| Agent | Rennies Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL016 | ||||||||
| Effective Date | 01/10/2018 | ||||||||
| Expiry Date | 02/10/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | MINESS MAGDALENA MBOMA | ||||||||
| Policy Number | T/RT375 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | GERMANY | ||||||||
| Address | RENNIES TRAVEL | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 44,982.00 | ||||||||
| Service Fees | 25000 | ||||||||
| Total Premium (After Tax) | 52,404.03 | ||||||||
| Signed by |
