52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>0</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>08/21/2021</StartDate>
  <EndDate>08/25/2021</EndDate>
  <DestinationPlan>Turks &amp;amp; Caicos Islands</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Ericka</Firstname>
    <Middlename/>
    <Lastname>Crowe</Lastname>
    <Age>30</Age>
    <Dob>12/02/1990</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/21/2021</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2453 Adam Clayton Powell Junior Boulevard</Address1>
      <Address2>3b</Address2>
      <Country>United States</Country>
      <State>New York</State>
      <City>New York</City>
      <Postcode>10030</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>ecrowe99@gmail.com</Email>
    <Phone>
      <Home>9177247782</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Alrica Clark </AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Discover</CreditcardType>
      <CreditcardNumber>6011950008973067</CreditcardNumber>
      <NameonCreditcard>Alrica Clark </NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>8.75</CreditcardAmount>
      <CreditcardCodeNumber>288</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>