| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 02/20/2021 |
|---|
| Expiry Date | 02/27/2021 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Covid19 Extension Cover | Yes |
|---|
| Name of Policy Holder | CHIMWEMWE TAMBALA NSABWE |
|---|
| Policy Number | T/BT527 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | DUBAI |
|---|
| Address | C/O STANDARD BANK
P.O.BOX 1297
BLANTYRE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| CHIMWEMWE TAMBALA NSABWE |
MB001571 |
41 |
46,389.72 |
|
|---|
| Net Premium (Before Tax) | 46,389.72 |
|---|
| Total Premium (After Tax) | 55,044.02 |
|---|
| Covid19 Extension Fee | 11008.804 |
|---|
| Total Premium Payable | 66052.824 |
|---|
| Signed by |  |
|---|
