| Agent | Libertas General Insurance Head Office |
|---|
| Agent Code | BT001 |
|---|
| Effective Date | 04/08/2021 |
|---|
| Expiry Date | 10/05/2021 |
|---|
| Plan | Plan A (World Wide Excluding USA & Canada) |
|---|
| Cover | Full Package A-I |
|---|
| Covid19 Extension Cover | No |
|---|
| Name of Policy Holder | GODWIN EPHRAIM KAMTUKULE |
|---|
| Policy Number | T/BT528 |
|---|
| Country of Origin | MALAWI |
|---|
| Destination Area | DARFUR,SUDAN |
|---|
| Address | P.O.BOX 1926,
BLANTYRE
|
|---|
| Number of Passengers | 1 |
|---|
| List of persons insured | | Name |
Passport Number |
Age |
Premium |
|---|
| GODWIN EPHRAIM KAMTUKULE |
MWA032314 |
49 |
274,052.90 |
|
|---|
| Net Premium (Before Tax) | 274,052.90 |
|---|
| Total Premium (After Tax) | 320,271.63 |
|---|
| Covid19 Extension Fee | 64054.326 |
|---|
| Total Premium Payable | 384325.956 |
|---|
| Signed by |  |
|---|
