| Agent | Rennies Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL016 | ||||||||
| Effective Date | 10/01/2017 | ||||||||
| Expiry Date | 10/07/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | MUSEKA RICHARD | ||||||||
| Policy Number | T/RT336 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | LUSAKA | ||||||||
| Address | RENNIES TRAVEL | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 27,912.50 | ||||||||
| Total Premium (After Tax) | 32,518.06 | ||||||||
| Signed by |
