54.87.230.228
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>08/13/2016</StartDate>
  <EndDate>08/16/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Goncalo </Firstname>
    <Middlename> </Middlename>
    <Lastname>Silva</Lastname>
    <Age>37</Age>
    <Dob>08/14/1978</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/13/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Tv encosta pilar bloco a6 - 3D </Address1>
      <Address2/>
      <Country>Portugal</Country>
      <State/>
      <City>Funchal </City>
      <Postcode>9000-777</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>gfjsilva@gmail.con</Email>
    <Phone>
      <Home>351966117703</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4281840000550005</CreditcardNumber>
      <NameonCreditcard>Goncalo Silva</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>8.2</CreditcardAmount>
      <CreditcardCodeNumber>463</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>