34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>06/07/2018</StartDate>
  <EndDate>06/23/2018</EndDate>
  <DestinationPlan>Italy</DestinationPlan>
  <NoOfApplicants>3</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Rosangela</Firstname>
    <Middlename>L</Middlename>
    <Lastname>Vieira</Lastname>
    <Age>63</Age>
    <Dob>02/26/1955</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Romeu</Firstname>
    <Middlename>G</Middlename>
    <Lastname>Vieira</Lastname>
    <Age>62</Age>
    <Dob>06/11/1955</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Doris</Firstname>
    <Middlename>P</Middlename>
    <Lastname>Vieira</Lastname>
    <Age>65</Age>
    <Dob>10/02/1952</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/07/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>193, Rua 24 de novembro</Address1>
      <Address2>Bairro Apediá</Address2>
      <Country>Brazil</Country>
      <State/>
      <City>Pimenta Bueno</City>
      <Postcode>76.970-000</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>rosangeladelacerda@yahoo.com.br</Email>
    <Phone>
      <Home>556934512627</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4984087012271580</CreditcardNumber>
      <NameonCreditcard>Rosângela  Lacerda</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2021</CreditcardExpirationYear>
      <CreditcardAmount>194.65</CreditcardAmount>
      <CreditcardCodeNumber>805</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>