| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 07/20/2019 |
|---|
| Expiry Date | 07/27/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Josephine Alinane Kamiza |
|---|
| Policy Number | T/BT449 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Czech Republic |
|---|
| Address | P/Bag 360, Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Joseph Alinane Kamiza |
MA056346 |
48 |
46,237.58 |
|
|---|
| Net Premium (Before Tax) | 46,237.58 |
|---|
| Total Premium (After Tax) | 53,866.79 |
|---|
| Signed by |  |
|---|
