117.220.240.226
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<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>

  <PlanId>2</PlanId>

  <DeductibleAmount>0</DeductibleAmount>

  <MaximumLimit>110000</MaximumLimit>

  <StartDate>12/9/2018</StartDate>

  <EndDate>12/9/2018</EndDate>

  <DestinationPlan>Dominican Republic</DestinationPlan>

  <NoOfApplicants>1</NoOfApplicants>

  <PersonalInfo>

    <Applicants>

  <Applicant>

    <Firstname>Vivek</Firstname>

    <Middlename/>

    <Lastname>Chavda</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>vivek.chavda@yahoo.com</Email>

    <Phone>

      <Home></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>4111111111111</CreditcardNumber>

      <NameonCreditcard>Vivek</NameonCreditcard>

      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>

      <CreditcardExpirationYear>2023</CreditcardExpirationYear>

      <CreditcardAmount>28.63</CreditcardAmount>

      <CreditcardCodeNumber>567</CreditcardCodeNumber>

    </Creditcard>

  </PaymentMethod>

</RegistrationXML>