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>12/26/2020</StartDate>
  <EndDate>01/05/2021</EndDate>
  <DestinationPlan>Mexico</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jaclyn</Firstname>
    <Middlename/>
    <Lastname>Klimes</Lastname>
    <Age>30</Age>
    <Dob>10/21/1990</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/26/2020</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Flat 28</Address1>
      <Address2>3 Ann Street</Address2>
      <Country>United Kingdom</Country>
      <State/>
      <City>London</City>
      <Postcode>N17FF</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jaclyn.klimes@gmail.com</Email>
    <Phone>
      <Home>07577780304</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lucie. Klimes</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Sister</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147202342026679</CreditcardNumber>
      <NameonCreditcard>Jaclyn Klimes</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>18.04</CreditcardAmount>
      <CreditcardCodeNumber>044</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>