| Agent | Continental Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 010 | ||||||||
| Effective Date | 03/30/2019 | ||||||||
| Expiry Date | 04/14/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Seodi Venekairudo White | ||||||||
| Policy Number | 125 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | SWITZERLAND | ||||||||
| Address | C/o Continental Travel and Tours | ||||||||
| Number of Passengers | One | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 40,238.66 | ||||||||
| Total Premium (After Tax) | 56,878.04 | ||||||||
| Signed by |
