| Agent | Rennies Travel |
|---|
| Agent Code | LL016 |
|---|
| Effective Date | 02/17/2018 |
|---|
| Expiry Date | 02/23/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Medical Only A-C |
|---|
| Name of Policy Holder | BENSON LAURENT KANSINJIRO |
|---|
| Policy Number | T/RT410 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | GERMANY |
|---|
| Address | RENNIES TRAVEL
P.O.BOX 31335
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| BENSON LAURENT KANSINJIRO |
MA069424 |
41 |
30,706.50 |
|
|---|
| Net Premium (Before Tax) | 30,706.50 |
|---|
| Total Premium (After Tax) | 35,773.07 |
|---|
| Signed by |  |
|---|
