Agent | Libertas Lilongwe | ||||||||
---|---|---|---|---|---|---|---|---|---|
Agent Code | LL001 | ||||||||
Effective Date | 11/10/2017 | ||||||||
Expiry Date | 11/18/2017 | ||||||||
Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
Cover | Medical Only A-C | ||||||||
Name of Policy Holder | Callum Coombes | ||||||||
Policy Number | T/LL338 | ||||||||
Country of Origin | Malawi | ||||||||
Destination Area | Brussels | ||||||||
Address | P.O Box 825 | ||||||||
Number of Passengers | 1 | ||||||||
List of persons insured |
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Net Premium (Before Tax) | 37,769.60 | ||||||||
Total Premium (After Tax) | 44,001.58 | ||||||||
Signed by |