| Agent | Libertas Lilongwe |
|---|
| Agent Code | 001 |
|---|
| Effective Date | 04/28/2020 |
|---|
| Expiry Date | 05/18/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | Benedicta Dorothy Fernandes |
|---|
| Policy Number | T/LL582 |
|---|
| Country of Origin | Malawi |
|---|
| Destination Area | Rome, Italy |
|---|
| Address | P.O. Box 601
Chiphaso
Kasungu
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| Benedicta Dorothy Fernandes |
Z2373346 |
61 |
68,267.81 |
|
|---|
| Net Premium (Before Tax) | 68,267.81 |
|---|
| Total Premium (After Tax) | 80,532.00 |
|---|
| Signed by |  |
|---|
