| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/05/2018 |
|---|
| Expiry Date | 10/12/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Sithembile Chimaliro |
|---|
| Policy Number | t/bt381 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Israel |
|---|
| Address | QUEENS
P.O. Box 95
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Sithembile Chimaliro |
MA807404 |
26 |
41,310.50 |
|
|---|
| Net Premium (Before Tax) | 41,310.50 |
|---|
| Total Premium (After Tax) | 48,126.73 |
|---|
| Signed by |  |
|---|
