184.72.211.106
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/26/2016</StartDate>
  <EndDate>11/30/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Othello</Firstname>
    <Middlename/>
    <Lastname>Brandy</Lastname>
    <Age>65</Age>
    <Dob>06/27/1951</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/26/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>Goodrige Buliding, 8th &amp; 9th Streets</Address1>
      <Address2>Jallah's Town Road, Sinkor</Address2>
      <Country>Liberia</Country>
      <State/>
      <City>Monrovia</City>
      <Postcode>N/A</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>lallen@rightsandresources.org</Email>
    <Phone>
      <Home>0014043990043</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Lerine Brandy</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Not recorded</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4712134050910411</CreditcardNumber>
      <NameonCreditcard>Thomas A White</NameonCreditcard>
      <CreditcardExpirationMonth>10</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>187.2</CreditcardAmount>
      <CreditcardCodeNumber>460</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
d75bcff6
ARS-02-0030260
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0030260</PolicyNumber><UserName>d75bcff6</UserName><Password>d75bcff6</Password></PolicyDetails></RegistrationRes>