174.129.122.238
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>09/16/2016</StartDate>
  <EndDate>10/04/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Musia</Firstname>
    <Middlename/>
    <Lastname>Palatnik</Lastname>
    <Age>75</Age>
    <Dob>06/18/1941</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/16/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Pinhas Lavon 27-12</Address1>
      <Address2/>
      <Country>Israel</Country>
      <State/>
      <City>Kiryat Yam</City>
      <Postcode>2905717</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>ilia@fishbein.me</Email>
    <Phone>
      <Home>048772721</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147097637461114</CreditcardNumber>
      <NameonCreditcard>Ilia Fishbein</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>136.8</CreditcardAmount>
      <CreditcardCodeNumber>648</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
8437cd15
ARS-02-0029518
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0029518</PolicyNumber><UserName>8437cd15</UserName><Password>8437cd15</Password></PolicyDetails></RegistrationRes>