54.198.116.54
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>08/14/2014</StartDate>
  <EndDate>09/16/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>karine</Firstname>
    <Middlename/>
    <Lastname>larin</Lastname>
    <Age>34</Age>
    <Dob>04/25/1980</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/14/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>6210 primeau</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Quebec</State>
      <City>laval</City>
      <Postcode>h7b1b2</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>larin_karine@hotmail.com</Email>
    <Phone>
      <Home>4506661442</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>serge larin</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Father</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4530911802507037</CreditcardNumber>
      <NameonCreditcard>karine  larin</NameonCreditcard>
      <CreditcardExpirationMonth>6</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>63.92</CreditcardAmount>
      <CreditcardCodeNumber>445</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
249c37fc
ARS-02-0017713
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0017713</PolicyNumber><UserName>249c37fc</UserName><Password>249c37fc</Password></PolicyDetails></RegistrationRes>