54.204.126.246
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>05/31/2014</StartDate>
  <EndDate>06/08/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Alberta</Firstname>
    <Middlename> </Middlename>
    <Lastname>Chadwick</Lastname>
    <Age>72</Age>
    <Dob>05/05/1942</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/31/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>34 Charcoal Drive</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Ontario</State>
      <City>Toronto</City>
      <Postcode>M1C 3V1</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>joncar.chadwick@sympatico.ca</Email>
    <Phone>
      <Home>4162847882</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Juli Ayn Schroeder</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4500600109344519</CreditcardNumber>
      <NameonCreditcard>Carole A. Chadwick</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>73.08</CreditcardAmount>
      <CreditcardCodeNumber>299</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
a258e95f
ARS-02-0016440
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0016440</PolicyNumber><UserName>a258e95f</UserName><Password>a258e95f</Password></PolicyDetails></RegistrationRes>