| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 03/20/2018 |
|---|
| Expiry Date | 06/17/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Mervis Liwasha |
|---|
| Policy Number | T/BT319 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Denmark |
|---|
| Address | P.O Box 1022
Blantyre.
Malawi
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Mervis Liwasha |
MA951485 |
34 |
100,329.20 |
|
|---|
| Net Premium (Before Tax) | 100,329.20 |
|---|
| Total Premium (After Tax) | 117,883.52 |
|---|
| Signed by |  |
|---|
