| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 04/09/2018 | ||||||||
| Expiry Date | 04/15/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Victoria Munthali | ||||||||
| Policy Number | T/LL388 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | France - Paris | ||||||||
| Address | P.O. Box 512 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 45,001.58 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 45,001.58 | ||||||||
| Signed by |
