| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 12/01/2017 | ||||||||
| Expiry Date | 02/27/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Thandikire Mbekeani | ||||||||
| Policy Number | T/LL336 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Sweden | ||||||||
| Address | P. O. Box 186 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 82,062.75 | ||||||||
| Service Fees | 0.00 | ||||||||
| Total Premium (After Tax) | 95,603.10 | ||||||||
| Signed by |
