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www.claim-loket.polismall.id Open in urlscan Pro
35.190.85.97  Public Scan

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URL: https://www.claim-loket.polismall.id/
Submission: On August 20 via automatic, source certstream-suspicious — Scanned from US

Form analysis 1 forms found in the DOM

<form class="ant-form ant-form-vertical css-1ae8k9u">
  <div class="ant-form-item css-1ae8k9u">
    <div class="ant-row ant-form-item-row css-1ae8k9u">
      <div class="ant-col ant-form-item-label css-1ae8k9u"><label for="transactionId" class="" title="No Transaksi Loket">No Transaksi Loket</label></div>
      <div class="ant-col ant-form-item-control css-1ae8k9u">
        <div class="ant-form-item-control-input">
          <div class="ant-form-item-control-input-content"><input placeholder="00000" id="transactionId" class="ant-input css-1ae8k9u ant-input-outlined field-claim" type="text" value=""></div>
        </div>
      </div>
    </div>
  </div>
  <div class="ant-form-item css-1ae8k9u">
    <div class="ant-row ant-form-item-row css-1ae8k9u">
      <div class="ant-col ant-form-item-label css-1ae8k9u"><label for="insuredIdenfityNumber" class="" title="Nomor KTP/KITAS/KITAP/No Paspor">Nomor KTP/KITAS/KITAP/No Paspor</label></div>
      <div class="ant-col ant-form-item-control css-1ae8k9u">
        <div class="ant-form-item-control-input">
          <div class="ant-form-item-control-input-content"><input placeholder="0000 0000 0000 0000" id="insuredIdenfityNumber" class="ant-input css-1ae8k9u ant-input-outlined field-claim" type="text" value=""></div>
        </div>
      </div>
    </div>
  </div>
  <div class="ant-form-item css-1ae8k9u">
    <div class="ant-row ant-form-item-row css-1ae8k9u">
      <div class="ant-col ant-form-item-label css-1ae8k9u"><label for="insuredPhoneNumber" class="" title="Nomor Telepon">Nomor Telepon</label></div>
      <div class="ant-col ant-form-item-control css-1ae8k9u">
        <div class="ant-form-item-control-input">
          <div class="ant-form-item-control-input-content"><input placeholder="00000000" type="number" id="insuredPhoneNumber" class="ant-input css-1ae8k9u ant-input-outlined field-claim" value=""></div>
        </div>
      </div>
    </div>
  </div>
  <div class="ant-form-item css-1ae8k9u">
    <div class="ant-row ant-form-item-row css-1ae8k9u">
      <div class="ant-col ant-form-item-control css-1ae8k9u">
        <div class="ant-form-item-control-input">
          <div class="ant-form-item-control-input-content"><button type="submit" class="ant-btn css-1ae8k9u ant-btn-primary button-check"><span>Periksa</span></button></div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

 * Riplay Umum
 * FAQ
 * Indonesia

Checking Insurance...
 1. Home
 2. /
 3. Klaim

Klaim Asuransi
No Transaksi Loket

Nomor KTP/KITAS/KITAP/No Paspor

Nomor Telepon

Periksa
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PT Pialang Asuransi Provis Mitra Sinergi
Dipo Business Center, Rukan B-02, Jl. Gatot Subroto No.Kav 50-52, Petamburan,
Kecamatan Tanah Abang, Jakarta, Daerah Khusus Ibukota Jakarta 10260
Indonesia

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