54.172.31.188
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>05/10/2016</StartDate>
  <EndDate>05/13/2016</EndDate>
  <DestinationPlan>Puerto Rico</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>leszek</Firstname>
    <Middlename>s</Middlename>
    <Lastname>bielat</Lastname>
    <Age>39</Age>
    <Dob>02/01/1977</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/10/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>318 dupont ave</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>New Jersey</State>
      <City>hopatcong</City>
      <Postcode>07843</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>ognennylev@yahoo.com</Email>
    <Phone>
      <Home>9732342605</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>leah bielat</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4400661423895066</CreditcardNumber>
      <NameonCreditcard>leszek s bielat</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>7.7</CreditcardAmount>
      <CreditcardCodeNumber>315</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
dca4d28a
ARS-01-0026585
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0026585</PolicyNumber><UserName>dca4d28a</UserName><Password>dca4d28a</Password></PolicyDetails></RegistrationRes>