54.167.122.208
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>50000</MaximumLimit>
  <StartDate>10/21/2014</StartDate>
  <EndDate>03/30/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Wilfred</Firstname>
    <Middlename>R</Middlename>
    <Lastname>Jackson</Lastname>
    <Age>74</Age>
    <Dob>08/01/1940</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/21/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2794 South Isl. Hwy.</Address1>
      <Address2></Address2>
      <Country>Canada</Country>
      <State>British Columbia</State>
      <City>Campbell River</City>
      <Postcode>V9W1C7</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>gailmartin239@yahoo.com</Email>
    <Phone>
      <Home>2509232749</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Mastercard</CreditcardType>
      <CreditcardNumber>5491980823107832</CreditcardNumber>
      <NameonCreditcard>Wilfred R Jackson</NameonCreditcard>
      <CreditcardExpirationMonth>9</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2016</CreditcardExpirationYear>
      <CreditcardAmount>1307.32</CreditcardAmount>
      <CreditcardCodeNumber>479</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
8538b41c
ARS-02-0018456
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0018456</PolicyNumber><UserName>8538b41c</UserName><Password>8538b41c</Password></PolicyDetails></RegistrationRes>