| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/28/2018 |
|---|
| Expiry Date | 05/06/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Sr Mercy Annie Kanyumbu |
|---|
| Policy Number | T/BT326 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Paris-France |
|---|
| Address | P.O Box 21
Lunzu
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Sr Mercy Annie Kanyumbu |
MA020613 |
62 |
62,443.42 |
|
|---|
| Net Premium (Before Tax) | 62,443.42 |
|---|
| Total Premium (After Tax) | 73,746.58 |
|---|
| Signed by |  |
|---|
