| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 12/07/2017 |
|---|
| Expiry Date | 01/16/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Jennifer Macpherson |
|---|
| Policy Number | T/BT290 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Perth, Malawi |
|---|
| Address | P. O. Box 15
Namitete
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Jennifer Macpherson |
534933249 (UK) |
74 |
195,552.40 |
|
|---|
| Net Premium (Before Tax) | 195,552.40 |
|---|
| Service Fees | 0.00 |
|---|
| Total Premium (After Tax) | 228,818.55 |
|---|
| Signed by |  |
|---|
