| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/10/2019 |
|---|
| Expiry Date | 04/17/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Violet Audrey Kumwenda |
|---|
| Policy Number | T\BT21 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | South Africa |
|---|
| Address | Box 31928, BT
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Violet Audrey Kumwenda |
MA444250 |
8 |
41,314.20 |
|
|---|
| Net Premium (Before Tax) | 41,314.20 |
|---|
| Total Premium (After Tax) | 48,131.04 |
|---|
| Signed by |  |
|---|
