| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 11/01/2017 |
|---|
| Expiry Date | 08/31/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | Kondwani Harrison Thangalimodzi |
|---|
| Policy Number | T/BT277 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Estonia |
|---|
| Address | P/Bag 303
Blantyre.3
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Kondwani Harrison Thangalimodzi |
MA141021 |
41 |
393,043.60 |
|
|---|
| Net Premium (Before Tax) | 393,043.60 |
|---|
| Total Premium (After Tax) | 457,892.80 |
|---|
| Signed by |  |
|---|
