| Agent | Libertas General Insurance Co. |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/05/2019 |
|---|
| Expiry Date | 04/29/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Aurthur Semusi Bvumbwe |
|---|
| Policy Number | T/BT408 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Netherlands |
|---|
| Address | P.O Box 650
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Aurther Semusi Bvumbwe |
MA858312 |
14 |
41,310.50 |
|
|---|
| Net Premium (Before Tax) | 41,310.50 |
|---|
| Total Premium (After Tax) | 49,126.73 |
|---|
| Signed by |  |
|---|
