| Agent | Guardian Insurance | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 3004 | ||||||||
| Effective Date | 11/03/2018 | ||||||||
| Expiry Date | 11/11/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Falison Dangali Lemani | ||||||||
| Policy Number | T/LLGIS464 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Cote' Divoure | ||||||||
| Address | P/Bag 11 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 42,429.18 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 49430.00 | ||||||||
| Signed by |
