54.198.116.54
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>08/20/2014</StartDate>
  <EndDate>12/01/2014</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Pon</Firstname>
    <Middlename/>
    <Lastname>Khamis</Lastname>
    <Age>78</Age>
    <Dob>04/06/1936</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>08/20/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>22 Jalan Kesuma 4</Address1>
      <Address2>Taman Kesuma</Address2>
      <Country>Malaysia</Country>
      <State></State>
      <City>Ampang Selangor</City>
      <Postcode>6800</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>zaifathome@aol.com</Email>
    <Phone>
      <Home>01160126760407</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147202145705800</CreditcardNumber>
      <NameonCreditcard>Rosdinah Baharin</NameonCreditcard>
      <CreditcardExpirationMonth>2</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>844.48</CreditcardAmount>
      <CreditcardCodeNumber>073</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
0e5bc55c
ARS-02-0017759
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0017759</PolicyNumber><UserName>0e5bc55c</UserName><Password>0e5bc55c</Password></PolicyDetails></RegistrationRes>