54.234.109.243
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>03/02/2015</StartDate>
  <EndDate>03/09/2015</EndDate>
  <DestinationPlan>Germany</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Douglas</Firstname>
    <Middlename>C</Middlename>
    <Lastname>Graham</Lastname>
    <Age>70</Age>
    <Dob>10/17/1944</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>03/02/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>PO Box 1464 Nana</Address1>
      <Address2></Address2>
      <Country>Thailand</Country>
      <State></State>
      <City>Bangkok</City>
      <Postcode>10110</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>douggra@gmail.com</Email>
    <Phone>
      <Home>9595063248</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Jureeporn Wangkuha</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4622881049121372</CreditcardNumber>
      <NameonCreditcard>Douglas C Graham</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>64.96</CreditcardAmount>
      <CreditcardCodeNumber>644</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
a267085f
ARS-02-0019997
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0019997</PolicyNumber><UserName>a267085f</UserName><Password>a267085f</Password></PolicyDetails></RegistrationRes>