| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT01 |
|---|
| Effective Date | 10/01/2020 |
|---|
| Expiry Date | 12/29/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | TAMARA MARIANA LONJE |
|---|
| Policy Number | T/BT494 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | GERMANY |
|---|
| Address | P.O.BOX 1057 BLANTYRE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| TAMARA MARIANA LONJE |
MA208418 |
27 |
103040.80 |
|
|---|
| Net Premium (Before Tax) | 103040.80 |
|---|
| Total Premium (After Tax) | 121042.53 |
|---|
| Signed by |  |
|---|
