| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 01 | ||||||||
| Effective Date | 02/21/2020 | ||||||||
| Expiry Date | 03/08/2020 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Samuel Foster Chiwanda | ||||||||
| Policy Number | T/LL572 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Spain | ||||||||
| Address | P/Bag B391 | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 44,500.50 | ||||||||
| Service Fees | 0 | ||||||||
| Total Premium (After Tax) | 52,843.08 | ||||||||
| Signed by |
