| Agent | Kailash Pahlwani | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | MC | ||||||||
| Effective Date | 12/07/2019 | ||||||||
| Expiry Date | 12/12/2019 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | ELLEN MDATHA MUMBA | ||||||||
| Policy Number | BB30 | ||||||||
| Country of Origin | MALAWI | ||||||||
| Destination Area | RWANDA | ||||||||
| Address | BLUEBERRY TRAVEL LIMITED | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 43,671.10 | ||||||||
| Total Premium (After Tax) | 50,876.83 | ||||||||
| Signed by |
