| Agent | Hubertus Clausius | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT007 | ||||||||
| Effective Date | 03/18/2018 | ||||||||
| Expiry Date | 03/24/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | James Mark Smith | ||||||||
| Policy Number | T/HC048 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Amsterdam-Netherlands | ||||||||
| Address | P.O Box 801 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41,314.20 | ||||||||
| Total Premium (After Tax) | 49,131.04 | ||||||||
| Signed by |
