34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>04/13/2017</StartDate>
  <EndDate>04/30/2017</EndDate>
  <DestinationPlan>Netherlands</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Bruce</Firstname>
    <Middlename>S</Middlename>
    <Lastname>Terrill</Lastname>
    <Age>68</Age>
    <Dob>01/21/1949</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>04/13/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>5735 Holly Hill Circle</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Texas</State>
      <City>Dallas</City>
      <Postcode>75231</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>terrill2@swbell.net</Email>
    <Phone>
      <Home>9728969000</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Christa Terrill</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5466388434997396</CreditcardNumber>
      <NameonCreditcard>Christa Terrill</NameonCreditcard>
      <CreditcardExpirationMonth>3</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>69.84</CreditcardAmount>
      <CreditcardCodeNumber>126</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
e2de10c4
ARS-01-0033292
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0033292</PolicyNumber><UserName>e2de10c4</UserName><Password>e2de10c4</Password></PolicyDetails></RegistrationRes>