174.129.122.238
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>2500</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>10/01/2016</StartDate>
  <EndDate>02/24/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Surathai</Firstname>
    <Middlename/>
    <Lastname>Junngam</Lastname>
    <Age>32</Age>
    <Dob>09/19/1984</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/01/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>1595 Sukhumvit Road, Apt. 26</Address1>
      <Address2>Phrakanong-nue, Wattana</Address2>
      <Country>Thailand</Country>
      <State/>
      <City>Bangkok</City>
      <Postcode>10110</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>B_E_J@hotmail.com</Email>
    <Phone>
      <Home>7606669853</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Bradley Edward Jordan</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Fiance</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5451984689925079</CreditcardNumber>
      <NameonCreditcard>Bradley Jordan</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>265.48</CreditcardAmount>
      <CreditcardCodeNumber>272</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
2d75533c
ARS-02-0029735
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0029735</PolicyNumber><UserName>2d75533c</UserName><Password>2d75533c</Password></PolicyDetails></RegistrationRes>