| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 11/11/2018 | ||||||||
| Expiry Date | 11/16/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Peter Dias | ||||||||
| Policy Number | T/BT387 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Lesotho | ||||||||
| Address | P.O Box 9037 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 41,314.19 | ||||||||
| Total Premium (After Tax) | 49,131.04 | ||||||||
| Signed by |
