34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>09/21/2017</StartDate>
  <EndDate>09/21/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Thiago</Firstname>
    <Middlename>L</Middlename>
    <Lastname>Gonçalves</Lastname>
    <Age>30</Age>
    <Dob>04/12/1987</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/21/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>via Indro Montanelli 13</Address1>
      <Address2/>
      <Country>Brazil</Country>
      <State/>
      <City>Pedrengo</City>
      <Postcode>24066</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>lenzi.corretor@hotmail.com</Email>
    <Phone>
      <Home>3427746222</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Maria Lenzi Goncalves</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5415916072704328</CreditcardNumber>
      <NameonCreditcard>LENZI GONCALVES THIAGO</NameonCreditcard>
      <CreditcardExpirationMonth>9</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>8.2</CreditcardAmount>
      <CreditcardCodeNumber>847</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>