| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 06/05/2019 |
|---|
| Expiry Date | 08/29/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Judith Efrida Talandira Van Meeuwen |
|---|
| Policy Number | T/LL492 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | schengen countries |
|---|
| Address | P.O. Box 30037
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Judith Efrida Talandira Van Meeuwen |
MB038294 |
6 |
100,329.20 |
|
|---|
| Net Premium (Before Tax) | 100,329.20 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 117,883.52 |
|---|
| Signed by |  |
|---|
