54.198.116.54
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>07/24/2014</StartDate>
  <EndDate>08/14/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>4</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>I GUSTI NYOMAN</Firstname>
    <Middlename/>
    <Lastname>DARTA</Lastname>
    <Age>36</Age>
    <Dob>03/20/1978</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>COKORDA ISTRI PUTRIADT</Firstname>
    <Middlename/>
    <Lastname>RUKMINI</Lastname>
    <Age>43</Age>
    <Dob>05/21/1971</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>I MADE</Firstname>
    <Middlename/>
    <Lastname>SUTEJA</Lastname>
    <Age>40</Age>
    <Dob>03/02/1974</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
  <Applicant>
    <Firstname>I DEWA KETUT</Firstname>
    <Middlename/>
    <Lastname>ALIT</Lastname>
    <Age>41</Age>
    <Dob>05/17/1973</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>07/24/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Banjar Pengosekan Kaja</Address1>
      <Address2></Address2>
      <Country>Indonesia</Country>
      <State></State>
      <City>Mas, Ubud, Gianyar, Bali</City>
      <Postcode>80571</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>lizbehrend@gmail.com</Email>
    <Phone>
      <Home>6177679435</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4563310016268157</CreditcardNumber>
      <NameonCreditcard>Elizabeth Behrend</NameonCreditcard>
      <CreditcardExpirationMonth>11</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2016</CreditcardExpirationYear>
      <CreditcardAmount>264.0</CreditcardAmount>
      <CreditcardCodeNumber>017</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
df705698
f6921d04
7ed3cf52
139e7de6
ARS-02-0017428
ARS-02-0017429
ARS-02-0017430
ARS-02-0017431
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0017428</PolicyNumber><UserName>df705698</UserName><Password>df705698</Password></PolicyDetails><PolicyDetails><PolicyNumber>ARS-02-0017429</PolicyNumber><UserName>f6921d04</UserName><Password>f6921d04</Password></PolicyDetails><PolicyDetails><PolicyNumber>ARS-02-0017430</PolicyNumber><UserName>7ed3cf52</UserName><Password>7ed3cf52</Password></PolicyDetails><PolicyDetails><PolicyNumber>ARS-02-0017431</PolicyNumber><UserName>139e7de6</UserName><Password>139e7de6</Password></PolicyDetails></RegistrationRes>