Travel Insurance Policy (Direct)

"*" indicates required fields

Departure Date*

Return Date*

Name of Policy Holder*

Email*

Where a copy of policy certificate will be sent to.

Date of Birth*

Passport Number*

Client Age

Address*

Cover*

Medical Only A-C

Full Package A-I

Plan*

Hidden

Travel Period (days)

Covid19 Extension Cover*

Yes

This will attract extra charge of 20% of the total premium.

Country of Origin*

Destination Country*

Premium

Price:

Payment

Net Premium (before tax)

Hidden

Tax

Total Premium (after tax)

Covid19 Extension Fee (50%)

Covid19 Extension Fee (35%)

Covid19 Extension Fee (20%)

Hidden

Stamp Duty

Total Premium Payable

Including MK5,000.00 Stamp Duty

Premium Payable

Price: $0.00

Total

Hidden

Date

Policy Number

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Subtotal
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Due Today

+265 111 832 844

+265 897 849 516

info@libertas.co.mw

Ground Floor, Unit House, Victoria Avenue, Blantyre

Travel Insurance Policy (Direct)

Payment

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