34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>10/25/2019</StartDate>
  <EndDate>11/04/2019</EndDate>
  <DestinationPlan>Saint Martin</DestinationPlan>
  <NoOfApplicants>2</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Charles</Firstname>
    <Middlename/>
    <Lastname>Bernard</Lastname>
    <Age>57</Age>
    <Dob>02/09/1962</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Patricia</Firstname>
    <Middlename>A</Middlename>
    <Lastname>Bernard</Lastname>
    <Age>55</Age>
    <Dob>10/26/1963</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/25/2019</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>5546 Wagon Trail</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Ohio</State>
      <City>Medina</City>
      <Postcode>44256</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>bernardch@zoominternet.net</Email>
    <Phone>
      <Home>3307257072</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Carol Bernard</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4100390528807791</CreditcardNumber>
      <NameonCreditcard>Charles  Bernard</NameonCreditcard>
      <CreditcardExpirationMonth>8</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>69.08</CreditcardAmount>
      <CreditcardCodeNumber>201</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>