34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>100</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>07/01/2017</StartDate>
  <EndDate>07/06/2017</EndDate>
  <DestinationPlan>Bermuda</DestinationPlan>
  <NoOfApplicants>2</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>James </Firstname>
    <Middlename>F</Middlename>
    <Lastname>Mandler</Lastname>
    <Age>57</Age>
    <Dob>06/15/1960</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Patrick</Firstname>
    <Middlename>T</Middlename>
    <Lastname>Conley</Lastname>
    <Age>47</Age>
    <Dob>06/12/1970</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>07/01/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>47 Kentnor Street</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>New Jersey</State>
      <City>Metuchen</City>
      <Postcode>08840</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jjmwav@hotmail.com</Email>
    <Phone>
      <Home>9739192534</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>John J  Mandler</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Brother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>371706485525003</CreditcardNumber>
      <NameonCreditcard>John J Mandler</NameonCreditcard>
      <CreditcardExpirationMonth>11</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>33.26</CreditcardAmount>
      <CreditcardCodeNumber>6956</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>