| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 01/03/2019 |
|---|
| Expiry Date | 01/12/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Khumbo Mtinkheni Kalua |
|---|
| Policy Number | T/STB/004/BT |
|---|
| Country of Origin | Malawian |
|---|
| Destination Area | China |
|---|
| Address | P.O. Box E180
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Khumbo Mtinkheni Kalua |
MA961966 |
49 |
43,671.10 |
|
|---|
| Net Premium (Before Tax) | 43,671.10 |
|---|
| Total Premium (After Tax) | 50,876.83 |
|---|
| Signed by |  |
|---|
