| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/21/2017 |
|---|
| Expiry Date | 11/19/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Innocent Peturo Makuwira |
|---|
| Policy Number | T/BT268 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Czech Republic |
|---|
| Address | C/O F Gunde
Maneb
P.O Box 191
Zomba
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Innocent Peturo Makuwira |
MA937594 |
19 |
55,477.80 |
|
|---|
| Net Premium (Before Tax) | 55,477.80 |
|---|
| Total Premium (After Tax) | 65,631.64 |
|---|
| Signed by |  |
|---|
