| 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 | ABdul Gaffar | ||||||||
| Policy Number | T/BT/415 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Germany | ||||||||
| Address | Box 241,Blantyre | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 165,242.00 | ||||||||
| Total Premium (After Tax) | 192,506.93 | ||||||||
| Signed by |
