| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 11/07/2019 |
|---|
| Expiry Date | 11/20/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Tutu Edwin Kachingwe Sisya |
|---|
| Policy Number | T/LL537 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | New York - United States of America |
|---|
| Address | C/O Standard Bank
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Tutu Edwin Kachingwe Sisya |
MA554907 |
39 |
70,337.00 |
|
|---|
| Net Premium (Before Tax) | 70,337.00 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 82,942.61 |
|---|
| Signed by |  |
|---|
