| Agent | blueberrytravel |
|---|
| Agent Code | MC |
|---|
| Effective Date | 02/14/2020 |
|---|
| Expiry Date | 02/22/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | MICHAEL PRINCE SELALA MWASE |
|---|
| Policy Number | BB056 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | ZIMBABWE |
|---|
| Address | BLUEBERRY TRAVEL LIMITED
P.O BOX 1358
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| MICHAEL PRINCE SELALA MWASE |
MS001491 |
54 |
43,671.10 |
|
|---|
| Net Premium (Before Tax) | 43,671.10 |
|---|
| Total Premium (After Tax) | 50,876.83 |
|---|
| Signed by |  |
|---|
