| Agent | Kailash Pahlwani |
|---|
| Agent Code | MC |
|---|
| Effective Date | 10/06/2019 |
|---|
| Expiry Date | 10/11/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | SHOUTS MAKHUMBO GALANG'A SIMEZAA |
|---|
| Policy Number | BB03 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | NORWAY |
|---|
| Address | BLUEBERRY TRAVEL
P.O BOX 1358
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| SHOUTS MAKHUMBO GALANG'A SIMEZA |
MA113077 |
44 |
43,674.80 |
|
|---|
| Net Premium (Before Tax) | 43,674.80 |
|---|
| Total Premium (After Tax) | 50,881.14 |
|---|
| Signed by |  |
|---|
