54.80.29.182
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>04/18/2014</StartDate>
  <EndDate>05/05/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Darcy</Firstname>
    <Middlename/>
    <Lastname>Moen</Lastname>
    <Age>49</Age>
    <Dob>01/29/1965</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>04/18/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2641 Grant Road</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Saskatchewan</State>
      <City>Regina</City>
      <Postcode>S4S 5E8</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>darcy.moen@customerloyaltynetwork.com</Email>
    <Phone>
      <Home>3065853248</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lisa Moen</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4835880011442199</CreditcardNumber>
      <NameonCreditcard>Darcy  Moen</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2015</CreditcardExpirationYear>
      <CreditcardAmount>84.6</CreditcardAmount>
      <CreditcardCodeNumber>532</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
428a6517
ARS-02-0016010
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0016010</PolicyNumber><UserName>428a6517</UserName><Password>428a6517</Password></PolicyDetails></RegistrationRes>