184.72.211.106
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/25/2016</StartDate>
  <EndDate>01/15/2017</EndDate>
  <DestinationPlan>Japan</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Remy</Firstname>
    <Middlename/>
    <Lastname>Khoung</Lastname>
    <Age>35</Age>
    <Dob>09/15/1981</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/25/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>979 Pinto Palm Terrace unit 26</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>California</State>
      <City>Sunnyvale </City>
      <Postcode>94087</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>rkhoung@gmail.com</Email>
    <Phone>
      <Home>6503084130</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4147202271516096</CreditcardNumber>
      <NameonCreditcard>Remy  Khoung </NameonCreditcard>
      <CreditcardExpirationMonth>8</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>74.7</CreditcardAmount>
      <CreditcardCodeNumber>597</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
550d7597
ARS-01-0030249
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-01-0030249</PolicyNumber><UserName>550d7597</UserName><Password>550d7597</Password></PolicyDetails></RegistrationRes>