| Agent | Continental Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 010 | ||||||||
| Effective Date | 06/08/2018 | ||||||||
| Expiry Date | 06/23/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Alexander Alexious Forster Nguwo | ||||||||
| Policy Number | 091 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | Austria | ||||||||
| Address | C/O Continental Travel and Tours | ||||||||
| Number of Passengers | ONE | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41,035.05 | ||||||||
| Total Premium (After Tax) | 47,805.83 | ||||||||
| Signed by |
