| Agent | Continental Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 010 | ||||||||
| Effective Date | 10/26/2018 | ||||||||
| Expiry Date | 11/05/2018 | ||||||||
| Plan | Plan B (World Wide Including USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Driana Patience Guwah | ||||||||
| Policy Number | 115 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | Montreal-Canada | ||||||||
| Address | C/O Continental Trael and Tours, | ||||||||
| Number of Passengers | ONE | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 61,367.68 | ||||||||
| Total Premium (After Tax) | 78,500.00 | ||||||||
| Signed by |
