| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 12/29/2019 |
|---|
| Expiry Date | 02/28/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | ANNABEL PROSPELLINE MUSGROVE |
|---|
| Policy Number | T/BT483 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | MODENA,ITALY |
|---|
| Address | P.O Box 60643
Blantyre 6
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| ANNABEL PROSPELLINE MUSGROVE |
MA520266 |
24 |
89,713.14 |
|
|---|
| Net Premium (Before Tax) | 89,713.14 |
|---|
| Total Premium (After Tax) | 105,515.81 |
|---|
| Signed by |  |
|---|
