| Agent | Ulendo Travel Group | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL02 | ||||||||
| Effective Date | 11/06/2017 | ||||||||
| Expiry Date | 11/10/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | EVELYN ZIONE UDEDI | ||||||||
| Policy Number | T/UTG245 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | TANZANIA | ||||||||
| Address | Subira Msumba, | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41104 | ||||||||
| Total Premium (After Tax) | 47887.00 | ||||||||
| Signed by |
