| Agent | Thofu Insurance Broker | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | TIB001 | ||||||||
| Effective Date | 12/28/2019 | ||||||||
| Expiry Date | 01/03/2020 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Medical Only A-C | ||||||||
| Name of Policy Holder | Khwima Yauka Kumwenda | ||||||||
| Policy Number | T/TIB484 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Dubai | ||||||||
| Address | P.O Box 31928 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 45,474.25 | ||||||||
| Total Premium (After Tax) | 53,977.50 | ||||||||
| Signed by |
