| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 09/10/2019 |
|---|
| Expiry Date | 09/27/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Milla Maria Gustafsson |
|---|
| Policy Number | T/BT464 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Finland |
|---|
| Address | P O Box 272
Mzuzu
|
|---|
| Number of Passengers | 2 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Milla Maria Gustafsson |
FP2215097 |
36 |
42,489..27 |
| Leo Liontafari Kaisi |
FP1406903 |
4 |
0 |
|
|---|
| Net Premium (Before Tax) | 42,489.27 |
|---|
| Total Premium (After Tax) | 50,500.00 |
|---|
| Signed by |  |
|---|
