Fill in Policy Information DATA Informasi Data Olahraga Anda Apakah Anda atlit profesional Pilihan atlit profesional Ya Tidak Pilih Periode 1 Month Periode 3 Month Periode 6 Month Periode 12 Month Periode Pilih periode olahraga sesuai dengan yang kamu inginkan Pilih Paket yang diinginkan Sport Shield IDR 25.000 IDR 50.000 IDR 85.000 IDR 125.000 Fitur & Manfaat Kematian & Cacat Tetap Karena Kecelakaan IDR 100.000.000 Biaya Pemakaman IDR 1.000.000 Biaya Medis Karena Kecelakaan Termasuk Fisioterapi & Ambulans IDR 10.000.000 PILIH PAKET BATAL Sport Shield Plus IDR 66.000 IDR 132.000 IDR 222.750 IDR 330.000 Fitur & Manfaat Kematian & Cacat Tetap Karena Kecelakaan IDR 150.000.000 Biaya Pemakaman IDR 1.000.000 Biaya Medis Karena Kecelakaan Termasuk Fisioterapi & Ambulans IDR 15.000.000 PILIH PAKET BATAL Active Guard IDR 80.000 IDR 150.000 IDR 275.000 IDR 400.000 Fitur & Manfaat Kematian & Cacat Tetap Karena Kecelakaan IDR 200.000.000 Biaya Pemakaman IDR 1.000.000 Biaya Medis Karena Kecelakaan Termasuk Fisioterapi & Ambulans IDR 20.000.000 PILIH PAKET BATAL Pilih Periode Mulai Policy Holder Data Email Full Name Title Choose Title Male Female Place of Birth Date of Birth DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM January February March April May June July August September October November December YYYY 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 Nomor Identitas (KTP or KITAP) Nationality Select Nationality WNI WNA Negara Akrotiri Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas da India Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet 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