| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 01/28/2018 | ||||||||
| Expiry Date | 02/14/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Tuchitechi Hawonga | ||||||||
| Policy Number | T/LL 356 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | India | ||||||||
| Address | Lilongwe | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 49,131.04 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 49,131.04 | ||||||||
| Signed by |
