| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/17/2019 |
|---|
| Expiry Date | 10/30/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | RODERICK KADAM'MANJA PHIRI |
|---|
| Policy Number | T/BT463 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | INDIA |
|---|
| Address | P O BOX 5792
LIMBE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| RODERICK KADAM'MANJA PHIRI |
MA992627 |
68 |
63,244.16 |
|
|---|
| Net Premium (Before Tax) | 63,244.16 |
|---|
| Total Premium (After Tax) | 73679.44 |
|---|
| Signed by |  |
|---|
