52.45.148.122
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>550000</MaximumLimit>
  <StartDate>12/21/2017</StartDate>
  <EndDate>01/06/2018</EndDate>
  <DestinationPlan>Canada</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>Jer-Ming</Firstname>
    <Middlename/>
    <Lastname>Chia</Lastname>
    <Age>41</Age>
    <Dob>10/16/1976</Dob>
    <Gender>Male</Gender>
    <SportsRider>yes</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>12/21/2017</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>711 President St</Address1>
      <Address2>Apt 2</Address2>
      <Country>United States</Country>
      <State>New York</State>
      <City>Brooklyn</City>
      <Postcode>11215</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>jermth@me.com</Email>
    <Phone>
      <Home>9173197573</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName>Alison Buchbinder</AdDBeneficiaryName>
    <AdDBeneficiaryRelationship>Spouse</AdDBeneficiaryRelationship>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>376765129932004</CreditcardNumber>
      <NameonCreditcard>Jer-Ming Chia</NameonCreditcard>
      <CreditcardExpirationMonth>4</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2020</CreditcardExpirationYear>
      <CreditcardAmount>88.4</CreditcardAmount>
      <CreditcardCodeNumber>5755</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
39f08a38
ARS-02-0038486
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0038486</PolicyNumber><UserName>39f08a38</UserName><Password>39f08a38</Password></PolicyDetails></RegistrationRes>