| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 12/24/2018 |
|---|
| Expiry Date | 01/07/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Mr Mahendra Kumar T Kotecha |
|---|
| Policy Number | T/BT397 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Dar-es-saalam |
|---|
| Address | P.O Box 473
Blantyre
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Mahendra Kumar T Kotecha |
MA927166 |
66 |
62,770.50 |
| Kimaya Kotecha |
544560372 |
4 |
0 |
|
|---|
| Net Premium (Before Tax) | 62,770.50 |
|---|
| Total Premium (After Tax) | 74,127.63 |
|---|
| Signed by |  |
|---|
