| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/05/2018 |
|---|
| Expiry Date | 10/15/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Patrick Dongosolo Kamalo |
|---|
| Policy Number | t/bt383 |
|---|
| 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 |
|---|
| Patrick Dongosolo Kamalo |
MA144812 |
44 |
46,031.70 |
|
|---|
| Net Premium (Before Tax) | 46,031.70 |
|---|
| Total Premium (After Tax) | 53,631.24 |
|---|
| Signed by |  |
|---|
