52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>09/13/2017</StartDate>
  <EndDate>10/21/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Takeshi</Firstname>
    <Middlename/>
    <Lastname>Okamura</Lastname>
    <Age>71</Age>
    <Dob>04/03/1946</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/13/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Kitahorie 4-14-6, Nishi-ku</Address1>
      <Address2>Kitahorie Kopo 603</Address2>
      <Country>Japan</Country>
      <State/>
      <City>Osaka-shi</City>
      <Postcode>550-0014</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>shigeaki.akamatsu@gmail.com</Email>
    <Phone>
      <Home>16466296435</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>371298415661009</CreditcardNumber>
      <NameonCreditcard>Shigeaki Akamatsu</NameonCreditcard>
      <CreditcardExpirationMonth>3</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2022</CreditcardExpirationYear>
      <CreditcardAmount>280.8</CreditcardAmount>
      <CreditcardCodeNumber>8968</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
c267e433
ARS-02-0036918
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0036918</PolicyNumber><UserName>c267e433</UserName><Password>c267e433</Password></PolicyDetails></RegistrationRes>