| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 03/14/2020 |
|---|
| Expiry Date | 03/31/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | MADALO CHRISPIN MUSSA |
|---|
| Policy Number | T/BT490 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Netherlands(Amsterdam) |
|---|
| Address | P.O Box 30507
Blantyre
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| MADALO CHRISPIN MUSSA |
MA832983 |
31 |
44,787.50 |
|
|---|
| Net Premium (Before Tax) | 44,787.50 |
|---|
| Total Premium (After Tax) | 53,177.55 |
|---|
| Signed by |  |
|---|
