52.91.49.203
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>12/31/2015</StartDate>
  <EndDate>01/11/2016</EndDate>
  <DestinationPlan>Brazil</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Rachael</Firstname>
    <Middlename>A</Middlename>
    <Lastname>Charlton</Lastname>
    <Age>32</Age>
    <Dob>07/14/1983</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/31/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>55 Triller Ave</Address1>
      <Address2>#2008</Address2>
      <Country>Canada</Country>
      <State>Ontario</State>
      <City>TO</City>
      <Postcode>M6R2H6</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>rachaelcharlton@me.com</Email>
    <Phone>
      <Home>6472053250</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Martha Charlton</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5280610003458094</CreditcardNumber>
      <NameonCreditcard>Rachael  Charlton</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>22.56</CreditcardAmount>
      <CreditcardCodeNumber>265</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>