTMIN0000060091
TTMIN0000061062
TTMIN0000061915
TTMIN0000062058
TTMIN0000066158
TTMIN0000066749
04.01.2007
06.03.2007
01.02.2007
11.11.2006
08.11.2006
09.03.2007
18.03.2007
02.12.2006
21.01.2007
22.08.2007
05.08.2006
18.12.2006
26.11.2006
07.06.2007
14.07.2007
09.05.2007
01.05.2007
01.02.2007
04.02.2012
06.02.2012
01.02.2012
11.02.2012
08.02.2012
09.02.2012
18.03.2012
02.02.2012
21.02.2012
22.02.2012
05.02.2012
18.02.2012
26.02.2012
07.05.2012
14.02.2012
09.02.2012
01.02.2012
01.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
128PAGE :
ILA NURLELA
TJIOE LILY SAMPURNA
ELAN BIANTORO
TINAWATI HALIM
ASTRALITA
TJIE FUNG KUO
SILVIANAWATI SUHENDR
SISWOKO UTOMO
ACHMAD ALI
TITIS YANUARI
SUPRIYANTI
HENNY SUKMAWATI
SRI HASTUTI
HARVEY
M DJAMAL GANI
LAMEN ROYAMI MANULAN
FAHD MIRZA GAZALI
HADI YENI
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
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2012
2011
2012
2012
2011
2011
2011
2012
2012
2011
2012
2011
2011
2011
2011
2011
2011
2011
2012
2011
2012
2012
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0.00
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0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
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PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000066767.01
0000067678.01
0000073216.01
0000075676
0000077102.01
0000078129.01
0000078516.01
0000078731.01
0000078774.01
0000078821.01
0000078933.01
0000080918.01
0000102536.01
0000115699.01
0000115831.01
0000116590.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2478
2479
2480
2481
2482
2483
2484
2485
2486
2487
2488
2489
2490
2491
2492
2493
TTMIN0000066767
TTMIN0000067678
TTMIN0000073216
TTMIN0000075676
TTMIN0000077102
TTMIN0000078129
TTMIN0000078516
TTMIN0000078731
TTMIN0000078774
TTMIN0000078821
TTMIN0000078933
TTMIN0000080918
TTMIN0000102536
TTMIN0000115699
TTMIN0000115831
TTMIN0000116590
02.02.2007
13.05.2007
20.05.2007
01.08.2007
16.03.2007
11.03.2007
01.06.2007
01.06.2007
04.06.2007
08.06.2007
01.05.2007
13.12.2006
08.04.2007
12.04.2007
19.04.2007
12.03.2007
02.02.2012
13.02.2012
20.04.2012
01.02.2012
16.02.2012
11.02.2012
01.02.2012
01.02.2012
04.02.2012
08.02.2012
01.02.2012
13.02.2012
08.02.2012
12.05.2012
19.02.2012
12.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
129PAGE :
SOEHARIJANTO
OOM KOMARIAH
LUKMAN HANAFI
IR. M. AZMI RIDHO
YANI MULYANI
JOSEFINE CHRISTI TAN
WAHYU SETIAWAN
SUPARMI
M.JUNAIDI
SITI HERLINA
GUSRITA KENCANA
DRS. YAYT RUHIMAT
LILI SUMANTRI ALIA
HENDRA OCBRON
DANOFAN. F
WENTY MARETINA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBNKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBNKB
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2012
2011
2012
2011
2012
2011
2011
2012
2011
2012
2011
2011
2011
2011
2011
2012
2011
2011
2012
2012
2011
2012
2011
2012
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000116758.01
0000117324.01
0000117961.01
0000118580
0000118992.01
0000119788.01
0000120251.01
0000120281.01
0000120322.01
0000123736
0000123766.01
0000123768
0000124239.01
0000126531.01
0000127974.01
0000128177.01
0000131025.01
000131029.01
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2494
2495
2496
2497
2498
2499
2500
2501
2502
2503
2504
2505
2506
2507
2508
2509
2510
2511
TTMIN0000116758
TTMIN0000117324
TTMIN0000117961
TTMIN0000118580
TTMIN0000118992
TTMIN0000119788
TTMIN0000120251
TTMIN0000120281
TTMIN0000120322
TTMIN0000123736
TTMIN0000123766
TTMIN0000123768
TTMIN0000124239
TTMIN0000126531
TTMIN0000127974
TTMIN0000128177
TTMIN0000131025
TTMIN0000131029
04.03.2007
05.05.2007
11.05.2007
02.09.2007
03.08.2007
24.08.2007
23.06.2007
20.07.2007
17.07.2007
08.09.2007
10.09.2007
10.09.2007
08.09.2007
01.09.2007
17.05.2007
01.09.2007
04.08.2007
05.08.2007
04.02.2012
05.02.2012
11.02.2012
02.02.2012
03.02.2012
24.02.2012
23.02.2012
20.02.2012
17.02.2012
08.02.2012
10.02.2012
10.02.2012
08.02.2012
01.02.2012
17.02.2012
01.02.2012
04.05.2012
05.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
130PAGE :
TATANG SUHENDAR MULI
ANDI SUGIANTO
HANNY DWI YANTI
AGUNG YULIANTO
BUDI LUKITOYO FAKKAR
JUNAEDI HIDAYAT
CHASY C.ANWAR
JOHN EDWARD
SUHERMANTO
SUNARMI
MISDI
SITI NURIATI
ROSALIA P.W.W
KOESNOE EFENDI
PARMAN HS
IR. ENDANG SAEPUDIN
DEWI
PUTU EKA PUTRI R.
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBBKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2012
2011
2012
2011
2012
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2012
2011
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
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0.00
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0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
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0.00
0.00
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0.00
0.00
0.00
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0.00
0.00
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0.00
0.00
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0.00
0.00
0.00
0.00
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0.00
0.00
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0.00
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0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000131121.01
0000131432.01
0000131960
0000132577.01
0000133028.01
0000134675.01
0000135040.01
0000135208.01
0000135264.01
0000139299.01
0000139534.01
0000007130
0000007300
0000011940
0000011580
0000022970
0000028160
0000032190
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2512
2513
2514
2515
2516
2517
2518
2519
2520
2521
2522
2523
2524
2525
2526
2527
2528
2529
TTMIN0000131121
TTMIN0000131432
TTMIN0000131960
TTMIN0000132577
TTMIN0000133028
TTMIN0000134675
TTMIN0000135040
TTMIN0000135208
TTMIN0000135264
TTMIN0000139299
TTMIN0000139534
TU00007130
TU00007300
TU00011940
UB00011580
UB00022970
UB00028160
UB00032190
13.08.2007
09.07.2007
01.09.2007
01.07.2007
24.06.2007
01.06.2007
10.06.2007
18.05.2007
20.05.2007
01.07.2007
11.06.2007
16.04.2007
23.04.2007
09.05.2007
28.08.2008
13.03.2009
05.02.2009
13.03.2009
13.02.2012
09.02.2012
01.02.2012
01.02.2012
24.02.2012
01.02.2012
10.02.2012
18.02.2012
20.02.2012
01.02.2012
11.02.2012
16.05.2012
29.05.2012
02.05.2012
11.05.2012
16.05.2012
05.05.2012
16.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
131PAGE :
CITRA FELLINY GONY
RINI MURDIAWATI
WIWIK
NOVI PRATIWI DEWI
INDRA FAJAR A
ANIK ANDAYANI
DEWI SUSILAWATI
YUDITH YULIANO
YULIANA PURNAMASARI
SAMAN
ENDANG
DR. SLAMET SOEBAGIO
BAHRUDDIN S.KOM
NAWA POERWANA THALO
ANTOINETTE MINTJE AM
YENY SOLINATA
APIPUDIN SAG
HENDRA TANU WIDJAJA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBKB
GEBNKB
GEBBKB
GEBBKB
GEBBKB
GEBBKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBNKB
GEBBKB
UNMPS
UNMPS
UNMPS
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2011
2011
2011
2011
2011
2011
2011
2011
2012
2011
2012
2011
2011
2012
2012
2012
2011
2011
2012
2012
2012
2012
2012
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
3,000,000.00
15,870,000.00
21,930,000.00
11,430,000.00
54,000,000.00
54,000,000.00
45,000,000.00
45,000,000.00
27,000,000.00
90,000,000.00
90,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000039040
0000053550
0000064170
0000067310
0000070300
0000073980
0000084150
0000084600
0000089400
0000091950
0000093880
0000098380
0000106120
0000113820
0000114420
0000114850
0000116910
0000118040
0000123580
0000125120
0000125150
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2530
2531
2532
2533
2534
2535
2536
2537
2538
2539
2540
2541
2542
2543
2544
2545
2546
2547
2548
2549
2550
UB00039040
UB00053550
UB00064170
UB00067310
UB00070300
UB00073980
UB00084150
UB00084600
UB00089400
UB00091950
UB00093880
UB00098380
UB00106120
UB00113820
UB00114420
UB00114850
UB00116910
UB00118040
UB00123580
UB00125120
UB00125150
29.03.2010
12.11.2009
27.09.2010
18.08.2010
25.02.2010
24.08.2010
17.01.2011
17.01.2011
28.12.2010
11.07.2011
04.07.2011
05.04.2012
01.06.2011
25.07.2011
17.11.2011
24.06.2011
25.07.2011
27.01.2012
04.10.2011
02.04.2012
27.04.2012
03.05.2012
12.05.2012
08.05.2012
24.05.2012
25.05.2012
24.05.2012
22.05.2012
08.05.2012
28.05.2012
11.05.2012
04.05.2012
02.05.2012
07.05.2012
25.05.2012
01.05.2012
24.05.2012
25.05.2012
01.05.2012
04.05.2012
02.05.2012
23.05.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
132PAGE :
. SHERLY
FAIZAL AHMAD
DR.ERNY MASYITAH
. WIDARSO
AHMAD RIFAI
WONG TJI ON
REZKI PUNDARI
IDA AYU SUASTINI
RINCA ERLINGGA
EKA MUNING
EKO SUPRIYANTO TJAND
. SUGIYANTO
IKA PERMATASARI
HENDRIK PURNOMO SH
HARYATI NURUL HIDAYAT
AINUR ROFIQ
DADANG AGUS SETYANTO
KURNIA TURAHMI
. DIENDY
PUTRI DWIMIRNANI
DODY WAHDIANSYAH
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
0.00
0.00
0.00
0.00
0.00
39,263.00
0.00
0.00
0.00
0.00
0.00
0.00
4,200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2011
2011
2012
2011
2012
2012
2011
2011
2011
2012
2011
2011
2011
2011
2011
2012
2011
2012
2012
0.00
0.00
0.00
0.00
0.00
157,050.00
0.00
0.00
0.00
0.00
0.00
0.00
50,400.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,040.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,000,000.00
45,000,000.00
45,000,000.00
27,000,000.00
27,000,000.00
45,000,000.00
22,500,000.00
27,000,000.00
45,000,000.00
45,000,000.00
27,000,000.00
135,000,000.00
72,000,000.00
45,000,000.00
27,000,000.00
45,000,000.00
27,000,000.00
135,000,000.00
45,000,000.00
27,000,000.00
90,000,000.00
0.00
0.00
0.00
0.00
0.00
45,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
72,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
420.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
39,263.00
0.00
0.00
0.00
0.00
0.00
0.00
3,780.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
39,263.00
0.00
0.00
0.00
0.00
0.00
0.00
3,780.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
0000125380
0000126600
0000135110
0000135260
0000136090
0000138220
0000138330
0000138470
000000659Z
000001031Z
0000007300
0000009460
0000010830
0000011380
0000011860
0000020440
0000030720
0000040340
0000047650
0000003080
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2551
2552
2553
2554
2555
2556
2557
2558
2559
2560
2561
2562
2563
2564
2565
2566
2567
2568
2569
2570
2570
UB00125380
UB00126600
UB00135110
UB00135260
UB00136090
UB00138220
UB00138330
UB00138470
UC0000659Z
UC0001031Z
UD00007300
UD00009460
UD00010830
UD00011380
UD00011860
UD00020440
UD00030720
UD00040340
UD00047650
UH00003080
16.03.2012
14.11.2011
05.04.2012
24.04.2012
27.04.2012
20.04.2012
02.04.2012
24.04.2012
09.12.2009
18.03.2010
16.09.2010
08.11.2011
07.10.2011
16.08.2011
05.08.2011
24.02.2011
17.11.2011
27.01.2012
27.04.2012
09.08.2011
28.05.2012
10.05.2012
09.05.2012
11.05.2012
28.05.2012
07.05.2012
09.05.2012
23.05.2012
22.05.2012
01.05.2012
16.05.2012
24.05.2012
03.05.2012
21.05.2012
05.05.2012
24.05.2012
24.05.2012
01.05.2012
15.05.2012
21.05.2012
09.02.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
133PAGE :
TITIN KOMALASARI
TRI RETNOWATI
MOHAMMAD HAMDAR. S. SOS
ABRAHAM SALADIN MONGULA
DENNY SAPUTRA
DINDIN SAEFUDIN SE
WINDI WERDININGRUM
GINO HERRYANSYAH
RICHARD EDUARD MAHIE
FASBIR ZAD .
HEPPI J M SILALAHI S
BRYAN BILVEN
ATI SOFIATI
NUR HASNIAWATI
MEUTIA RIZKY AMANDA
YUDHI KRISTANTO ST
NUR ASIKIN
KURNIA TURAHMI
. HERNILAWATI
. R.A MELISSA
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
UUS02
ROP03
ROP01
UUS03
UUS03
UUS03
UUS03
UUS03
UUS04
UUS03
UUS03
UUS03
UUH01
GEBBKB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
141,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2012
2011
2012
2012
2012
2012
2012
2012
2011
2012
2011
2011
2011
2011
2011
2012
2011
2012
2012
2011
2011
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
243,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
90,000,000.00
36,000,000.00
135,000,000.00
72,000,000.00
90,000,000.00
45,000,000.00
45,000,000.00
90,000,000.00
100,000,000.00
200,000,000.00
27,000,000.00
18,000,000.00
18,000,000.00
18,000,000.00
90,000,000.00
18,000,000.00
90,000,000.00
27,000,000.00
108,000,000.00
18,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
100,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
141,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
141,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
2570 23.03.2012
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
134PAGE :
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
GEBBK
GEBBKB
GEBBK
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
NIAOP
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,833.00
27,500.00
27,500.00
0.00
45,833.00
27,500.00
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
480,000,000.00
300,000,000.00
6,950,000,000.00
735,000,000.00
130,000,000.00
385,000,000.00
245,000,000.00
1,650,000,000.00
26,650,000,000.00
185,000,000.00
400,000,000.00
120,000,000.00
0.00
3,710,000,000.00
220,000,000.00
10,000,000.00
140,000,000.00
0.00
250,000,000.00
3,600,000,000.00
0.00
200,000,000.00
591,600.00
0.00
8,376,500.00
379,500.00
7,000.00
140,000.00
0.00
1,086,000.00
6,875,000.00
0.00
321,000.00
49,300.00
0.00
4,269,251.00
193,825.00
1,750.00
70,000.00
0.00
461,000.00
3,283,959.00
0.00
151,000.00
0.00
0.00
793,200.00
37,950.00
700.00
14,000.00
0.00
0.00
408,900.00
0.00
17,600.00
0.00
0.00
386,726.00
19,383.00
175.00
7,000.00
0.00
0.00
169,860.00
0.00
10,267.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
49,300.00
0.00
3,882,526.00
174,443.00
1,575.00
63,000.00
0.00
461,000.00
3,114,101.00
0.00
140,733.00
AMNTLF
BCASHP
BNIDRD
BNIDRR
BNIHLF
BNIJB3
BNIJBA
BNIJBT
BNIJBX
CBP01
CIGCFY
TOTAL : 4
16
51
8
13
3
2
21
142
1
2
750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
50,000.00
30,000.00
30,000.00
0.00
50,000.00
30,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
60,000,000.00
3,000,000.00
60,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
150,000,000.00
300,000,000.00
300,000,000.00
300,000,000.00
150,000,000.00
300,000,000.00
300,000,000.00
3,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
250,000,000.00
150,000,000.00
150,000,000.00
0.00
250,000,000.00
150,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,833.00
27,500.00
27,500.00
0.00
45,833.00
27,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
63.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
45,833.00
27,500.00
27,500.00
0.00
45,833.00
27,500.00
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
135PAGE :
200,000,000.00
20,000,000.00
30,000,000.00
400,000,000.00
500,000,000.00
22,500,000,000.00
500,000,000.00
500,000,000.00
22,700,000,000.00
1,200,000,000.00
500,000,000.00
2,493,450,000.00
2,917,000,000.00
15,000,000.00
126,000,000.00
2,109,000,000.00
99,000,000.00
2,425,000,000.00
90,000,000.00
4,950,000,000.00
4,240,000,000.00
30,000,000.00
2,400,000,000.00
500,000,000.00
800,000,000.00
650,000,000.00
200,000,000.00
0.00
10,000,000.00
100,000,000.00
0.00
10,670,000,000.00
500,000,000.00
500,000,000.00
15,580,000,000.00
700,000,000.00
0.00
135,000,000.00
289,000,000.00
0.00
6,000,000.00
10,500,000.00
0.00
238,000,000.00
0.00
1,150,000,000.00
230,000,000.00
30,000,000.00
1,200,000,000.00
0.00
0.00
50,000,000.00
162,000.00
0.00
12,900.00
70,000.00
0.00
16,251,350.00
350,000.00
1,215,000.00
24,274,300.00
715,000.00
0.00
105,950.00
497,420.00
0.00
1,500.00
82,815.00
0.00
267,100.00
0.00
1,559,000.00
622,300.00
35,400.00
1,317,000.00
0.00
0.00
802,000.00
81,000.00
0.00
5,375.00
46,667.00
0.00
8,047,666.00
233,333.00
202,500.00
15,564,168.00
431,250.00
0.00
53,467.00
216,353.00
0.00
126.00
6,901.00
0.00
174,550.00
0.00
544,750.00
300,342.00
23,600.00
415,583.00
0.00
0.00
467,833.00
0.00
0.00
0.00
7,000.00
0.00
967,340.00
0.00
121,500.00
1,658,300.00
23,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,250.00
0.00
82,600.00
2,840.00
3,540.00
131,700.00
0.00
0.00
0.00
0.00
0.00
0.00
4,667.00
0.00
414,021.00
0.00
20,250.00
949,536.00
1,975.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,500.00
0.00
41,300.00
1,657.00
2,360.00
41,558.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
81,000.00
0.00
5,375.00
42,000.00
0.00
7,633,645.00
233,333.00
182,250.00
14,614,634.00
429,275.00
0.00
53,467.00
216,353.00
0.00
126.00
6,901.00
0.00
171,050.00
0.00
503,450.00
298,685.00
21,240.00
374,025.00
0.00
0.00
467,833.00
CIGFYY
CIGHCH
CIGHLP
CIGHPL
CIGLCF
CIGLPN
CIGLPO
CIGLPR
CIGSRN
CIGYSR
DAFLPN
DANHCP
DANLFP
DN305
GEBBK
GEBBKB
GEBNKB
GECRPL
HDRHL
HSBCPP
HSBTLC
HUMHL
IMCGLP
LBCA1
LBD01
LDRNF
1
2
3
1
1
83
1
1
98
4
1
127
41
1
4
226
45
38
2
47
100
1
6
3
5
11
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
136PAGE :
11,100,000,000.00
105,000,000.00
150,000,000.00
24,500,000,000.00
5,450,000,000.00
1,950,000,000.00
70,000,000.00
395,000,000.00
300,000,000.00
100,000,000.00
450,000,000.00
1,300,000,000.00
600,000,000.00
3,600,000,000.00
3,100,000,000.00
48,000,000.00
10,997,000,000.00
21,100,000,000.00
625,000,000.00
19,540,000,000.00
3,061,000,000.00
2,675,000,000.00
350,000,000.00
225,000,000.00
200,000,000.00
100,000,000.00
3,900,000,000.00
0.00
0.00
11,100,000,000.00
1,356,600,000.00
1,350,000,000.00
0.00
25,000,000.00
0.00
0.00
0.00
1,300,000,000.00
400,000,000.00
1,200,000,000.00
1,108,010,000.00
2,000,000.00
0.00
1,525,000,000.00
0.00
7,447,000,000.00
809,500,000.00
100,000,000.00
0.00
0.00
0.00
100,000,000.00
4,223,000.00
0.00
0.00
25,454,500.00
1,866,110.00
1,174,000.00
0.00
54,000.00
0.00
0.00
0.00
2,350,000.00
320,000.00
240,000.00
1,172,607.00
1,580.00
0.00
2,374,250.00
0.00
4,095,310.00
251,310.00
71,000.00
0.00
0.00
0.00
243,000.00
1,343,332.00
0.00
0.00
15,460,336.00
975,258.00
788,833.00
0.00
31,500.00
0.00
0.00
0.00
1,132,500.00
175,167.00
219,999.00
881,069.00
790.00
0.00
1,128,063.00
0.00
2,477,040.00
120,025.00
20,667.00
0.00
0.00
0.00
141,750.00
0.00
0.00
0.00
153,900.00
87,600.00
117,400.00
0.00
5,400.00
0.00
0.00
0.00
0.00
15,800.00
0.00
7,000.00
0.00
0.00
135,375.00
0.00
204,421.00
5,717.00
7,100.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
76,968.00
13,749.00
78,883.00
0.00
3,150.00
0.00
0.00
0.00
0.00
1,317.00
0.00
4,083.00
0.00
0.00
66,933.00
0.00
139,061.00
4,873.00
2,067.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,343,332.00
0.00
0.00
15,383,369.00
961,509.00
709,950.00
0.00
28,350.00
0.00
0.00
0.00
1,132,500.00
173,850.00
219,999.00
876,986.00
790.00
0.00
1,061,134.00
0.00
2,338,018.00
115,154.00
18,600.00
0.00
0.00
0.00
141,750.00
LIFCRP
MANCGP
MANCLP
MANDEX
MANGMK
MANGPL
MANGPX
MANTLF
MANTLP
MANUTD
MANUTV
MISLPN
MISSRN
NIAOP
NIAPMD
NIAPMK
NISINP
PMCSHP
PMSSHP
PMTBPL
PMTBPS
PMTSHI
PMTSHT
RBSTLE
ROP01
ROP03
51
2
2
195
35
12
1
6
1
2
5
3
4
18
13
10
164
313
10
646
35
55
7
2
1
1
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADMINISTRATION REINSURANCE DIVISION
LIST OF CHANGE & PREMIUM ADJUSTMENT
ACCOUNTING ENTR
C U R R E N C Y
C O M P A N Y
:
:
:
2nd
RUPIAH
PT ASURANSI CIGNA
TYPE OF REINS.
LINE OF BUSINESS
CLASS OF BUSINESS
:
:
:
TREATY
INDIVIDUAL
NON MEDICAL
P O O L C O D E : 022
NO. CERT. NO. POLICY NO. DATE OFCOMMENC.
DATE OFCHANGES
NATURE OF CH.
PLAN CODE SUM ASSURED YEAR ORIGINALPREM. REFUND PREM. ORIG. COMM. PREM. DUE TO
REINSURERSPREM. DUE TO
CEDANTREFUND.COMM.
SUM REASSURED
01105/II/2012/01NO :
Quarter 2012
NON POOL
137PAGE :
Jakarta, 01 June 2012
PT. REASURANSI INTERNASIONAL INDONESIA CLAIM & TECHNICAL ADM. REINS. DEPARTMENT
SECTION HEAD
01 Cancellation
PT REASURANSI INTERNASIONAL INDONESIA 100.00% 2,569,002.00 59,803,314.00
C O M P A N Y SHARE GROSS PREMIUM COMMISSION NET. PREMIUM
REMARKS :
09 July 2012
GRAND TOTAL 232,488,420,000.00 73,498,610,000.00 59,803,367.00 0.002570
2,600,000,000.00
2,050,000,000.00
252,000,000.00
100,000,000.00
300,000,000.00
398,000,000.00
108,000,000.00
646,470,000.00
270,000,000.00
180,000,000.00
18,000,000.00
2,056,500,000.00
396,000,000.00
18,000,000.00
800,000,000.00
800,000,000.00
0.00
0.00
0.00
0.00
0.00
0.00
210,000,000.00
0.00
0.00
117,000,000.00
0.00
0.00
1,179,500.00
1,294,000.00
0.00
0.00
0.00
0.00
0.00
0.00
1,226,600.00
0.00
0.00
207,450.00
0.00
0.00
743,708.00
972,167.00
0.00
0.00
0.00
0.00
0.00
0.00
421,100.00
0.00
0.00
43,463.00
0.00
0.00
45,450.00
69,700.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,040.00
0.00
0.00
39,371.00
63,892.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
420.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
704,338.00
908,275.00
0.00
0.00
0.00
0.00
0.00
0.00
421,100.00
0.00
0.00
43,043.00
0.00
0.00
UBCA1
UBCA2
UBDN2
UBMU1
UBMU11
UBNG2
UBPM1
UNMPS
UOBEXP
USCB1
UUH01
UUS02
UUS03
UUS04
62,372,316.00
19
13
5
1
3
10
1
60
32
3
1
36
8
1
113,915,852.00 62,372,316.00 5,136,023.00 2,569,002.00
