52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>05/18/2017</StartDate>
  <EndDate>05/22/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>rafael</Firstname>
    <Middlename>e</Middlename>
    <Lastname>bueno</Lastname>
    <Age>26</Age>
    <Dob>06/20/1990</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/18/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>rua comendador julio pereira lopes 17</Address1>
      <Address2/>
      <Country>Brazil</Country>
      <State/>
      <City>são paulo</City>
      <Postcode>04114120</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>marcopuerta@me.com</Email>
    <Phone>
      <Home>5511951090588</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>marco antonio puerta</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Step-parent</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>371690128502001</CreditcardNumber>
      <NameonCreditcard>marco antonio puerta</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2021</CreditcardExpirationYear>
      <CreditcardAmount>6.2</CreditcardAmount>
      <CreditcardCodeNumber>5326</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
2523e3e5
ARS-02-0034258
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0034258</PolicyNumber><UserName>2523e3e5</UserName><Password>2523e3e5</Password></PolicyDetails></RegistrationRes>