| Agent | Libertas Lilongwe/Kingfisher |
|---|
| Agent Code | LL001 |
|---|
| Effective Date | 09/23/2017 |
|---|
| Expiry Date | 09/30/2017 |
|---|
| Plan | Plan B (World Wide Including USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | JOSHUA MICHAEL LICHAKALA |
|---|
| Policy Number | T/KFLL103 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | U.S.A |
|---|
| Address | P.O. Box 30433
Lilongwe 3
Malawi
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Joshua Michael Lichakala |
MA110619 |
48 |
96,251.80 |
|
|---|
| Net Premium (Before Tax) | 96,251.80 |
|---|
| Total Premium (After Tax) | 113,133.35 |
|---|
| Signed by |  |
|---|
