| Agent | Libertas | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 001 | ||||||||
| Effective Date | 02/02/2014 | ||||||||
| Expiry Date | 03/01/2014 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Marshall Dyton | ||||||||
| Policy Number | T001 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Canada | ||||||||
| Address | XYZ123 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 2000 | ||||||||
| Total Premium (After Tax) | 2000 | ||||||||
| Signed by |
+265 111 832 844
+265 897 849 516
info@libertas.co.mw
Ground Floor, Unit House, Victoria Avenue, Blantyre
