54.204.126.246
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>05/16/2014</StartDate>
  <EndDate>05/23/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>ines</Firstname>
    <Middlename/>
    <Lastname>Chiba Bennani</Lastname>
    <Age>21</Age>
    <Dob>11/19/1992</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/16/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>137 rue guy fregault </Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Quebec</State>
      <City>boucherville</City>
      <Postcode>J4B 8M3</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>benna_ines@hotmail.fr</Email>
    <Phone>
      <Home>212661146610</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4530913746481022</CreditcardNumber>
      <NameonCreditcard>ines  Chiba Bennani</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2015</CreditcardExpirationYear>
      <CreditcardAmount>11.04</CreditcardAmount>
      <CreditcardCodeNumber>182</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
229c2a3f
ARS-02-0016539
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0016539</PolicyNumber><UserName>229c2a3f</UserName><Password>229c2a3f</Password></PolicyDetails></RegistrationRes>