52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>11/11/2018</StartDate>
  <EndDate>11/17/2018</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Carlos Eduardo</Firstname>
    <Middlename>M</Middlename>
    <Lastname>Calheiros</Lastname>
    <Age>35</Age>
    <Dob>12/14/1982</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>11/11/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Rua manuel guedes 522</Address1>
      <Address2>Ap 81</Address2>
      <Country>Brazil</Country>
      <State/>
      <City>Sao Paulo</City>
      <Postcode>04536-070</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>carloscalheiros@gmail.com</Email>
    <Phone>
      <Home>5511997528110</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5228403115640568</CreditcardNumber>
      <NameonCreditcard>Carlos Eduardo M Calheiros</NameonCreditcard>
      <CreditcardExpirationMonth>5</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>11.48</CreditcardAmount>
      <CreditcardCodeNumber>886</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>