Page 1 of 2

BPI Car Insurance Form

This form takes about 2 minutes. Please have your STNK (or STCK for new vehicles) and 4 photos of your car ready before you start.

1/ Car Use

What is this car primarily used for?

Motorbike Use

Personal use (private, non-commercial)

Business use (rental, delivery, taxi, or other commercial activity)

Company use (owned by a company, used by employees)

2/ Car Value

What is the current market value of your car? (in IDR) This is the insured amount used to calculate your premium. If unsure, check OLX or a local dealer for the current resale price of your model.

3/ STNK / STCK

Please upload your STNK (or STCK if the vehicle is new). [file upload]

4/ Car Photos

Please upload 4 photos of your car — front, back, left side, right side. [file upload]

5/ Existing Insurance

Is this car currently insured?

Active Insurance

yes

6/ Claims History

Have there been any insurance claims on this car in the last 2 years?

Claims in the past 2 years

yes

7/ Your Address in Indonesia

8/ Contact Details

9/ Your BPI Contact

Are you already in touch with a BPI team member?

In touch with BPI

yes

Additional Note