| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 10/02/2020 |
|---|
| Expiry Date | 11/30/2020 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Name of Policy Holder | ODYSSEUS CHANTAYA |
|---|
| Policy Number | T/BT498 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | JOHANNESBURG |
|---|
| Address | C/O STANDARD BANK MALAWI
P.O.BOX 30380
LILONGWE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| ODYSSEUS CHANTAYA |
MWA008404 |
13 |
72,253.50 |
|
|---|
| Net Premium (Before Tax) | 72,253.50 |
|---|
| Total Premium (After Tax) | 85,175.33 |
|---|
| Signed by |  |
|---|
