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>07/09/2015</StartDate>
  <EndDate>01/01/2016</EndDate>
  <DestinationPlan>Ukraine</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Colin</Firstname>
    <Middlename>E</Middlename>
    <Lastname>Kubik</Lastname>
    <Age>20</Age>
    <Dob>03/18/1995</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>07/09/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>7022 N Greenwood Blvd</Address1>
      <Address2></Address2>
      <Country>United States</Country>
      <State>Washington</State>
      <City>Spokane</City>
      <Postcode>99208</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>kubikfam@q.com</Email>
    <Phone>
      <Home>5099937813</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Eugene Kubik</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Father</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5291499030473012</CreditcardNumber>
      <NameonCreditcard>Sherry Kubik</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>150.45</CreditcardAmount>
      <CreditcardCodeNumber>463</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
eb516dfc
ARS-01-0022073
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0022073</PolicyNumber><UserName>eb516dfc</UserName><Password>eb516dfc</Password></PolicyDetails></RegistrationRes>