| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 12/19/2018 |
|---|
| Expiry Date | 01/11/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Patricia Joyce Kambalame |
|---|
| Policy Number | T/BT386 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Ireland |
|---|
| Address | P.O Box 55179
Limbe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Patricia Joyce Kambalame |
MA056730 |
49 |
50,756.60 |
|
|---|
| Net Premium (Before Tax) | 50,75660 |
|---|
| Total Premium (After Tax) | 60,131.44 |
|---|
| Signed by |  |
|---|
