184.72.211.106
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>10/24/2016</StartDate>
  <EndDate>10/28/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>George </Firstname>
    <Middlename/>
    <Lastname>Gough</Lastname>
    <Age>74</Age>
    <Dob>03/05/1942</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/24/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>c/o Jamnong Chuanlakhon</Address1>
      <Address2>74 m. 12 t. Surplur a. Kumpawapi</Address2>
      <Country>Thailand</Country>
      <State/>
      <City>Udonthani</City>
      <Postcode>41370</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>goffen1@Gmail.com</Email>
    <Phone>
      <Home>66873858293</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Jamnong Chuanlakhon</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4539031047746844</CreditcardNumber>
      <NameonCreditcard>George   Gough</NameonCreditcard>
      <CreditcardExpirationMonth>9</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>36.0</CreditcardAmount>
      <CreditcardCodeNumber>903</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
a7edf1ea
ARS-02-0029691
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0029691</PolicyNumber><UserName>a7edf1ea</UserName><Password>a7edf1ea</Password></PolicyDetails></RegistrationRes>