54.198.151.126
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>06/21/2014</StartDate>
  <EndDate>06/20/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Phuc</Firstname>
    <Middlename>V</Middlename>
    <Lastname>Tang</Lastname>
    <Age>26</Age>
    <Dob>10/12/1987</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>06/21/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>10049 ashworth ave n</Address1>
      <Address2></Address2>
      <Country>Viet Nam</Country>
      <State></State>
      <City>seattle</City>
      <Postcode>98133</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jack_acmilan@hotmail.com</Email>
    <Phone>
      <Home>12068495491</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>tu m hoang</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Fiance</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>379744487841013</CreditcardNumber>
      <NameonCreditcard>Phuc V Tang</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>503.7</CreditcardAmount>
      <CreditcardCodeNumber>2362</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
767304f2
ARS-02-0017048
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0017048</PolicyNumber><UserName>767304f2</UserName><Password>767304f2</Password></PolicyDetails></RegistrationRes>