| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/12/2018 |
|---|
| Expiry Date | 05/01/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Wezi Chatepa |
|---|
| Policy Number | T/BT312 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Schengen Countries-Netherlands,France,Spain |
|---|
| Address | P.O Box 30746
Blantyre.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Wezi Chatepa |
MA225578 |
19 |
42,490.80 |
|
|---|
| Net Premium (Before Tax) | 42,490.80 |
|---|
| Total Premium (After Tax) | 51,501.78 |
|---|
| Signed by |  |
|---|
