| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 05/11/2019 | ||||||||
| Expiry Date | 06/10/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Evalistar Phiri | ||||||||
| Policy Number | T/BT431 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Ukraine | ||||||||
| Address | Box 5211, Limbe | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 165,242.00 | ||||||||
| Total Premium (After Tax) | 193,506.93 | ||||||||
| Signed by |
