34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>09/10/2021</StartDate>
  <EndDate>09/27/2021</EndDate>
  <DestinationPlan>Thailand</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Neil</Firstname>
    <Middlename>E</Middlename>
    <Lastname>Weidman</Lastname>
    <Age>66</Age>
    <Dob>07/25/1955</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/10/2021</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>717 S Columbus Blvd #411</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Pennsylvania</State>
      <City>Philadelphia</City>
      <Postcode>19147</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>nweidman@comcast.net</Email>
    <Phone>
      <Home>6102022605</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Amanda Weidman</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5122304600233686</CreditcardNumber>
      <NameonCreditcard>Neil Weidman</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>91.8</CreditcardAmount>
      <CreditcardCodeNumber>203</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>