| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 03/03/2018 |
|---|
| Expiry Date | 03/05/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Chipiliro Chizuzu |
|---|
| Policy Number | T/BT316 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Norway |
|---|
| Address | Queen Elizabeth Central Hosp.
P.O Box 95
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Chipiliro Chizuzu |
MA950943 |
39 |
41,314.20 |
|
|---|
| Net Premium (Before Tax) | 41,314.20 |
|---|
| Total Premium (After Tax) | 49,131.04 |
|---|
| Signed by |  |
|---|
