| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL001 | ||||||||
| Effective Date | 09/22/2018 | ||||||||
| Expiry Date | 10/05/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | MARTHA CHISAMBA | ||||||||
| Policy Number | t/ll430 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Rome-Italy | ||||||||
| Address | Private Bag 67,Lilongwe | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41,314.20 | ||||||||
| Total Premium (After Tax) | 48,131.04 | ||||||||
| Signed by |
