54.147.187.137
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>12000</MaximumLimit>
  <StartDate>05/24/2015</StartDate>
  <EndDate>06/30/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>tam</Firstname>
    <Middlename/>
    <Lastname>nguyen</Lastname>
    <Age>91</Age>
    <Dob>10/25/1923</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/24/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>168 john street apt 503</Address1>
      <Address2/>
      <Country>Canada</Country>
      <State>Ontario</State>
      <City>toronto</City>
      <Postcode>m5t2x9</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>lynnvy@yahoo.com</Email>
    <Phone>
      <Home>4169776266</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lan Nguyen</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5466160264533843</CreditcardNumber>
      <NameonCreditcard>hung nguyen</NameonCreditcard>
      <CreditcardExpirationMonth>5</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>540.74</CreditcardAmount>
      <CreditcardCodeNumber>973</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
de6087cb
ARS-02-0021167
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0021167</PolicyNumber><UserName>de6087cb</UserName><Password>de6087cb</Password></PolicyDetails></RegistrationRes>