| Agent | Libertas Lilongwe |
|---|
| Agent Code | LL001 |
|---|
| Effective Date | 11/17/2017 |
|---|
| Expiry Date | 11/26/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Patrick William Michael Kadewa |
|---|
| Policy Number | T/LL 335 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | France/ Belgium/ Norway |
|---|
| Address | P.O. Box 2047
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Patrick William Michael Kadewa |
MA115457 |
50 |
50,881.14 |
|
|---|
| Net Premium (Before Tax) | 50,881.14 |
|---|
| Total Premium (After Tax) | 50,881.17 |
|---|
| Signed by |  |
|---|
