| Agent | Ultimate Travel-LL | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | UTLL006 | ||||||||
| Effective Date | 06/01/2019 | ||||||||
| Expiry Date | 07/01/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | JACK NJANJI | ||||||||
| Policy Number | U/UT015 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | PORTUGAL | ||||||||
| Address | P.O. BOX 1041 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 82,823.76 | ||||||||
| Total Premium (After Tax) | 82,823.76 | ||||||||
| Signed by |
