54.86.99.59
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>04/15/2016</StartDate>
  <EndDate>05/04/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Yuval</Firstname>
    <Middlename/>
    <Lastname>Samuel</Lastname>
    <Age>22</Age>
    <Dob>04/09/1994</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>04/15/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>20 Hahistadrut st.</Address1>
      <Address2>Apt 8</Address2>
      <Country>Israel</Country>
      <State/>
      <City>Givataim</City>
      <Postcode>5352501</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>shai.samuel@gmail.com</Email>
    <Phone>
      <Home>0543043373</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Shai Samuel</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Father</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5326120381805979</CreditcardNumber>
      <NameonCreditcard>Yaffa  Samuel</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>27.6</CreditcardAmount>
      <CreditcardCodeNumber>310</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
1555d64e
ARS-02-0026145
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0026145</PolicyNumber><UserName>1555d64e</UserName><Password>1555d64e</Password></PolicyDetails></RegistrationRes>