52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>0</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/12/2017</StartDate>
  <EndDate>11/30/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Bar </Firstname>
    <Middlename/>
    <Lastname>Barzilai</Lastname>
    <Age>24</Age>
    <Dob>07/12/1993</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/12/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>12 En Gev ST </Address1>
      <Address2/>
      <Country>Israel</Country>
      <State/>
      <City>tel aviv</City>
      <Postcode>67319</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>gina.barzilai@gmail.com</Email>
    <Phone>
      <Home>972544424934</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Gina Barzilai</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Mother</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4580240102213263</CreditcardNumber>
      <NameonCreditcard>Ronen  Barzilai</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2018</CreditcardExpirationYear>
      <CreditcardAmount>77.5</CreditcardAmount>
      <CreditcardCodeNumber>936</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
046e1be7
ARS-02-0037412
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0037412</PolicyNumber><UserName>046e1be7</UserName><Password>046e1be7</Password></PolicyDetails></RegistrationRes>