QBE PA Extra CoverPersonal accident insurance that protects you against unexpected accidents

Step 1: Apply

• ApproachanauthorisedQBE

agent/broker and discuss your

requirements, then select the plan

that best meets your needs.

• Fillouttheproposalformanddecide

onthemodeofpaymentmost

convenient to you.

Step 2: Understand the coverages in your Policy

• UponreceivingyourPolicy,read

through the policy wording, and

ensure that your needs are correctly

and sufficiently met.

• Callyouragent/brokerimmediately

forclarificationsshouldyoube

unclearofanywording.

What you need to do

Step 3: Check your Policy

• Ensurethatalldetailsand

informationareinorder.

What should you do in the event of a claim?

• Allclaimsmustbemadeto

PTQBEGeneralInsuranceIndonesia

immediatelyupontheoccurrenceof

the claim

• Doctor’sreportsorcertificatesand

hospital bills are required to support

the claim

• Retainallbills,invoicesandreceipts

To report a claim or to obtain a claim

form,pleasecontactyourinsurance

advisorortheQBEIndonesiaClaims

Departmentat+62215723737,emailat

claims@qbe.co.id or visit our website

at www.qbe.co.id

Just three simple steps and you can enjoy peace of mind.Jakarta MaspionPlaza8thFloorJalanGunungSahariRayaKav.18Jakarta14420Tel :+622164701278Fax:+622164701267/8

SemarangRukoMetroPlazaBlokB-12JalanMTHaryono970Semarang50242Tel :+62248457058/9Fax:+62248417867

MedanKompleksRukoJatiJunctionJalanTimorNo.3-TMedan20234Tel:+626188817009Fax:+626188817010

MakassarJalanJenderalAhmadYaniKomplekRukoA.YaniNo.23/25BlokC46Makassar90174Tel :+624113617978Fax:+624113610434

PT QBE General Insurance Indonesia

MidPlaza 2, 23rd Floor, Jalan Jenderal Sudirman Kav. 10-11Jakarta 10220, IndonesiaPhone : +62 21 5723737Fax : +62 21 5710547, 5710548Email : info.indo@qbe.co.idWebsite : www.qbe.co.id

PTQBEGeneralInsuranceIndonesiaisregisteredandsupervisedbytheFinancialServicesAuthority(OJK)

SurabayaGedungMedanPemuda7thFloorJalanPemudaNo.27-31Surabaya60271Tel :+62315477300Fax:+62315477370

CirebonKomplekRukoPulasarenJalanPulasarenRayaNo.C-5Cirebon45116Tel :+62231207784,234054Fax:+62231207784

BatamKomplekTanjungPantunBlokRNo.5.SeiJodoh,Batam29433Tel :+62778421066Fax:+62778430492

BaliPusatPertokoanSudirmanAgungBlokB12JalanJenderalSudirmanDenpasar80225Tel :+62361229894,255149Fax:+62361255150

SerpongSuteraNiaga3BlokCNo.11JalanRayaSerpongTangerang15325Tel :+622153122468Fax:+622153122431

BandungKomplekInternasionalTradeCentre(ITC)KosambiBlokDNo9JalanBaranangsiangNo.10Bandung40112Tel :+62224261848,70707042Fax:+62224262134

PekanbaruJalanKH.HasyimAshari16Pekanbaru28113Tel :+6276132708Fax:+6276131427

SamarindaJalanJenderalAhmadYaniNo.12Samarinda75117Tel :+62541200833Fax:+62541748878

Benefits at a glance• No medical examination is required

• Coverage up to IDR 1,000,000,000 available

• 125% compensationforTotalPermanentDisablement and Partial PermanentDisablement

• Accidental medical expenses limit is 20%

• Higher sub-limit for chinese physician/chiropractic treatment

• Excess free

• Free cover fordrivingamotorcycleandsportactivity(non-profesional)

• 24-hourworldwide cover

Cover1. Death, Total Permanent Disablement,

Partial Permanent Disablement andMedicalExpensesduetoanaccident

2. Riots,StrikesandCivilCommotions3. MurderandMolestation4. Missing5. Motorcyclingrisk6. SportsActivity(non-professional)

QBE Personal Accident (PA) Extra Cover

Extra Cover

1. Higher sub-limit for chinese physician /chiropractic treatment

2. AmbulanceExpenses

3. CertificateofDeathExpenses

4. FuneralExpensesSubsidy

Classification for Insured Person

Class 1:

Work in the office, accountants, architects, auditors, doctors, lawyers, secretaries, teachers, housewives, etc.

Class 2:

Field workers, civil engineers, projectmanagers, sales personnel, drivers, merchantsRetail,etc.

Class 3:

Operator of heavy machinery, workshop,Mine worker, builders, electrical workers, manual workers, etc.

Accidents can impact both your physical and yourfinancial health. With QBE PA Extra Cover, you willhave peace of mind knowing you are protected.Safeguardingyourwell-beingisourbusiness.

QBEPAExtraCoveroffersyouprotectionagainstanyunexpected accidents. This insurance is applicable to both individuals and businesses.

RESULT BENEFITS(% OF THE CAPITAL

SUM INSURED)

A DEATH 100%

B TOTAL PERMANENT DISABLEMENT

1. lossofsightofbotheyes 125%

2. lossormalfunctionofbotharms 125%

3. lossormalfunctionofbothlegs 125%

4. lossormalfunctionofsightofoneeyeandonearm;sightofoneeyeandoneleg;oronelegandonearm

125%

5. insanityortotalparalysis 125%

PARTIAL PERMANENT DISABLEMENT

6. Rightarmfromshoulderjoint 75%

7. Leftarmfromshoulderjoint 63%

8. Rightarmfromupperelbowjoint 63%

9. Leftarmfromupperelbowjoint 50%

10. Righthandfromupperwrist 50%

11. Lefthandfromupperwrist 38%

12. Onelegfromkneetohip 63%

13. Onelegfromankletoknee 31%

14. Rightthumb 19%

15. Leftthumb 13%

16. Rightindexfinger 13%

17. Leftindexfinger 10%

18. Rightlittlefinger 10%

19. Leftlittlefinger 8%

20.Rightmiddlefinger 6%

21. Leftmiddlefinger 5%

22. Onebigtoe 10%

23. Oneothertoe 6%

24. Incurableblindnessinoneeye 63%

25. Incurabledeafinbothears 63%

26. Incurabledeafinoneear 31%

27. Ear-side 6%

C MEDICAL EXPENSES 20%

Table of compensation

QBE PA Extra Cover

Tab

le o

f ben

efit

s

PLA

NA

BC

DE

FG

HI

Dea

th10,000,000

25,000,00050

,000,000

100,000,000

200,000,000

300,000,000

400,000,000

500,000,0001,0

00,000,000

Tota

l Per

man

ent

Disab

lemen

t12,500,000

31,250

,000

62,500,000

125,000,000

250,000,000

375,000,000

500,000,000

625,000,000

1,250

,000,000

Part

ial P

erm

anen

t Disab

lemen

t12,500,000

31,250

,000

62,500,000

125,000,000

250,000,000

375,000,000

500,000,000

625,000,000

1,250

,000,000

Acciden

talM

edical

Expe

nses

2,000,000

5,000,000

10,000,000

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

200,000,000

EXTR

A C

OV

ERA

BC

DE

FG

HI

Costo

falternative

trea

tmen

t(sinshe

)50

0,000

1,250

,000

2,50

0,000

5,000,000

10,000,000

10,000,000

10,000,000

10,000,000

10,000,000

Costo

fAmbu

lanc

e50

0,000

1,250

,000

2,50

0,000

5,000,000

5,000,000

5,000,000

5,000,000

5,000,000

5,000,000

Dea

thCertificate

Han

dlingCosts

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

Fune

ralC

osts

1,000,000

1,250

,000

2,50

0,000

5,000,000

5,000,000

5,000,000

5,000,000

5,000,000

5,000,000

AN

NU

AL

PREM

IUM

AB

CD

EF

GH

I

Class1

22,000

55,000

110,000

220

,000

440

,000

670

,000

875

,000

1,100,000

2,20

0,000

Class2

27,50

0

68,75

0

137,50

0

275

,000

550

,000

825

,000

1,100,000

1,375

,000

2,75

0,000

Class3

33,000

82,50

0

165,000

330

,000

660

,000

990

,000

1,325

,000

1,650

,000

3,30

0,000

Imp

ort

ant n

oti

ce:

Theinform

ationcontained

hereinissubjectto

theterm

s,conditionsan

dexclusionsofthepolicywording,acopyofw

hich

canbeobtained

fromQBEIn

donesiaoffice,yourag

entorbroker.