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>06/19/2014</StartDate>
  <EndDate>06/30/2014</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Theodore</Firstname>
    <Middlename>H</Middlename>
    <Lastname>Arcoverde Greiner</Lastname>
    <Age>65</Age>
    <Dob>08/15/1948</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/19/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>#1304 Viva Family Officetel</Address1>
      <Address2>Seongdong-gu</Address2>
      <Country>Korea (South)</Country>
      <State></State>
      <City>Seoul</City>
      <Postcode>133-850</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>tedgreiner@yahoo.com</Email>
    <Phone>
      <Home>01080601743</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Denise Arcoverde</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4266841156184861</CreditcardNumber>
      <NameonCreditcard>Theodore H Greiner</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2015</CreditcardExpirationYear>
      <CreditcardAmount>72.0</CreditcardAmount>
      <CreditcardCodeNumber>755</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
25a9541b
ARS-02-0016621
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0016621</PolicyNumber><UserName>25a9541b</UserName><Password>25a9541b</Password></PolicyDetails></RegistrationRes>