| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 11/01/2017 | ||||||||
| Expiry Date | 11/30/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | David Mbewe | ||||||||
| Policy Number | T/LL328 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Spain | ||||||||
| Address | Escom | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 59,795.25 | ||||||||
| Service Fees | 0.00 | ||||||||
| Total Premium (After Tax) | 69,657.97 | ||||||||
| Signed by |
