{"id":7312,"date":"2026-06-25T11:43:14","date_gmt":"2026-06-25T11:43:14","guid":{"rendered":"https:\/\/grupoxandra.eu\/?page_id=7312"},"modified":"2026-06-25T11:47:32","modified_gmt":"2026-06-25T11:47:32","slug":"autoverzekeringsformulier","status":"publish","type":"page","link":"https:\/\/grupoxandra.eu\/fr\/autoverzekeringsformulier\/","title":{"rendered":"autoverzekeringsformulier"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"7312\" class=\"elementor elementor-7312\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-add4a18 e-flex e-con-boxed e-con e-parent\" data-id=\"add4a18\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-53d38e9 elementor-widget elementor-widget-heading\" data-id=\"53d38e9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Recevoir une proposition unique<br> pour votre assurance auto sur mesure.<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b53704c e-flex e-con-boxed e-con e-parent\" data-id=\"b53704c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f4609c0 elementor-widget elementor-widget-shortcode\" data-id=\"f4609c0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-7195 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-7195\" data-uid=\"6a3d8d3fc0425\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-7195\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-7195 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"7195\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a3d8d3fc0425\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-pagination-progress\" aria-hidden=\"true\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Finish\"\n\t\t\t\tdata-actual-label=\"Page 1\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VOS DONN\u00c9ES PERSONNELLES<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_6a3d8d3fc0425\" id=\"forminator-field-first-name-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Pr\u00e9nom\" id=\"forminator-field-first-name-1_6a3d8d3fc0425\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_6a3d8d3fc0425\" id=\"forminator-field-last-name-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Nom de famille <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Nom de famille\" id=\"forminator-field-last-name-1_6a3d8d3fc0425\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a3d8d3fc0425\" id=\"forminator-field-phone-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre num\u00e9ro de t\u00e9l\u00e9phone, auquel nous pouvons vous joindre le mieux <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-phone-1_6a3d8d3fc0425-description\" class=\"forminator-description\">Avec code pays<\/span><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a3d8d3fc0425\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" aria-describedby=\"forminator-field-phone-1_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a3d8d3fc0425\" id=\"forminator-field-email-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre adresse e-mail o\u00f9 nous pouvons vous joindre le mieux <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Courriel\" id=\"forminator-field-email-1_6a3d8d3fc0425\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-1_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-1_6a3d8d3fc0425-label\" class=\"forminator-label\">\u00cates-vous d\u00e9j\u00e0 client chez nous ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-1_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-1_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Ja\"  data-calculation=\"0\">Oui<\/option><option value=\"Nee\"  data-calculation=\"0\">Non<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"Page  1\"\n\t\t\t\tdata-actual-label=\"Page 2\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VOS DONN\u00c9ES PERSONNELLES<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-2_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-2_6a3d8d3fc0425-label\" class=\"forminator-label\">Comment \u00eates-vous tomb\u00e9 sur nous ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-2_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-2_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Google\"  data-calculation=\"0\">Google<\/option><option value=\"Sociale media\"  data-calculation=\"0\">M\u00e9dias sociaux<\/option><option value=\"Via makelaar of gestor\u00eda of andere professionals\"  data-calculation=\"0\">Via un agent immobilier, un bureau de gestion ou d'autres professionnels<\/option><option value=\"Via kennissen \/ vrienden\"  data-calculation=\"0\">Via des connaissances \/ amis<\/option><option value=\"custom_option\"  data-calculation=\"0\">Autres<\/option><\/select><div class=\"forminator-field forminator-custom-input\"><input id=\"custom-forminator-form-7195__field--select-2_6a3d8d3fc0425\" name=\"custom-select-2\" class=\"forminator-input\" placeholder=\"Via\" aria-label=\"Autres\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a3d8d3fc0425\" id=\"forminator-field-text-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Pouvez-vous communiquer le nom ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"Nom\" id=\"forminator-field-text-1_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-3_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-3_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre num\u00e9ro fiscal espagnol (NIE) <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-3_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-3_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Ik heb een NIE nummer\"  data-calculation=\"0\">J'ai un num\u00e9ro NIE<\/option><option value=\"Ik heb nog geen NIE nummer\"  data-calculation=\"0\">Je n'ai pas encore de num\u00e9ro NIE<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a3d8d3fc0425\" id=\"forminator-field-text-2_6a3d8d3fc0425-label\" class=\"forminator-label\">NIE <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"N0000000N\" id=\"forminator-field-text-2_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-4_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-4_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre genre <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-4_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-4_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Man\"  data-calculation=\"0\">Homme<\/option><option value=\"Vrouw\"  data-calculation=\"0\">Femme<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a3d8d3fc0425\" id=\"forminator-field-date-1-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a3d8d3fc0425\" id=\"forminator-field-text-3_6a3d8d3fc0425-label\" class=\"forminator-label\">Votre nationalit\u00e9 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Votre nationalit\u00e9\" id=\"forminator-field-text-3_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Page  2\"\n\t\t\t\tdata-actual-label=\"Uw verblijfsadres in Spanje\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Votre adresse de r\u00e9sidence en Espagne<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6a3d8d3fc0425\" id=\"forminator-field-text-17_6a3d8d3fc0425-label\" class=\"forminator-label\">Code postal <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-17_6a3d8d3fc0425-description\" class=\"forminator-description\"><span data-limit=\"10\" data-type=\"characters\">0 \/ 10<\/span><\/span><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"10\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a3d8d3fc0425\" id=\"forminator-field-text-4_6a3d8d3fc0425-label\" class=\"forminator-label\">Commune <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a3d8d3fc0425\" id=\"forminator-field-text-5_6a3d8d3fc0425-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a3d8d3fc0425\" id=\"forminator-field-text-6_6a3d8d3fc0425-label\" class=\"forminator-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"Uw verblijfsadres in Spanje\"\n\t\t\t\tdata-actual-label=\"Page 4\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-9\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VOS DONN\u00c9ES PERSONNELLES<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-5_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-5_6a3d8d3fc0425-label\" class=\"forminator-label\">L'assur\u00e9 est-il une entreprise ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-5_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-5_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Nee\"  data-calculation=\"0\">Non<\/option><option value=\"Ja\"  data-calculation=\"0\">Oui<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"Page  4\"\n\t\t\t\tdata-actual-label=\"Page 5\"\n\t\t\t\tdata-name=\"page-break-6\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-10\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VOS DONN\u00c9ES PERSONNELLES<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a3d8d3fc0425\" id=\"forminator-field-text-7_6a3d8d3fc0425-label\" class=\"forminator-label\">Quel est le nom de l'entreprise ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a3d8d3fc0425\" id=\"forminator-field-text-8_6a3d8d3fc0425-label\" class=\"forminator-label\">Quel est le num\u00e9ro fiscal de l'entreprise ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Quelle est l'adresse fiscale de l'entreprise ?<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a3d8d3fc0425\" id=\"forminator-field-text-9_6a3d8d3fc0425-label\" class=\"forminator-label\">Terre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a3d8d3fc0425\" id=\"forminator-field-text-10_6a3d8d3fc0425-label\" class=\"forminator-label\">Code postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6a3d8d3fc0425\" id=\"forminator-field-text-11_6a3d8d3fc0425-label\" class=\"forminator-label\">Commune <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6a3d8d3fc0425\" id=\"forminator-field-text-12_6a3d8d3fc0425-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6a3d8d3fc0425\" id=\"forminator-field-text-13_6a3d8d3fc0425-label\" class=\"forminator-label\">Num\u00e9ro de maison <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"Page  5\"\n\t\t\t\tdata-actual-label=\"Page 6\"\n\t\t\t\tdata-name=\"page-break-7\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Sp\u00e9cifique<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-6_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-6_6a3d8d3fc0425-label\" class=\"forminator-label\">En quelle langue souhaitez-vous recevoir le devis ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-6_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-6_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Spaans\"  data-calculation=\"0\">Espagnol<\/option><option value=\"Engels\"  data-calculation=\"0\">Anglais<\/option><option value=\"Frans\"  data-calculation=\"0\">Frans<\/option><option value=\"Duits\"  data-calculation=\"0\">Allemand<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a3d8d3fc0425\" id=\"forminator-field-date-2-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Quand souhaitez-vous que l'assurance prenne effet ? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"\" id=\"forminator-field-date-2-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6a3d8d3fc0425\" id=\"forminator-field-text-18_6a3d8d3fc0425-label\" class=\"forminator-label\">Nom de la personne qui est le titulaire de la police et qui conduira habituellement le v\u00e9hicule ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6a3d8d3fc0425\" id=\"forminator-field-text-19_6a3d8d3fc0425-label\" class=\"forminator-label\">Num\u00e9ro d'identification fiscale espagnol ou num\u00e9ro NIE de cette personne ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6a3d8d3fc0425\" id=\"forminator-field-date-3-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la date de naissance de cette personne ? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"\" id=\"forminator-field-date-3-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6a3d8d3fc0425\" id=\"forminator-field-date-4-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Depuis quand cette personne poss\u00e8de-t-elle un permis de conduire ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-date-4-picker_6a3d8d3fc0425-description\" class=\"forminator-description\">(quel que soit le pays o\u00f9 ce permis de conduire a \u00e9t\u00e9 d\u00e9livr\u00e9) Indiquez la date d'origine de la premi\u00e8re d\u00e9livrance.<\/span><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"\" id=\"forminator-field-date-4-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-4-picker_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-20\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-20_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-20_6a3d8d3fc0425-label\" class=\"forminator-label\">Souhaitez-vous d\u00e9signer un deuxi\u00e8me conducteur sur la police ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-form-7195__field--select-20_6a3d8d3fc0425-description\" class=\"forminator-description\">Ceci n'est n\u00e9cessaire que si une autre personne conduit r\u00e9guli\u00e8rement la voiture) Par d\u00e9faut, tous les conducteurs \u00e2g\u00e9s de 26 ans et plus avec un permis de conduire valide depuis au moins 2 ans sont couverts.<\/span><select  id=\"forminator-form-7195__field--select-20_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-20\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-20_6a3d8d3fc0425-label\" aria-describedby=\"forminator-form-7195__field--select-20_6a3d8d3fc0425-description\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Ja\"  data-calculation=\"0\">Oui<\/option><option value=\"Nee\"  data-calculation=\"0\">Non<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6a3d8d3fc0425\" id=\"forminator-field-text-20_6a3d8d3fc0425-label\" class=\"forminator-label\">Quel est le nom et le pr\u00e9nom du deuxi\u00e8me conducteur ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6a3d8d3fc0425\" id=\"forminator-field-text-21_6a3d8d3fc0425-label\" class=\"forminator-label\">Quel est le num\u00e9ro fiscal espagnol ou num\u00e9ro NIE du deuxi\u00e8me conducteur ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-21_6a3d8d3fc0425-description\" class=\"forminator-description\">Attention, un conducteur suppl\u00e9mentaire ne peut \u00eatre ajout\u00e9 que s'il poss\u00e8de un num\u00e9ro NIE.<\/span><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-21_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_6a3d8d3fc0425\" id=\"forminator-field-date-5-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la naissance du deuxi\u00e8me conducteur ? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"\" id=\"forminator-field-date-5-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_6a3d8d3fc0425\" id=\"forminator-field-date-6-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la date de la premi\u00e8re d\u00e9livrance du permis de conduire du deuxi\u00e8me conducteur ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-date-6-picker_6a3d8d3fc0425-description\" class=\"forminator-description\">Quelle que soit le pays de d\u00e9livrance de ce permis de conduire) Indiquer la date originale de la premi\u00e8re d\u00e9livrance.<\/span><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"\" id=\"forminator-field-date-6-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-6-picker_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-6\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-6-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"6\"\n\t\t\t\tdata-label=\"Page  6\"\n\t\t\t\tdata-actual-label=\"Page 7\"\n\t\t\t\tdata-name=\"page-break-8\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">INFORMATIONS SUR VOTRE V\u00c9HICULE \u00c0 ASSURER<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-22\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-22_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-22_6a3d8d3fc0425-label\" class=\"forminator-label\">La voiture a-t-elle d\u00e9j\u00e0 une plaque d'immatriculation espagnole ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-form-7195__field--select-22_6a3d8d3fc0425-description\" class=\"forminator-description\">Si vous remplissez le num\u00e9ro d'immatriculation, nous pouvons souvent v\u00e9rifier automatiquement des informations suppl\u00e9mentaires sur le v\u00e9hicule.<\/span><select  id=\"forminator-form-7195__field--select-22_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-22\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-22_6a3d8d3fc0425-label\" aria-describedby=\"forminator-form-7195__field--select-22_6a3d8d3fc0425-description\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Ja\"  data-calculation=\"0\">Oui<\/option><option value=\"Nee\"  data-calculation=\"0\">Non<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6a3d8d3fc0425\" id=\"forminator-field-text-22_6a3d8d3fc0425-label\" class=\"forminator-label\">Veuillez fournir le num\u00e9ro d'immatriculation. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6a3d8d3fc0425\" id=\"forminator-field-text-23_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la marque et le mod\u00e8le de la voiture ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-23_6a3d8d3fc0425-description\" class=\"forminator-description\">Vous trouverez ceci sur votre certificat d'immatriculation (permiso de circulaci\u00f3n) ou votre facture d'achat.<\/span><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-23_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_6a3d8d3fc0425\" id=\"forminator-field-text-24_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle version est-ce ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-24_6a3d8d3fc0425-description\" class=\"forminator-description\">Ceci est important car le m\u00eame v\u00e9hicule peut avoir diff\u00e9rentes versions avec une valeur diff\u00e9rente. Vous le trouverez g\u00e9n\u00e9ralement sur la facture d'achat, dans les documents d'entretien ou aupr\u00e8s de votre garage. Vous ne trouvez pas \u00e7a? Remplissez alors au mieux ce que vous savez.<\/span><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_6a3d8d3fc0425\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-24_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a3d8d3fc0425\" id=\"forminator-field-number-1_6a3d8d3fc0425-label\" class=\"forminator-label\">Ann\u00e9e de construction du v\u00e9hicule. <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-number-1_6a3d8d3fc0425-description\" class=\"forminator-description\">Veuillez indiquer l'ann\u00e9e de production du v\u00e9hicule. Par exemple : 2021. Vous la trouverez g\u00e9n\u00e9ralement sur la facture d'achat ou aupr\u00e8s de votre garage.<\/span><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6a3d8d3fc0425\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999\" aria-describedby=\"forminator-field-number-1_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_6a3d8d3fc0425\" id=\"forminator-field-date-7-picker_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la date de premi\u00e8re mise en circulation du v\u00e9hicule ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-date-7-picker_6a3d8d3fc0425-description\" class=\"forminator-description\">Cela peut \u00eatre trouv\u00e9 sur le permis de circulation.<\/span><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"Choisir la date\" id=\"forminator-field-date-7-picker_6a3d8d3fc0425\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-7-picker_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a3d8d3fc0425\" id=\"forminator-field-number-2_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la cylindr\u00e9e de la voiture ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-number-2_6a3d8d3fc0425-description\" class=\"forminator-description\">Vous trouverez ceci sur votre certificat d'inscription.<\/span><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6a3d8d3fc0425\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" aria-describedby=\"forminator-field-number-2_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6a3d8d3fc0425\" id=\"forminator-field-number-3_6a3d8d3fc0425-label\" class=\"forminator-label\">Quelle est la puissance (en CV) de la voiture ? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-number-3_6a3d8d3fc0425-description\" class=\"forminator-description\">Vous trouverez ceci sur votre certificat d'inscription<\/span><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_6a3d8d3fc0425\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" aria-describedby=\"forminator-field-number-3_6a3d8d3fc0425-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6a3d8d3fc0425\" id=\"forminator-field-number-4_6a3d8d3fc0425-label\" class=\"forminator-label\">Combien de porti\u00e8res a la voiture ? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-4\" value=\"\" placeholder=\"\" id=\"forminator-field-number-4_6a3d8d3fc0425\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-23\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-23_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-23_6a3d8d3fc0425-label\" class=\"forminator-label\">\u00c0 quel carburant roule la voiture ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-23_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-23\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-23_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Diesel\"  data-calculation=\"0\">Diesel<\/option><option value=\"Benzine\"  data-calculation=\"0\">Benzine<\/option><option value=\"Hybride\"  data-calculation=\"0\">Hybride<\/option><option value=\"Plug-in-Hybride\"  data-calculation=\"0\">Hybride rechargeable<\/option><option value=\"Elektrisch\"  data-calculation=\"0\">\u00c9lectrique<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-24\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-24_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-24_6a3d8d3fc0425-label\" class=\"forminator-label\">La voiture est-elle manuelle ou automatique ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-24_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-24\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-24_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Handgeschakeld\"  data-calculation=\"0\">Manuelle<\/option><option value=\"Automatisch\"  data-calculation=\"0\">Automatique<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-25\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-25_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-25_6a3d8d3fc0425-label\" class=\"forminator-label\">La voiture a-t-elle un attelage ? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-7195__field--select-25_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-25\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies \u00e9\u00e9n optie\" data-search=\"false\" data-search-placeholder=\"Kies \u00e9\u00e9n optie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-25_6a3d8d3fc0425-label\"><option value=\"\"  >Choisissez une option<\/option><option value=\"Ja\"  data-calculation=\"0\">Oui<\/option><option value=\"Nee\"  data-calculation=\"0\">Non<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-7\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-7-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"7\"\n\t\t\t\tdata-label=\"Page  7\"\n\t\t\t\tdata-actual-label=\"Page 8\"\n\t\t\t\tdata-name=\"page-break-9\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-12\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">DEKKINGEN<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-21\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-7195__field--select-21_6a3d8d3fc0425\" id=\"forminator-form-7195__field--select-21_6a3d8d3fc0425-label\" class=\"forminator-label\">Souhaitez-vous une option d'assistance d\u00e9pannage plus compl\u00e8te avec un v\u00e9hicule de remplacement en cas de panne ?<\/label><span id=\"forminator-form-7195__field--select-21_6a3d8d3fc0425-description\" class=\"forminator-description\">Par d\u00e9faut, une voiture de remplacement est incluse en cas d'accident, sous r\u00e9serve de certaines conditions. Avec cette extension, vous \u00eates \u00e9galement couvert en cas de panne.<\/span><select  id=\"forminator-form-7195__field--select-21_6a3d8d3fc0425\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-21\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-7195__field--select-21_6a3d8d3fc0425-label\" aria-describedby=\"forminator-form-7195__field--select-21_6a3d8d3fc0425-description\"><option value=\"Ja, ik wens ook dekking bij pech\"  data-calculation=\"0\">Oui, je souhaite \u00e9galement une couverture en cas de d\u00e9pannage.<\/option><option value=\"Nee, enkel dekking bij ongeval (standaard inbegrepen)\"  data-calculation=\"0\">Non, seule la couverture en cas d'accident (incluse par d\u00e9faut)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-7195--page-8\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-7195--page-8-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"8\"\n\t\t\t\tdata-label=\"Page  8\"\n\t\t\t\tdata-actual-label=\"Page 9\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">DERNI\u00c8RE V\u00c9RIFICATION<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p>Parfait, nous avons bien re\u00e7u toutes les informations. Souhaitez-vous les v\u00e9rifier attentivement avant de cliquer sur \u2018 envoyer \u2019 ? Ainsi, nous pourrons traiter votre demande imm\u00e9diatement et correctement.<\/p>\n<p>Apr\u00e8s confirmation, nous commencerons imm\u00e9diatement \u00e0 pr\u00e9parer votre devis personnalis\u00e9. Si des informations manquent ou si des pr\u00e9cisions suppl\u00e9mentaires sont n\u00e9cessaires, nous vous contacterons personnellement.<\/p><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Exp\u00e9dition et demande de devis<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"59195110d2\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/7312\" \/><input type=\"hidden\" name=\"form_id\" value=\"7195\"><input type=\"hidden\" name=\"page_id\" value=\"7312\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/grupoxandra.eu\/fr\/autoverzekeringsformulier\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_48\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_48\" type=\"text\" name=\"input_48\" value=\"\" autocomplete=\"off\"><\/label><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Recevez une proposition unique pour votre assurance auto personnalis\u00e9e.<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7312","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/pages\/7312","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/comments?post=7312"}],"version-history":[{"count":7,"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/pages\/7312\/revisions"}],"predecessor-version":[{"id":7322,"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/pages\/7312\/revisions\/7322"}],"wp:attachment":[{"href":"https:\/\/grupoxandra.eu\/fr\/wp-json\/wp\/v2\/media?parent=7312"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}