54.80.29.182
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>2500</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>06/11/2014</StartDate>
  <EndDate>08/25/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Volodymyr</Firstname>
    <Middlename/>
    <Lastname>Medvediev</Lastname>
    <Age>70</Age>
    <Dob>02/21/1944</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/11/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>120 Lenin prospekt, apt. 47</Address1>
      <Address2></Address2>
      <Country>Ukraine</Country>
      <State></State>
      <City>Oleksandriya</City>
      <Postcode>28008</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>ayeremin@gmail.com</Email>
    <Phone>
      <Home>19492318360</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Yuliya Medvedeva</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>374716015404550</CreditcardNumber>
      <NameonCreditcard>Andriy Yeromin</NameonCreditcard>
      <CreditcardExpirationMonth>11</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2015</CreditcardExpirationYear>
      <CreditcardAmount>431.98</CreditcardAmount>
      <CreditcardCodeNumber>2388</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
e1b19797
ARS-02-0016869
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0016869</PolicyNumber><UserName>e1b19797</UserName><Password>e1b19797</Password></PolicyDetails></RegistrationRes>