| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT0001 | ||||||||
| Effective Date | 11/24/2019 | ||||||||
| Expiry Date | 12/01/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | MERCY PHIRI | ||||||||
| Policy Number | T/BT478 | ||||||||
| Country of Origin | ZAMBIAN | ||||||||
| Destination Area | SWITZERLAND | ||||||||
| Address | C/O SOLOMON BANDA | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 43,017.00 | ||||||||
| Total Premium (After Tax) | 51,114.81 | ||||||||
| Signed by |
