| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/06/2019 |
|---|
| Expiry Date | 07/06/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Talitha Abdul Gaffar |
|---|
| Policy Number | T/BT/413 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Germany |
|---|
| Address | Box 241,Blantyre
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Talitha Abdul Gaffar |
MA923853 |
30 |
165,202.00 |
| Ayden Khan |
MA923854 |
2 |
0 |
|
|---|
| Net Premium (Before Tax) | 165,202.00 |
|---|
| Total Premium (After Tax) | 193,506.93 |
|---|
| Signed by |  |
|---|
