| 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 | PRISCA KAIMA | ||||||||
| Policy Number | T/BT471 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | DUBLIN, IRELAND | ||||||||
| Address | P O BOX 5863 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 52,848.58 | ||||||||
| Total Premium (After Tax) | 62,568.60 | ||||||||
| Signed by |
