| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT001 | ||||||||
| Effective Date | 08/15/2019 | ||||||||
| Expiry Date | 10/30/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Mary Kazembe | ||||||||
| Policy Number | T/BT459 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Italy | ||||||||
| Address | P.O Box 21 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 100,329.20 | ||||||||
| Total Premium (After Tax) | 117,883.52 | ||||||||
| Signed by |
