Agent | Libertas Lilongwe | ||||||||
---|---|---|---|---|---|---|---|---|---|
Agent Code | LL001 | ||||||||
Effective Date | 03/23/2018 | ||||||||
Expiry Date | 04/08/2018 | ||||||||
Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
Cover | Medical Only A-C | ||||||||
Name of Policy Holder | Shin Young Kim | ||||||||
Policy Number | T/LL383 | ||||||||
Country of Origin | Malawi | ||||||||
Destination Area | Amsterdam, London | ||||||||
Address | P. O. Box 31371 | ||||||||
Number of Passengers | 1 | ||||||||
List of persons insured |
| ||||||||
Net Premium (Before Tax) | 38,9583.60 | ||||||||
Service Fees | 0.00 | ||||||||
Total Premium (After Tax) | 46,380.94 | ||||||||
Signed by |