| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 05/27/2019 |
|---|
| Expiry Date | 06/17/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Mgawa Mkandawire |
|---|
| Policy Number | T/BT406 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | London- UK/Rome-Italy |
|---|
| Address | P.O Box 40131
Kanengo
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Mgawa Mkandawire |
MA314234 |
29 |
55,477.80 |
|
|---|
| Net Premium (Before Tax) | 55,477.80 |
|---|
| Total Premium (After Tax) | 65,627.33 |
|---|
| Signed by |  |
|---|
