54.87.111.42
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>09/24/2014</StartDate>
  <EndDate>10/14/2014</EndDate>
  <DestinationPlan>Czech Republic</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Tatjana</Firstname>
    <Middlename/>
    <Lastname>Scarborough</Lastname>
    <Age>63</Age>
    <Dob>12/13/1950</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>09/24/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>1735 Peachtree St. NE</Address1>
      <Address2>#228</Address2>
      <Country>United States</Country>
      <State>Georgia</State>
      <City>Atlanta</City>
      <Postcode>30309</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>bbrunob@mindspring.com</Email>
    <Phone>
      <Home>7703167332</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>371245810221012</CreditcardNumber>
      <NameonCreditcard>Tatjana Scarborough</NameonCreditcard>
      <CreditcardExpirationMonth>9</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>87.78</CreditcardAmount>
      <CreditcardCodeNumber>4591</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
73f7d836
ARS-01-0018131
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0018131</PolicyNumber><UserName>73f7d836</UserName><Password>73f7d836</Password></PolicyDetails></RegistrationRes>