52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>100</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>07/04/2018</StartDate>
  <EndDate>07/18/2018</EndDate>
  <DestinationPlan>Croatia</DestinationPlan>
  <NoOfApplicants>3</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Felix</Firstname>
    <Middlename>B</Middlename>
    <Lastname>Brownstein</Lastname>
    <Age>2</Age>
    <Dob>05/27/2016</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Matthew</Firstname>
    <Middlename>K</Middlename>
    <Lastname>Brownstein</Lastname>
    <Age>33</Age>
    <Dob>03/04/1985</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Hillary</Firstname>
    <Middlename>B</Middlename>
    <Lastname>Mills</Lastname>
    <Age>36</Age>
    <Dob>06/16/1982</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>07/04/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>65-02 68th avenue</Address1>
      <Address2>apartment 1</Address2>
      <Country>United States</Country>
      <State>New York</State>
      <City>Ridgewood</City>
      <Postcode>11385</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>matthewkbrownstein@gmail.com</Email>
    <Phone>
      <Home>4156098062</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Michael Brownstein</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Brother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147099519564346</CreditcardNumber>
      <NameonCreditcard>Matthew K Brownstein</NameonCreditcard>
      <CreditcardExpirationMonth>3</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>41.25</CreditcardAmount>
      <CreditcardCodeNumber>309</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>