| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 10/12/2017 | ||||||||
| Expiry Date | 10/30/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Maria Mendulo | ||||||||
| Policy Number | T/BT257 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | China | ||||||||
| Address | Amitofo Care Centre | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 38,953.60 | ||||||||
| Total Premium (After Tax) | 46,380.94 | ||||||||
| Signed by |
