34.192.94.100
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>12000</MaximumLimit>
  <StartDate>04/29/2017</StartDate>
  <EndDate>05/09/2017</EndDate>
  <DestinationPlan>Georgia</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Nery</Firstname>
    <Middlename>O</Middlename>
    <Lastname>Kasanezky</Lastname>
    <Age>85</Age>
    <Dob>06/29/1931</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>04/29/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>6272 Sumter Ave N</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Minnesota</State>
      <City>Brooklyn Park</City>
      <Postcode>55428</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>randahl2@aol.com</Email>
    <Phone>
      <Home>7635319388</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Tina Kerner, George Kasanezky, Allison Olsen</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Child</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4342570028976703</CreditcardNumber>
      <NameonCreditcard>Nery O Kasanezky</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2021</CreditcardExpirationYear>
      <CreditcardAmount>118.25</CreditcardAmount>
      <CreditcardCodeNumber>148</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
fab38e28
ARS-01-0033713
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0033713</PolicyNumber><UserName>fab38e28</UserName><Password>fab38e28</Password></PolicyDetails></RegistrationRes>