| Agent | Libertas General Insurance Lilongwe Branch |
|---|
| Agent Code | LL001 |
|---|
| Effective Date | 10/09/2017 |
|---|
| Expiry Date | 10/22/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | Bhubhile Chiwaya |
|---|
| Policy Number | T/LL311 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Delhi-India |
|---|
| Address | P/Bag B362
Lilongwe.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Bhubhile Chiwaya |
MA855369 |
19 |
37,769.60 |
|
|---|
| Net Premium (Before Tax) | 37,769.60 |
|---|
| Total Premium (After Tax) | 44,001.58 |
|---|
| Signed by |  |
|---|
