| Agent | Ultimate Travel-LL | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | UTLL006 | ||||||||
| Effective Date | 04/04/2018 | ||||||||
| Expiry Date | 04/08/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | JOHN NYIRENDA | ||||||||
| Policy Number | U/UT005 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | NETHERLANDS | ||||||||
| Address | P.O. BOX 20 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 58,781.46 | ||||||||
| Total Premium (After Tax) | 58,781.46 | ||||||||
| Signed by |
