52.91.49.203
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>12/19/2015</StartDate>
  <EndDate>12/31/2015</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>4</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Yi</Firstname>
    <Middlename/>
    <Lastname>Dai</Lastname>
    <Age>48</Age>
    <Dob>11/17/1967</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Mei</Firstname>
    <Middlename/>
    <Lastname>Wang</Lastname>
    <Age>49</Age>
    <Dob>03/05/1966</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Clarey</Firstname>
    <Middlename>T</Middlename>
    <Lastname>Dai</Lastname>
    <Age>19</Age>
    <Dob>07/17/1996</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Edric</Firstname>
    <Middlename>T</Middlename>
    <Lastname>Dai</Lastname>
    <Age>13</Age>
    <Dob>09/27/2002</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/19/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>7-12A City Garden Phase 3</Address1>
      <Address2>8th Industrial Road, Shekou</Address2>
      <Country>China</Country>
      <State/>
      <City>Shenzhen</City>
      <Postcode>518067</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>rdai2000@163.com</Email>
    <Phone>
      <Home>8618688975270</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>370246019138529</CreditcardNumber>
      <NameonCreditcard>DAI Yi</NameonCreditcard>
      <CreditcardExpirationMonth>3</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>106.73</CreditcardAmount>
      <CreditcardCodeNumber>6167</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>