| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 001 | ||||||||
| Effective Date | 10/05/2019 | ||||||||
| Expiry Date | 10/21/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Mariam Ashley Matenje | ||||||||
| Policy Number | T/LL21 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Norway | ||||||||
| Address | P.O. Box 609 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 42,490.80 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 50,501.78 | ||||||||
| Signed by |
