| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT0001 |
|---|
| Effective Date | 11/17/2019 |
|---|
| Expiry Date | 12/08/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | FRED RABSON KAIMA |
|---|
| Policy Number | T/BT470 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | DUBLIN, IRELAND |
|---|
| Address | P O BOX 5863
LIMBE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| FRED RABSON KAIMA |
MA149724 |
63 |
76,672.44 |
|
|---|
| Net Premium (Before Tax) | 76,672.44 |
|---|
| Total Premium (After Tax) | 90,323.39 |
|---|
| Signed by |  |
|---|
