| Agent | Rennies Travel |
|---|
| Agent Code | LL016 |
|---|
| Effective Date | 10/19/2017 |
|---|
| Expiry Date | 10/29/2017 |
|---|
| Plan | Plan B (World Wide Including USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | GEOFFREY FRANCIS SALANJE |
|---|
| Policy Number | T/RT342 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | UNITED STATES OF AMERICA (USA) |
|---|
| Address | Rennies Travel
P.o Box 31335
ADL House
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| GEOFFREY FRANCIS SALANJE |
MA021172 |
56 |
58,529.25 |
|
|---|
| Net Premium (Before Tax) | 58,529.25 |
|---|
| Service Fees | 15000 |
|---|
| Total Premium (After Tax) | 68,186.58 |
|---|
| Signed by |  |
|---|
