| Agent | Continental Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 010 | ||||||||
| Effective Date | 05/31/2018 | ||||||||
| Expiry Date | 08/28/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Jackson Stonaldy Chibwezo | ||||||||
| Policy Number | 091 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | Madrid Spain | ||||||||
| Address | C/O CONTINENTAL TRAVEL AND TOURS | ||||||||
| Number of Passengers | ONE | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 91,316.94 | ||||||||
| Total Premium (After Tax) | 106,384.24 | ||||||||
| Signed by |
