52.91.49.203
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>12000</MaximumLimit>
  <StartDate>02/15/2016</StartDate>
  <EndDate>04/15/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Grace</Firstname>
    <Middlename>M</Middlename>
    <Lastname>Pearce</Lastname>
    <Age>92</Age>
    <Dob>11/05/1923</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>02/15/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>#303  5 peron St</Address1>
      <Address2/>
      <Country>Canada</Country>
      <State>Alberta</State>
      <City>St Albert</City>
      <Postcode>T8N 1E3</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>teakchafer@ymail.com</Email>
    <Phone>
      <Home>13525059669</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Kenneth A. Pearce</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Son</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4536000011897001</CreditcardNumber>
      <NameonCreditcard>Grace M Pearce</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>868.03</CreditcardAmount>
      <CreditcardCodeNumber>632</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>