34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>0</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>08/13/2019</StartDate>
  <EndDate>08/22/2019</EndDate>
  <DestinationPlan>Israel</DestinationPlan>
  <NoOfApplicants>3</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Meir</Firstname>
    <Middlename>s</Middlename>
    <Lastname>Loebenstein</Lastname>
    <Age>25</Age>
    <Dob>10/13/1993</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Bayla</Firstname>
    <Middlename/>
    <Lastname>Loebenstein</Lastname>
    <Age>22</Age>
    <Dob>09/17/1996</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Rochel</Firstname>
    <Middlename>S</Middlename>
    <Lastname>Loebenstein</Lastname>
    <Age>1</Age>
    <Dob>08/20/2018</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/13/2019</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>315 8th St apt 6B</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>New Jersey</State>
      <City>Lakewood</City>
      <Postcode>08701</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>baylaglustein@gmail.com</Email>
    <Phone>
      <Home>7325670147</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Meir Simcha Loebenstein</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147202328806037</CreditcardNumber>
      <NameonCreditcard>Meir s Loebenstein</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>34.39</CreditcardAmount>
      <CreditcardCodeNumber>824</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>