157.50.26.42
<?xml version="1.0" encoding="UTF-8"?>
<registrationxml>
<referenceid>b529243b</referenceid>
<planid>2</planid>
<deductibleamount>2500</deductibleamount>
<maximumlimit>60000</maximumlimit>
<startdate>05/13/2018</startdate>
<enddate>06/12/2018</enddate>
<destinationplan>US</destinationplan>
<noofapplicants>1</noofapplicants>
<personalinfo>
<applicants>
<applicant>
<firstname>Jeyaram</firstname>
<middlename></middlename>
<lastname>A</lastname>
<age>34</age>
<dob>01/01/1984</dob>
<gender>Male</gender>
<sportsrider>no</sportsrider>
</applicant>
</applicants>
</personalinfo>
<departureinfo>
<homecountrydeparturedate>05/13/2018</homecountrydeparturedate>
</departureinfo>
<applicantaddress>
<residenceaddress>
<address1>123, raju nagar</address1>
<address2>test</address2>
<country>IN</country>
<state>tamilnadu</state>
<city>chennai</city>
<postcode>600097</postcode>
</residenceaddress>
<mailforwardingaddress>
<address1>123, raju nagar</address1>
<address2>test</address2>
<country>IN</country>
<state>tamilnadu</state>
<city>chennai</city>
<postcode>600097</postcode>
</mailforwardingaddress>
<billingaddress>
<address1>123, raju nagar</address1>
<address2>test</address2>
<country>India</country>
<state>tamilnadu</state>
<city>chennai</city>
<postcode>600097</postcode>
</billingaddress>
<citizenshipcountry>IN</citizenshipcountry>
<email>jram@birbals.com</email>
<phone>
<home>(724) 234-7347</home>
<work></work>
</phone>
</applicantaddress>
<beneficiary>
<addbeneficiaryname>Selvi</addbeneficiaryname>
<addbeneficiaryrelationship>wife</addbeneficiaryrelationship>
<uniqueindentifiertype>Passport</uniqueindentifiertype>
<uniqueindentifiernumber>SFF3343433</uniqueindentifiernumber>
<issuingcountry>India</issuingcountry>
</beneficiary>
<couriercharges>no</couriercharges>
<paymentmethod>
<creditcard>
<creditcardtype>Visa</creditcardtype>
<creditcardnumber>4111111111111111</creditcardnumber>
<nameoncreditcard>Jeyaram</nameoncreditcard>
<creditcardexpirationmonth>02</creditcardexpirationmonth>
<creditcardexpirationyear>2021</creditcardexpirationyear>
<creditcardamount>35.59</creditcardamount>
<creditcardcodenumber>123</creditcardcodenumber>
</creditcard>
</paymentmethod>
</registrationxml>