| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 11/11/2018 |
|---|
| Expiry Date | 11/18/2018 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Wezzie Rubigha Mwase |
|---|
| Policy Number | T/BT380 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Germany |
|---|
| Address | P.O BOX 51484
LIMBE
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Wezzie Rubigha Mwase |
MA266959 |
37 |
41,314.20 |
| Elsie Mwase |
|
5 months |
|
|
|---|
| Net Premium (Before Tax) | 41,314.20 |
|---|
| Service Fees | 6868.96 |
|---|
| Total Premium (After Tax) | 55,000.00 |
|---|
| Signed by |  |
|---|
