54.90.161.130
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/16/2015</StartDate>
  <EndDate>10/20/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Michele</Firstname>
    <Middlename/>
    <Lastname>Keane</Lastname>
    <Age>54</Age>
    <Dob>03/30/1961</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/16/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>343 Smith Avenue</Address1>
      <Address2/>
      <Country>Canada</Country>
      <State>Ontario</State>
      <City>Burlington</City>
      <Postcode>L7R2T9</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>michelekeane@sympatico.ca</Email>
    <Phone>
      <Home>9056377312</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5228790007927768</CreditcardNumber>
      <NameonCreditcard>Michele H Keane</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>20.25</CreditcardAmount>
      <CreditcardCodeNumber>007</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>