| Agent | Libertas Lilongwe |
|---|
| Agent Code | T/LL349 |
|---|
| Effective Date | 12/09/2017 |
|---|
| Expiry Date | 12/18/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | Odala Lewis Peter Chakhwatha |
|---|
| Policy Number | T/LL349 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Switzerland |
|---|
| Address | P. O. Box 201
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Odala Lewis Peter Chakhwatha |
MS001854 |
39 |
37,769.60 |
|
|---|
| Net Premium (Before Tax) | 37,769.60 |
|---|
| Service Fees | 0.00 |
|---|
| Total Premium (After Tax) | 44,001.58 |
|---|
| Signed by |  |
|---|
