| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 11/03/2017 |
|---|
| Expiry Date | 11/07/2017 |
|---|
| Plan | Plan B (World Wide Including USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Dr Mwayiwawo Morrison Madanitsa |
|---|
| Policy Number | T/BT281 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Baltimore,Maruland-USA |
|---|
| Address | P.O Box E198
Post Dot Net
Blantyre.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Dr Mwayiwawo Morrison Madanitsa |
MS000466 |
33 |
70,337.00 |
|
|---|
| Net Premium (Before Tax) | 70,337.00 |
|---|
| Total Premium (After Tax) | 82,942.61 |
|---|
| Signed by |  |
|---|
