| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 09/24/2017 |
|---|
| Expiry Date | 10/01/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Denis Nansongole Banda |
|---|
| Policy Number | T/BT258 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Ghana |
|---|
| Address | P.O Box 20
Thyolo.
Malawi
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Denis Nansongole Banda |
MA528405 |
62 |
62,774.20 |
|
|---|
| Net Premium (Before Tax) | 62,774.20 |
|---|
| Total Premium (After Tax) | 74,131.94 |
|---|
| Signed by |  |
|---|
