| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 06/23/2019 |
|---|
| Expiry Date | 06/29/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Amanda Jaja Babu Pulla |
|---|
| Policy Number | T/BT450 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Rome, Italy |
|---|
| Address | Box 31439, Chichiri
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Amanda Jaja Babu Pulla |
J7942740 |
42 |
46,237.58 |
|
|---|
| Net Premium (Before Tax) | 46,237.58 |
|---|
| Total Premium (After Tax) | 53,866.79 |
|---|
| Signed by |  |
|---|
