34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>07/15/2017</StartDate>
  <EndDate>01/31/2018</EndDate>
  <DestinationPlan>Australia</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>James</Firstname>
    <Middlename>H</Middlename>
    <Lastname>Shelby</Lastname>
    <Age>48</Age>
    <Dob>09/16/1968</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>07/15/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2688 Wellfleet Dr.</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>North Carolina</State>
      <City>High point</City>
      <Postcode>27265</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jshelby@integrityoffshore.com</Email>
    <Phone>
      <Home>3368703032</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Pamela Y Shelby</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4744830008194055</CreditcardNumber>
      <NameonCreditcard>James H Shelby</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2021</CreditcardExpirationYear>
      <CreditcardAmount>301.5</CreditcardAmount>
      <CreditcardCodeNumber>668</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>