| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 03/23/2018 |
|---|
| Expiry Date | 04/08/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Mahendrakumar T. Kotecha |
|---|
| Policy Number | T/BT321 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Delhi-India |
|---|
| Address | P.O Box 473
Blantyre.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Mahendrakumar T. Kotecha |
MA927166 |
66 |
62,774.20 |
|
|---|
| Net Premium (Before Tax) | 62,774.20 |
|---|
| Total Premium (After Tax) | 74,131.94 |
|---|
| Signed by |  |
|---|
