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>12/11/2018</StartDate>
  <EndDate>01/28/2019</EndDate>
  <DestinationPlan>Tanzania</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>darryl</Firstname>
    <Middlename>k</Middlename>
    <Lastname>moore</Lastname>
    <Age>35</Age>
    <Dob>06/18/1983</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/11/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>4018 phase 4</Address1>
      <Address2>la horquetta</Address2>
      <Country>Trinidad and Tobago</Country>
      <State/>
      <City>arima</City>
      <Postcode>00000</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>dmooretobago1@gmail.com</Email>
    <Phone>
      <Home>8687175743</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>moore</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Estate</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4091601500442873</CreditcardNumber>
      <NameonCreditcard>darryl k moore</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>80.36</CreditcardAmount>
      <CreditcardCodeNumber>368</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>