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>11/16/2018</StartDate>
  <EndDate>11/26/2018</EndDate>
  <DestinationPlan>France</DestinationPlan>
  <NoOfApplicants>3</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>NATHALIE</Firstname>
    <Middlename>A</Middlename>
    <Lastname>TAYLOR</Lastname>
    <Age>31</Age>
    <Dob>03/28/1987</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>ROBERTH</Firstname>
    <Middlename>C</Middlename>
    <Lastname>KOHLER</Lastname>
    <Age>31</Age>
    <Dob>07/06/1987</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Emilie</Firstname>
    <Middlename>S</Middlename>
    <Lastname>KOHLER TAYLOR</Lastname>
    <Age>1</Age>
    <Dob>07/15/2017</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>11/16/2018</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>3829 Orloff</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>New York</State>
      <City>Bronx</City>
      <Postcode>10463</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>betotaylor@hotmail.com</Email>
    <Phone>
      <Home>3475636619</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>JOSH TAYLOR</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Father</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5178059057339179</CreditcardNumber>
      <NameonCreditcard>JOSH TAYLOR</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>50.87</CreditcardAmount>
      <CreditcardCodeNumber>618</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>