| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 05/27/2019 |
|---|
| Expiry Date | 06/03/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Kalero Mkandawire |
|---|
| Policy Number | T/BT403 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Italy |
|---|
| Address | P.O Box 30176
Chichiri
Blantyre 3.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Kalero Mkandawire |
MA044082 |
63 |
62,774.19 |
|
|---|
| Net Premium (Before Tax) | 62,774.19 |
|---|
| Total Premium (After Tax) | 74,131.94 |
|---|
| Signed by |  |
|---|
