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Insurance Verification Form

Insurance Verification Form Template for Indonesia

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Key Requirements PROMPT example:

Insurance Verification Form

"I need an Insurance Verification Form for my construction company in Jakarta that will be used to verify our comprehensive general liability and professional indemnity coverage to potential clients, with specific emphasis on projects starting in March 2025."

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Document background
The Insurance Verification Form is a critical document in the Indonesian insurance landscape, designed to meet the requirements set forth by the Financial Services Authority (OJK) and Law No. 40 of 2014 on Insurance. This document is typically required when businesses or individuals need to provide proof of insurance to third parties, such as landlords, business partners, or government agencies. The form includes essential information about the insurance policy, coverage details, and validity period, while incorporating necessary declarations and authorizations. It serves as an official verification tool that helps stakeholders confirm insurance coverage while ensuring compliance with Indonesian insurance regulations and documentation requirements. The standardized format of the Insurance Verification Form facilitates efficient processing and verification while maintaining consistency across different insurance providers and business sectors.
Suggested Sections

1. Form Identification: Document title, form number, and date of completion

2. Policyholder Information: Basic details of the policyholder including full legal name, address, and contact information as required by Indonesian regulations

3. Insurance Policy Details: Policy number, type of coverage, effective dates, and basic coverage information

4. Coverage Verification: Specific details of what is being verified, including coverage limits, deductibles, and any specific endorsements

5. Declaration of Accuracy: Statement confirming the accuracy of provided information, as required by Indonesian insurance regulations

6. Authorization: Permission to release and verify insurance information

7. Signature Block: Space for signatures, dates, and official stamps as required under Indonesian law

Optional Sections

1. Additional Insured Parties: Section for listing additional insured parties when applicable

2. Claims History: Optional section for declaring recent claims history when required by the requesting party

3. Premium Payment Verification: Section confirming premium payment status, used when specifically requested

4. Agent/Broker Information: Details of insurance agent or broker when policy was obtained through an intermediary

5. Foreign Language Translation: Parallel translation in another language if required for international use, as per Indonesian regulations

Suggested Schedules

1. Schedule A - Coverage Details: Detailed breakdown of specific coverage types, limits, and sublimits

2. Schedule B - Property Schedule: List of insured properties or assets when applicable

3. Appendix 1 - Supporting Documents: List of required supporting documents to be attached to the verification form

4. Appendix 2 - Terms and Conditions: Standard terms and conditions applicable to the verification process

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Linkedin in social icon imageX social icon image
alex.den.21@genieai.co
Relevant Industries

Financial Services

Insurance

Banking

Real Estate

Construction

Manufacturing

Healthcare

Transportation

Logistics

Retail

Professional Services

Energy

Mining

Agriculture

Technology

Relevant Teams

Legal

Risk Management

Compliance

Finance

Operations

Facilities Management

Procurement

Administrative Services

Insurance

Corporate Governance

Contract Management

Relevant Roles

Risk Manager

Insurance Coordinator

Compliance Officer

Legal Counsel

Finance Director

Operations Manager

Facility Manager

Property Manager

Contract Administrator

Insurance Underwriter

Claims Manager

Business Development Manager

Procurement Manager

Corporate Secretary

Chief Financial Officer

Chief Risk Officer

Industries
Law No. 40 of 2014 on Insurance: The primary insurance law in Indonesia that regulates insurance business operations, requirements for insurance products, and protection of policyholders' interests
OJK Regulation No. 23/POJK.05/2015: Regulation on insurance products and marketing of insurance products, including requirements for insurance documentation and disclosure
Indonesian Civil Code (KUHPerdata): Governs contractual relationships and legal requirements for valid agreements in Indonesia, including insurance contracts
Law No. 8 of 1999 on Consumer Protection: Provides framework for consumer protection rights and obligations, including insurance consumers
OJK Regulation No. 1/POJK.07/2013: Regulation on consumer protection in the financial services sector, including requirements for transparency and disclosure in insurance documentation
Law No. 11 of 2008 on Electronic Information and Transactions: Governs electronic transactions and documents, relevant if the insurance verification form will be used in digital format
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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