52.91.53.224
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>12/14/2015</StartDate>
  <EndDate>01/28/2016</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Luiza Siqueira</Firstname>
    <Middlename>A</Middlename>
    <Lastname>Reis</Lastname>
    <Age>22</Age>
    <Dob>10/11/1993</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/14/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>SHVP 15 casa 01</Address1>
      <Address2/>
      <Country>Brazil</Country>
      <State/>
      <City>Guara 1</City>
      <Postcode>71095000</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>siqueira.mariana00@gmail.com</Email>
    <Phone>
      <Home>556133810909</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Mariana Orlando</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Sister</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4264285778969022</CreditcardNumber>
      <NameonCreditcard>Mariana R Orlando</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>63.48</CreditcardAmount>
      <CreditcardCodeNumber>476</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
84f71e75
ARS-02-0024247
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0024247</PolicyNumber><UserName>84f71e75</UserName><Password>84f71e75</Password></PolicyDetails></RegistrationRes>