| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 07/08/2019 | ||||||||
| Expiry Date | 07/28/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | David Chitsonga | ||||||||
| Policy Number | T/BT/445 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Netherland | ||||||||
| Address | Box 193, Blantyre | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 46,035.40 | ||||||||
| Total Premium (After Tax) | 53,631.24 | ||||||||
| Signed by |
