| Agent | Libertas Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 02/20/2021 |
|---|
| Expiry Date | 03/06/2021 |
|---|
| Plan | Plan B (World Wide Including USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Covid19 Extension Cover | Yes |
|---|
| Name of Policy Holder | DIVINE NYASHA MUSHAVA |
|---|
| Policy Number | T/BT526 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | CYPRUS |
|---|
| Address | MALAWI SUN HOTEL
P.O. BOX 2800
BLANTYRE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| DIVINE NYASHA MUSHAVA |
MWA049036 |
19 |
73,663.75 |
|
|---|
| Net Premium (Before Tax) | 73,663.75 |
|---|
| Total Premium (After Tax) | 86,818.27 |
|---|
| Covid19 Extension Fee | 17363.654 |
|---|
| Total Premium Payable | 104181.924 |
|---|
| Signed by |  |
|---|
