| Agent | Manica Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL016 | ||||||||
| Effective Date | 10/21/2018 | ||||||||
| Expiry Date | 10/26/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | MITCH MATOGA | ||||||||
| Policy Number | T/R587 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | MADRID | ||||||||
| Address | MANICA TRAVEL | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41,310.50 | ||||||||
| Service Fees | 29874 | ||||||||
| Total Premium (After Tax) | 78,000.00 | ||||||||
| Signed by |
