54.89.137.34
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>05/22/2015</StartDate>
  <EndDate>07/05/2015</EndDate>
  <DestinationPlan>Czech Republic</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jaromir</Firstname>
    <Middlename/>
    <Lastname>Sedlar</Lastname>
    <Age>31</Age>
    <Dob>12/01/1983</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>05/22/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>9807 N FM 620</Address1>
      <Address2>APT 22306</Address2>
      <Country>United States</Country>
      <State>Texas</State>
      <City>Austin</City>
      <Postcode>78726</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jaromiro@gmail.com</Email>
    <Phone>
      <Home>2405052690</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>David Sedlar</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Son</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4744722066356132</CreditcardNumber>
      <NameonCreditcard>Jaromir  Sedlar</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>45.0</CreditcardAmount>
      <CreditcardCodeNumber>438</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
8d515943
ARS-01-0021249
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0021249</PolicyNumber><UserName>8d515943</UserName><Password>8d515943</Password></PolicyDetails></RegistrationRes>