| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 02/17/2019 | ||||||||
| Expiry Date | 04/17/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Rose Chimtole | ||||||||
| Policy Number | T/BT399 | ||||||||
| Country of Origin | Malawian | ||||||||
| Destination Area | Ireland | ||||||||
| Address | P.O Box 3158 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 70,818.00 | ||||||||
| Total Premium (After Tax) | 83,502.97 | ||||||||
| Signed by |
