| Agent | Manica Travel | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | LL016 | ||||||||
| Effective Date | 07/30/2019 | ||||||||
| Expiry Date | 08/14/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | BANDAZI SHEILA NTOMBOCELA | ||||||||
| Policy Number | T/RT661 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | NORWAY | ||||||||
| Address | MANICA TRAVEL | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 54,323.40 | ||||||||
| Service Fees | 13677 | ||||||||
| Total Premium (After Tax) | 68000 | ||||||||
| Signed by |
