54.86.99.59
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>06/29/2016</StartDate>
  <EndDate>07/08/2016</EndDate>
  <DestinationPlan>Peru</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Carl</Firstname>
    <Middlename/>
    <Lastname>Hlavenka</Lastname>
    <Age>40</Age>
    <Dob>06/26/1975</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/29/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>695 Connecticut St Apt 7</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>California</State>
      <City>San Francisco</City>
      <Postcode>94107</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>chlavenka@hotmail.com</Email>
    <Phone>
      <Home>7073911535</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147099563129830</CreditcardNumber>
      <NameonCreditcard>Carl  Hlavenka</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>21.8</CreditcardAmount>
      <CreditcardCodeNumber>696</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
4450fc43
ARS-01-0026183
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0026183</PolicyNumber><UserName>4450fc43</UserName><Password>4450fc43</Password></PolicyDetails></RegistrationRes>