52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>110000</MaximumLimit>
  <StartDate>10/16/2017</StartDate>
  <EndDate>11/22/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Chifor</Firstname>
    <Middlename/>
    <Lastname>Chifor Valery</Lastname>
    <Age>35</Age>
    <Dob>01/19/1982</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/16/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>IYA, Great Soppo, Bongo Square, </Address1>
      <Address2/>
      <Country>Cameroon</Country>
      <State/>
      <City>Buea</City>
      <Postcode>P.O.Box 301 </Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>chifdaz@yahoo.com</Email>
    <Phone>
      <Home>23775396767</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4257870032193284</CreditcardNumber>
      <NameonCreditcard>RoseLee Goldberg</NameonCreditcard>
      <CreditcardExpirationMonth>12</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>79.04</CreditcardAmount>
      <CreditcardCodeNumber>757</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
428527d7
ARS-02-0037452
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0037452</PolicyNumber><UserName>428527d7</UserName><Password>428527d7</Password></PolicyDetails></RegistrationRes>