| Agent | Excpress Insurance Brokers |
|---|
| Agent Code | 3016 |
|---|
| Effective Date | 02/16/2020 |
|---|
| Expiry Date | 02/24/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Steven Derrick Manyozo |
|---|
| Policy Number | T/LL567 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Sweden |
|---|
| Address | P/Bag 360
Chichiri
Blantyre 3.
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Steven Derrick Manyozo |
MA638103 |
26 |
47,082.74 |
|
|---|
| Net Premium (Before Tax) | 47,082.74 |
|---|
| Service Fees | 0 |
|---|
| Total Premium (After Tax) | 47,082.74 |
|---|
| Signed by |  |
|---|
