52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>500</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>06/18/2017</StartDate>
  <EndDate>06/25/2017</EndDate>
  <DestinationPlan>Saint Martin</DestinationPlan>
  <NoOfApplicants>5</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Linh</Firstname>
    <Middlename>D</Middlename>
    <Lastname>Bui</Lastname>
    <Age>59</Age>
    <Dob>03/13/1958</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Tram</Firstname>
    <Middlename>B</Middlename>
    <Lastname>Bui</Lastname>
    <Age>43</Age>
    <Dob>09/06/1973</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Anh Tram</Firstname>
    <Middlename>D</Middlename>
    <Lastname>Bui</Lastname>
    <Age>21</Age>
    <Dob>05/08/1996</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Ton</Firstname>
    <Middlename>D</Middlename>
    <Lastname>Bui</Lastname>
    <Age>18</Age>
    <Dob>08/26/1998</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Mai Tram</Firstname>
    <Middlename>D</Middlename>
    <Lastname>Bui</Lastname>
    <Age>13</Age>
    <Dob>09/16/2003</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/18/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>28437 Christopher Ln</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>California</State>
      <City>Los Altos Hills</City>
      <Postcode>94022</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>drlinhbui@gmail.com</Email>
    <Phone>
      <Home>6508529764</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lan Trinh</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Other</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4100390462745064</CreditcardNumber>
      <NameonCreditcard>Linh Bui</NameonCreditcard>
      <CreditcardExpirationMonth>11</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>61.92</CreditcardAmount>
      <CreditcardCodeNumber>237</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>