54.160.242.53
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>11/15/2014</StartDate>
  <EndDate>11/24/2014</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Ann</Firstname>
    <Middlename>K</Middlename>
    <Lastname>Krawciw</Lastname>
    <Age>34</Age>
    <Dob>12/19/1979</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>11/15/2014</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>47-388 Mapumapu Rd.</Address1>
      <Address2></Address2>
      <Country>United States</Country>
      <State>Hawaii</State>
      <City>Kaneohe</City>
      <Postcode>96744</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>akrawciw55@hotmail.com</Email>
    <Phone>
      <Home>8082207600</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName></AdDBeneficiaryName>
    <AdDBeneficiaryRelationship></AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4145800000787722</CreditcardNumber>
      <NameonCreditcard>Ann K Krawciw</NameonCreditcard>
      <CreditcardExpirationMonth>3</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2017</CreditcardExpirationYear>
      <CreditcardAmount>28.4</CreditcardAmount>
      <CreditcardCodeNumber>149</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
813321e5
ARS-02-0018743
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0018743</PolicyNumber><UserName>813321e5</UserName><Password>813321e5</Password></PolicyDetails></RegistrationRes>