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Jan 30, 2022

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AgentKailash Pahlwani
Agent CodeMC
Effective Date11/29/2019
Expiry Date12/19/2019
PlanPlan A (World Wide Excluding USA & Canada)
CoverFull Package A-I
Name of Policy HolderMODESTO SLYVESTER GOMANI
Policy NumberBB025
Country of OriginMALAWI
Destination AreaCHINA
Address

BLUEBERRY TRAVEL LIMITED
P.O BOX 1358
LILONGWE

Number of Passengers1
List of persons insured
Name Passport Number Age Premium
MODESTO SLYVESTER GOMANI MA280615 47 46,031.70
Net Premium (Before Tax)46,031.70
Total Premium (After Tax)53,626.93
Signed by