| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT014 |
|---|
| Effective Date | 12/11/2017 |
|---|
| Expiry Date | 12/13/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Memory Dawe |
|---|
| Policy Number | T/KF171 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Mozambique |
|---|
| Address | Private Bag 143
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Memory Dawe |
MA098701 |
42 |
43,674.80 |
|
|---|
| Net Premium (Before Tax) | 43,674.80 |
|---|
| Service Fees | 0.00 |
|---|
| Total Premium (After Tax) | 50,881.14 |
|---|
| Signed by |  |
|---|
