| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT007 |
|---|
| Effective Date | 12/14/2017 |
|---|
| Expiry Date | 12/29/2017 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Kaylyn Carvalho |
|---|
| Policy Number | T/HC041 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Thailand |
|---|
| Address | P. O. Box 2832
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Kaylyn Carvalho |
MA641904 |
8 |
42,490.80 |
|
|---|
| Net Premium (Before Tax) | 42,490.80 |
|---|
| Service Fees | 0.00 |
|---|
| Total Premium (After Tax) | 50,501.78 |
|---|
| Signed by |  |
|---|
