| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | Lingalithu | ||||||||
| Effective Date | 09/17/2019 | ||||||||
| Expiry Date | 09/23/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Owen Dalton Sambo | ||||||||
| Policy Number | T/LL522 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Italy - Vatican | ||||||||
| Address | C/O Stansfield Motors | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 43,674.80 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 51,881.14 | ||||||||
| Signed by |
