52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>12/24/2020</StartDate>
  <EndDate>12/30/2020</EndDate>
  <DestinationPlan>Mexico</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Holly</Firstname>
    <Middlename/>
    <Lastname>Stark</Lastname>
    <Age>31</Age>
    <Dob>05/30/1989</Dob>
    <Gender>Female</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/24/2020</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>688 110th Ave NE</Address1>
      <Address2>S1807</Address2>
      <Country>United States</Country>
      <State>Washington</State>
      <City>Bellevue</City>
      <Postcode>98034</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>holly.p.stark@gmail.com</Email>
    <Phone>
      <Home>2069202440</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147342053658821</CreditcardNumber>
      <NameonCreditcard>Holly  Stark</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>9.45</CreditcardAmount>
      <CreditcardCodeNumber>111</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>