| Agent | Libertas General Insurance Head Office | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | BT0001 | ||||||||
| Effective Date | 12/17/2019 | ||||||||
| Expiry Date | 01/04/2020 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | CHIKUMBUTSO MATHUMBA | ||||||||
| Policy Number | T/BT481 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | ITALY | ||||||||
| Address | P O BOX 5101 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 44,242.10 | ||||||||
| Total Premium (After Tax) | 52,542.04 | ||||||||
| Signed by |
