54.221.58.28
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>11/03/2014</StartDate>
  <EndDate>03/24/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>steve</Firstname>
    <Middlename/>
    <Lastname>ewashko</Lastname>
    <Age>69</Age>
    <Dob>05/18/1945</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>11/03/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>#48 Estates Court</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>Alberta</State>
      <City>Sherwood Park</City>
      <Postcode>T8B 1M9</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jeanpearson70@yahoo.ca</Email>
    <Phone>
      <Home>7804162454</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>jean ewashko</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Other</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4512238618981749</CreditcardNumber>
      <NameonCreditcard>jean ewashko</NameonCreditcard>
      <CreditcardExpirationMonth>5</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>1313.5</CreditcardAmount>
      <CreditcardCodeNumber>639</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
07cc23b1
ARS-02-0018219
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0018219</PolicyNumber><UserName>07cc23b1</UserName><Password>07cc23b1</Password></PolicyDetails></RegistrationRes>