| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 02/10/2019 | ||||||||
| Expiry Date | 02/16/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Stuart Sindani | ||||||||
| Policy Number | T/BT405 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Nairobi-Kenya | ||||||||
| Address | P.O Box 30537 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 40,129.61 | ||||||||
| Total Premium (After Tax) | 47,751.68 | ||||||||
| Signed by |
