| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT0001 |
|---|
| Effective Date | 11/01/2019 |
|---|
| Expiry Date | 11/30/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | LLOYD SAMATI |
|---|
| Policy Number | T/BT467 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | NETHERLANDS, IRELAND, ENGLAND |
|---|
| Address | P O BOX 51712
LIMBE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| LLOYD SAMATI |
MB028933 |
34 |
57,389.51 |
|
|---|
| Net Premium (Before Tax) | 57,389.51 |
|---|
| Total Premium (After Tax) | 67,858.77 |
|---|
| Signed by |  |
|---|
