| Agent | Guardian - LL | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 12/09/2017 | ||||||||
| Expiry Date | 12/17/2017 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Salih Celiksoydan | ||||||||
| Policy Number | T/LLGIS002 | ||||||||
| Country of Origin | Turkis | ||||||||
| Destination Area | Germany - Manheim | ||||||||
| Address | Lilongwe | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 45,001.58 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 45,001.58 | ||||||||
| Signed by |
