| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/15/2017 |
|---|
| Expiry Date | 10/28/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Saidi/Justin Adack Kumpheto |
|---|
| Policy Number | T/BT273 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Zurich,Switzerland |
|---|
| Address | C/O TMT
P.O Box 423
Blantyre.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Saidi/Justin Adack Kumpheto |
MD001740 |
54 |
43,674.80 |
|
|---|
| Net Premium (Before Tax) | 43,674.80 |
|---|
| Total Premium (After Tax) | 51,881.14 |
|---|
| Signed by |  |
|---|
