| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 10/09/2019 |
|---|
| Expiry Date | 10/12/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Dr. Lazarus McCarthy Chakwera |
|---|
| Policy Number | T/LL539 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Rome. Italy |
|---|
| Address | P.O. Box 3199
Lilongwe
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Dr. Lazarus McCarthy Chakwera |
MD001936 |
65 |
62.774.20 |
|
|---|
| Net Premium (Before Tax) | 62.774.20 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 74,131.94 |
|---|
| Signed by |  |
|---|
