54.234.109.243
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>05/16/2015</StartDate>
  <EndDate>05/20/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>2</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Colin</Firstname>
    <Middlename/>
    <Lastname>Belyea</Lastname>
    <Age>24</Age>
    <Dob>05/16/1990</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Hilary</Firstname>
    <Middlename/>
    <Lastname>Smith</Lastname>
    <Age>25</Age>
    <Dob>01/03/1990</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/16/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>451 Avenue </Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Quebec</State>
      <City>Edouard Charles</City>
      <Postcode>HQV2N3</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>colinjamesbelyea@gmail.com</Email>
    <Phone>
      <Home>5066085196</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5191230172721780</CreditcardNumber>
      <NameonCreditcard>Hilary Smith</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>13.8</CreditcardAmount>
      <CreditcardCodeNumber>762</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>