| Agent | Continental Travel and Tours | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 010 | ||||||||
| Effective Date | 11/19/2019 | ||||||||
| Expiry Date | 12/04/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Charlotte Rachel Mpambachulu | ||||||||
| Policy Number | 144 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Ireland | ||||||||
| Address | C/O Continental Travel and Tours, | ||||||||
| Number of Passengers | One | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 38,953.60 | ||||||||
| Total Premium (After Tax) | 47,380.94 | ||||||||
| Signed by |
