| Agent | Libertas Lilongwe |
|---|
| Agent Code | Guardian |
|---|
| Effective Date | 07/07/2019 |
|---|
| Expiry Date | 08/08/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Moussa Jamal Mphonda Valle |
|---|
| Policy Number | T/GIS508 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Windhoek - Namibia |
|---|
| Address | P.O. Box 30337,
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Moussa Jamal Mphonda Valle |
MA051946 |
62 |
86,784.40 |
|
|---|
| Net Premium (Before Tax) | 86,784.40 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 101,103.83 |
|---|
| Signed by |  |
|---|
