52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>12000</MaximumLimit>
  <StartDate>12/15/2016</StartDate>
  <EndDate>01/12/2017</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>nivy</Firstname>
    <Middlename>r</Middlename>
    <Lastname>todescan</Lastname>
    <Age>89</Age>
    <Dob>02/23/1927</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/15/2016</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>rua tucuna 395</Address1>
      <Address2>Perdizes-Sao Paulo-SP</Address2>
      <Country>Brazil</Country>
      <State/>
      <City>Sao Paulo</City>
      <Postcode>05021-010</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>southernstudio@earthlink.net</Email>
    <Phone>
      <Home>47992598460</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>ana young</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Daughter</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>Visa</CreditcardType>
      <CreditcardNumber>4223240002459886</CreditcardNumber>
      <NameonCreditcard>sey young</NameonCreditcard>
      <CreditcardExpirationMonth>1</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>355.25</CreditcardAmount>
      <CreditcardCodeNumber>507</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
666a5b36
ARS-02-0031155
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0031155</PolicyNumber><UserName>666a5b36</UserName><Password>666a5b36</Password></PolicyDetails></RegistrationRes>