| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 07/18/2019 |
|---|
| Expiry Date | 07/27/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Micheal Tsilizani Eliya Phiri |
|---|
| Policy Number | T/BT453 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Mexico |
|---|
| Address | Box 30377, Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Micheal Tsilizani Eliya Phiri |
MA031236 |
56 |
42,482.15 |
|
|---|
| Net Premium (Before Tax) | 42,482.15 |
|---|
| Total Premium (After Tax) | 51,876.83 |
|---|
| Signed by |  |
|---|
