| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 12/27/2018 |
|---|
| Expiry Date | 01/07/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Nicholas Raynard Kodwo Nyengo |
|---|
| Policy Number | T/LL473 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Udine - Italy |
|---|
| Address | P.O. Box 2297,
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Nicholas Raynard Kodwo Nyengo |
MA135736 |
78 |
125,548.40 |
|
|---|
| Net Premium (Before Tax) | 125,548.40 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 147,263.89 |
|---|
| Signed by |  |
|---|
