52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>08/15/2018</StartDate>
  <EndDate>08/28/2018</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Disna</Firstname>
    <Middlename/>
    <Lastname>Chelew</Lastname>
    <Age>57</Age>
    <Dob>02/21/1961</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/15/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>12475Brickellua Street</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>California</State>
      <City>San Diego</City>
      <Postcode>82119</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>chelew@att.net</Email>
    <Phone>
      <Home>8582184365</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Steve chelew</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Significant other</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147180125407664</CreditcardNumber>
      <NameonCreditcard>Disna  Chelew</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>50.4</CreditcardAmount>
      <CreditcardCodeNumber>685</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>