52.91.49.203
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>02/01/2016</StartDate>
  <EndDate>02/29/2016</EndDate>
  <DestinationPlan>Portugal</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Kiki</Firstname>
    <Middlename/>
    <Lastname>Bridges</Lastname>
    <Age>64</Age>
    <Dob>04/15/1951</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>02/01/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>120 Republican Street</Address1>
      <Address2>Apt 309</Address2>
      <Country>United States</Country>
      <State>Washington</State>
      <City>Seattle</City>
      <Postcode>98109</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>bridgeskiki@hotmail.com</Email>
    <Phone>
      <Home>2067887216</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4492200111098524</CreditcardNumber>
      <NameonCreditcard>Kiki D Bridges</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2015</CreditcardExpirationYear>
      <CreditcardAmount>104.98</CreditcardAmount>
      <CreditcardCodeNumber>524</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>