| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 06/15/2019 |
|---|
| Expiry Date | 06/22/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | James Raphael Kandulu |
|---|
| Policy Number | T/BT443 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Germany |
|---|
| Address | Box 31928, Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| James Raphael Kandulu |
MS003002 |
49 |
43,674.80 |
|
|---|
| Net Premium (Before Tax) | 43,674.80 |
|---|
| Total Premium (After Tax) | 51,881.14 |
|---|
| Signed by |  |
|---|
