54.87.111.42
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>09/29/2014</StartDate>
  <EndDate>11/16/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Tia</Firstname>
    <Middlename>Z</Middlename>
    <Lastname>Brown</Lastname>
    <Age>34</Age>
    <Dob>10/23/1979</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/29/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2796 lower six mile road</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>British Columbia</State>
      <City>Nelson</City>
      <Postcode>V1L 6L5</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>tbirdstar@hotmail.com</Email>
    <Phone>
      <Home>12503047844</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Christina Smitheram</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Sister</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5191330000595545</CreditcardNumber>
      <NameonCreditcard>Tia Z Brown</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>92.12</CreditcardAmount>
      <CreditcardCodeNumber>582</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>