| Agent | Satguru Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LLW004 | ||||||||
| Effective Date | 09/23/2017 | ||||||||
| Expiry Date | 10/05/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Elizabeth Mairead Petersen | ||||||||
| Policy Number | Aug/22 | ||||||||
| Country of Origin | Ireland | ||||||||
| Destination Area | Tanzania | ||||||||
| Address | Lilongwe Malawi | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 43,674. | ||||||||
| Total Premium (After Tax) | 51,000 | ||||||||
| Signed by |
