52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>1</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>1100000</MaximumLimit>
  <StartDate>12/08/2019</StartDate>
  <EndDate>01/05/2020</EndDate>
  <DestinationPlan>Lao</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Allen</Firstname>
    <Middlename>J</Middlename>
    <Lastname>Follis</Lastname>
    <Age>54</Age>
    <Dob>06/21/1965</Dob>
    <Gender>Male</Gender>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/08/2019</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>212 S 92nd Ave</Address1>
      <Address2/>
      <Country>United States</Country>
      <State>Washington</State>
      <City>Yakima</City>
      <Postcode>98908</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>follisanesthesiologyllc@gmail.com</Email>
    <Phone>
      <Home>2084063394</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Susan M Follis</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>377295918721003</CreditcardNumber>
      <NameonCreditcard>Allen J Follis</NameonCreditcard>
      <CreditcardExpirationMonth>9</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2024</CreditcardExpirationYear>
      <CreditcardAmount>91.06</CreditcardAmount>
      <CreditcardCodeNumber>7750</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
4175fab1
701943239

<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>701943239</PolicyNumber><UserName>4175fab1</UserName><Password>4175fab1</Password></PolicyDetails></RegistrationRes>