184.72.211.106
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>09/26/2016</StartDate>
  <EndDate>10/02/2016</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jair</Firstname>
    <Middlename>J</Middlename>
    <Lastname>Tjon En Fa</Lastname>
    <Age>22</Age>
    <Dob>10/19/1993</Dob>
    <SportsRider>yes</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/26/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>7855 W 10th Ave</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Florida</State>
      <City>Hialeah</City>
      <Postcode>33014</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>epfrankel@yahoo.com</Email>
    <Phone>
      <Home>7863971607</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Deborah Leckie</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5440280218258148</CreditcardNumber>
      <NameonCreditcard>Frankel Eddy P</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>11.28</CreditcardAmount>
      <CreditcardCodeNumber>9230</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>