54.160.242.53
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>11/30/2014</StartDate>
  <EndDate>12/13/2014</EndDate>
  <DestinationPlan>Hong Kong</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jason</Firstname>
    <Middlename/>
    <Lastname>Koo</Lastname>
    <Age>35</Age>
    <Dob>01/05/1979</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>11/30/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>1740 Oval Cir</Address1>
      <Address2></Address2>
      <Country>United States</Country>
      <State>Nevada</State>
      <City>Las Vegas</City>
      <Postcode>89117</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jason.koo11@gmail.com</Email>
    <Phone>
      <Home>7024184938</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4426441038773820</CreditcardNumber>
      <NameonCreditcard>Jason  Koo</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>24.08</CreditcardAmount>
      <CreditcardCodeNumber>780</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>