52.90.170.232
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>1000</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>06/09/2016</StartDate>
  <EndDate>08/05/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>COOPER</Firstname>
    <Middlename>c</Middlename>
    <Lastname>Hearne</Lastname>
    <Age>24</Age>
    <Dob>11/12/1991</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/09/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>1500 1/2 S Sycamore Ave, Los Angeles, CA</Address1>
      <Address2/>
      <Country>Australia</Country>
      <State/>
      <City>LA</City>
      <Postcode>90019</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>coopercdavenport@gmail.com</Email>
    <Phone>
      <Home>3237409732</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Samuel Burchfield</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5163610046351787</CreditcardNumber>
      <NameonCreditcard>COOPER c Hearne</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>115.07</CreditcardAmount>
      <CreditcardCodeNumber>585</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>