52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>0</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>10/10/2018</StartDate>
  <EndDate>10/14/2018</EndDate>
  <DestinationPlan>Dominican Republic</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>LEONARDO</Firstname>
    <Middlename/>
    <Lastname>RAMIREZ</Lastname>
    <Age>53</Age>
    <Dob>06/01/1965</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/10/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>HC 57 BOX 11941</Address1>
      <Address2/>
      <Country>Puerto Rico</Country>
      <State/>
      <City>AGUADA</City>
      <Postcode>00602</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>lrcrespo2009@gmail.com</Email>
    <Phone>
      <Home>78730611160</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>LISSY I GONZALEZ COLON</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4549516300672347</CreditcardNumber>
      <NameonCreditcard>LEONARDO  RAMIREZ CRESPO</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2023</CreditcardExpirationYear>
      <CreditcardAmount>28.63</CreditcardAmount>
      <CreditcardCodeNumber>708</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>