| Agent | Kailash Pahlwani |
|---|
| Agent Code | MC |
|---|
| Effective Date | 11/16/2019 |
|---|
| Expiry Date | 11/30/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | ELLIOT PAVEL WALDERSON MULANJE |
|---|
| Policy Number | BB021 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | DUBAI |
|---|
| Address | BLUEBERRY TRAVEL LIMITED
P.O BOX 1358
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| ELLIOT PAVEL WALDERSON MULANJE |
MA038931 |
56 |
46,031.70 |
|
|---|
| Net Premium (Before Tax) | 46,031.70 |
|---|
| Total Premium (After Tax) | 53,626.93 |
|---|
| Signed by |  |
|---|
