| Agent | Libertas General Insurance Lilongwe Branch |
|---|
| Agent Code | LL001 |
|---|
| Effective Date | 01/22/2018 |
|---|
| Expiry Date | 02/01/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | Virginia Trindade |
|---|
| Policy Number | T/KFLL104 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | India |
|---|
| Address | P.O Box 30419
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Virginia Trindade |
MA023853 |
67 |
84,500.60 |
|
|---|
| Net Premium (Before Tax) | 84,500.60 |
|---|
| Total Premium (After Tax) | 99,443.20 |
|---|
| Signed by |  |
|---|
