54.221.1.109
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>09/04/2014</StartDate>
  <EndDate>10/07/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>2</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Wiktor</Firstname>
    <Middlename/>
    <Lastname>Szymanski</Lastname>
    <Age>76</Age>
    <Dob>07/25/1937</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>Wanda</Firstname>
    <Middlename/>
    <Lastname>Szymanska</Lastname>
    <Age>78</Age>
    <Dob>02/28/1936</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/04/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Wajdeloty 14/19</Address1>
      <Address2></Address2>
      <Country>Poland</Country>
      <State></State>
      <City>Lublin</City>
      <Postcode>20-604</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>klocm@yahoo.com</Email>
    <Phone>
      <Home>4843594335</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Jolanta Kloc</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147097831734266</CreditcardNumber>
      <NameonCreditcard>Jolanta Kloc</NameonCreditcard>
      <CreditcardExpirationMonth>5</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2016</CreditcardExpirationYear>
      <CreditcardAmount>552.16</CreditcardAmount>
      <CreditcardCodeNumber>396</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
1d62659b
3fbb6c6b
ARS-02-0017399
ARS-02-0017400
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0017399</PolicyNumber><UserName>1d62659b</UserName><Password>1d62659b</Password></PolicyDetails><PolicyDetails><PolicyNumber>ARS-02-0017400</PolicyNumber><UserName>3fbb6c6b</UserName><Password>3fbb6c6b</Password></PolicyDetails></RegistrationRes>