| Agent | Hubertus Clausius |
|---|
| Agent Code | BT007 |
|---|
| Effective Date | 03/01/2018 |
|---|
| Expiry Date | 03/31/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | Arjuna Kanishka Abeyweera |
|---|
| Policy Number | T/HC042 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | France and Switzerland |
|---|
| Address | P.O Box 5338
Limbe.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Arjuna Kanishka Abeyweera |
N5134632 |
32 |
48,396.00 |
|
|---|
| Net Premium (Before Tax) | 48,396.00 |
|---|
| Total Premium (After Tax) | 57,381.34 |
|---|
| Signed by |  |
|---|
