| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 12/08/2019 |
|---|
| Expiry Date | 12/15/2019 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | DR. Mphatso Steve Wilbes Kam'ndaya |
|---|
| Policy Number | T/LL565 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Germany |
|---|
| Address | P/Bag 303
Blantyre 3.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| DR. Mphatso Steve Wilbes Kam'ndaya |
MB118486 |
43 |
45,740.50 |
|
|---|
| Net Premium (Before Tax) | 45,740.50 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 54,287.68 |
|---|
| Signed by |  |
|---|
