52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/29/2018</StartDate>
  <EndDate>10/30/2018</EndDate>
  <DestinationPlan>Ecuador</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>MICHAEL </Firstname>
    <Middlename>C</Middlename>
    <Lastname>OLEA</Lastname>
    <Age>44</Age>
    <Dob>03/23/1974</Dob>
    <Gender>Male</Gender>
    <SportsRider>yes</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/29/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>3910 W 238th St, unit 26</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>California</State>
      <City>Torrance</City>
      <Postcode>90505</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>nataliyaolea@gmail.com</Email>
    <Phone>
      <Home>2134472338</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>NATALIYA OLEA</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4815821033874690</CreditcardNumber>
      <NameonCreditcard>Nataliya OLea</NameonCreditcard>
      <CreditcardExpirationMonth>5</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2021</CreditcardExpirationYear>
      <CreditcardAmount>9.75</CreditcardAmount>
      <CreditcardCodeNumber>043</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>