| Agent | Libertas Lilongwe |
|---|
| Agent Code | LL001 |
|---|
| Effective Date | 03/10/2018 |
|---|
| Expiry Date | 03/18/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Mike Tiyamike Mangani Mkayenda |
|---|
| Policy Number | T/LL373 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Spain |
|---|
| Address | P.O. Box 2047,
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Mike Tiyamike Mangani Mkayenda |
MA116831 |
39 |
41,314.20 |
|
|---|
| Net Premium (Before Tax) | 49,131.04 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 49,131.04 |
|---|
| Signed by |  |
|---|
