| Agent | Libertas Lilongwe | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Agent Code | 001 | ||||||||
| Effective Date | 03/22/2020 | ||||||||
| Expiry Date | 03/27/2020 | ||||||||
| Plan | Plan A (World Wide Excluding USA & Canada) | ||||||||
| Cover | Full Package A-I | ||||||||
| Name of Policy Holder | Golden Golie Nyasulu | ||||||||
| Policy Number | T/LL 579 | ||||||||
| Country of Origin | Malawi | ||||||||
| Destination Area | Germany | ||||||||
| Address | Private Bag 309, | ||||||||
| Number of Passengers | 1 | ||||||||
| List of persons insured |
| ||||||||
| Net Premium (Before Tax) | 43,674.80 | ||||||||
| Total Premium (After Tax) | 51,500.00 | ||||||||
| Signed by |
