| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 09/10/2019 |
|---|
| Expiry Date | 09/19/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | JANE GENEROUS KAMWENDO |
|---|
| Policy Number | T/BT466 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | BELGIUM-NORWAY |
|---|
| Address | ESCOM
P O BOX 2047
BLANTYRE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| JANE GENEROUS |
MA039686 |
56 |
44,709.96 |
|
|---|
| Net Premium (Before Tax) | 44,709.96 |
|---|
| Total Premium (After Tax) | 53,087.10 |
|---|
| Signed by |  |
|---|
