| Agent | Ultimate Travel-LL | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | UTLL006 | ||||||||
| Effective Date | 12/04/2018 | ||||||||
| Expiry Date | 12/14/2018 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | JULIUS NG'OMA | ||||||||
| Policy Number | U/UT014 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | POLAND | ||||||||
| Address | P.O.BOX 1041 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 69,820.89 | ||||||||
| Total Premium (After Tax) | 69,820.89 | ||||||||
| Signed by |
