| Agent | Rennies Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL016 | ||||||||
| Effective Date | 04/16/2018 | ||||||||
| Expiry Date | 05/01/2018 | ||||||||
| Plan | Plan B (World Wide Including USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | ROSE CONSTANCE KAMOTO | ||||||||
| Policy Number | T/RT461 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | USA | ||||||||
| Address | Rennies Travel | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 71,683.32 | ||||||||
| Service Fees | 15000 | ||||||||
| Total Premium (After Tax) | 71,683.32 | ||||||||
| Signed by |
