52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>0</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>06/07/2019</StartDate>
  <EndDate>06/15/2019</EndDate>
  <DestinationPlan>French Polynesia</DestinationPlan>
  <NoOfApplicants>2</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jenna</Firstname>
    <Middlename>I</Middlename>
    <Lastname>Gillis</Lastname>
    <Age>25</Age>
    <Dob>02/07/1994</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Peter</Firstname>
    <Middlename>F</Middlename>
    <Lastname>Gillis</Lastname>
    <Age>26</Age>
    <Dob>08/19/1992</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/07/2019</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>1204 Oak Ridge Drive</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Indiana</State>
      <City>South Bend</City>
      <Postcode>46617</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>petergillisrealty@gmail.com</Email>
    <Phone>
      <Home>5744857214</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lucinda Kil Gillis</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5571422016257747</CreditcardNumber>
      <NameonCreditcard>Lucinda Kil Gillis</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>24.76</CreditcardAmount>
      <CreditcardCodeNumber>947</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>