| Agent | Kailash Pahlwani |
|---|
| Agent Code | MC |
|---|
| Effective Date | 11/02/2019 |
|---|
| Expiry Date | 11/10/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | HALMITON MOKIPATHA JIMMY DELEZAH |
|---|
| Policy Number | BB014 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | NIGERIA |
|---|
| Address | BLUEBERRY TRAVEL
P.O BOX 1358
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| HALMITON MOKIPATHA JIMMY DELEZAH |
MA101520 |
37 |
41,310.50 |
|
|---|
| Net Premium (Before Tax) | 41,310.50 |
|---|
| Total Premium (After Tax) | 48,126.73 |
|---|
| Signed by |  |
|---|
