| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 12/14/2018 |
|---|
| Expiry Date | 01/11/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Caroline Balakasi |
|---|
| Policy Number | T/BT389 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Portugal |
|---|
| Address | P.O Box 31379
Neno Mwanza
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Carloreen Balakasi |
MA928734 |
25 |
55,477.80 |
| Luiza Balakasi Torais |
MB004727 |
6 Months |
|
|
|---|
| Net Premium (Before Tax) | 55,477.80 |
|---|
| Total Premium (After Tax) | 65,631.64 |
|---|
| Signed by |  |
|---|
