| 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 | Leesha Kotecha |
|---|
| Policy Number | T/BT400 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Dubai |
|---|
| Address | P.O Box 473
Blantyre.
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Leesha Kotecha |
M00236895 |
35 |
42,490.80 |
| Kimaya Kotecha |
544560372 |
4 |
0 |
|
|---|
| Net Premium (Before Tax) | 42,490.80 |
|---|
| Total Premium (After Tax) | 50,501.78 |
|---|
| Signed by |  |
|---|
