| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT0001 |
|---|
| Effective Date | 10/16/2019 |
|---|
| Expiry Date | 10/23/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | KALIYAPERUMAL PUGALENDHI |
|---|
| Policy Number | T/BT469 |
|---|
| Country of Origin | INDIAN |
|---|
| Destination Area | GERMANY |
|---|
| Address | EASYPACK LIMITED
P O BOX 30477
CHICHIRI
BLANYTRE 3
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| KALIYAPERUMAL PUGALENDHI |
719397 |
51 |
44,236.85 |
|
|---|
| Net Premium (Before Tax) | 44,236.85 |
|---|
| Total Premium (After Tax) | 53,978.26 |
|---|
| Signed by |  |
|---|
