Car Insurance Form

Any insurance claims on this car in the past 2 years?

A – Banten (Serang, Pandeglang, Lebak, Cilegon)

D – Bandung, West Java (Cimahi, Sumedang)

E – Cirebon, Indramayu, Majalengka, Kuningan

K – Kudus, Jepara, Pati, Blora, Rembang

M – Madura Island (Bangkalan, Sampang, Pamekasan, Sumenep)

N – Malang, Probolinggo, Pasuruan, Lumajang

R – Banyumas, Cilacap, Purbalingga, Banjarnegara

BA – West Sumatra (Padang, Bukittinggi, Solok)

BG – South Sumatra (Palembang, Lubuklinggau)

BK – North Sumatra (Medan, Binjai, Deli Serdang)

BP – Riau Islands (Batam, Tanjung Pinang)

DK – Bali (Denpasar, Badung, Gianyar, etc.)

DR – West Nusa Tenggara (Mataram, Lombok)

DH – East Nusa Tenggara (Kupang, Flores, Sumba)

DA – South Kalimantan (Banjarmasin, Banjarbaru)

KB – West Kalimantan (Pontianak, Singkawang)

KH – Central Kalimantan (Palangka Raya)

KT – East Kalimantan (Balikpapan, Samarinda)

KU – North Kalimantan (Tarakan, Tanjung Selor)

DD – South Sulawesi (Makassar, Gowa, Maros)

DL – North Sulawesi (Tomohon, Minahasa)

DT – Southeast Sulawesi (Kendari, Bau-Bau)

DW – South Sulawesi (Bone, Wajo, Soppeng)