| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 11/03/2017 | ||||||||
| Expiry Date | 11/17/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Yanira Mseka Ntupanyama | ||||||||
| Policy Number | T/LL 325 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Germany | ||||||||
| Address | P/Bag 350 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 53,196.39 | ||||||||
| Total Premium (After Tax) | 53,196.39 | ||||||||
| Signed by |
