{"id":4336,"date":"2012-09-23T13:29:28","date_gmt":"2012-09-23T13:29:28","guid":{"rendered":"http:\/\/@WEBSITE_1@\/?page_id=4336"},"modified":"2018-09-28T12:10:36","modified_gmt":"2018-09-28T12:10:36","slug":"offerte-familiale-verzekering","status":"publish","type":"page","link":"https:\/\/www.zakenkantoorgoethals.be\/en\/offerte-familiale-verzekering\/","title":{"rendered":"Quotation Family Insurance"},"content":{"rendered":"<p>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_9' ><div id='gf_9' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action=\"\/en\/wp-json\/wp\/v2\/pages\/4336#gf_9\" data-formid='9' novalidate>\n        <div id='gf_progressbar_wrapper_9' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_9_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_9' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_9_18\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_18' class='gfield_label gform-field-label' for='input_9_18'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='ginput_container'><input name='input_18' id='input_9_18' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_9_18'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_9_1\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Policyholder<\/h2><\/li><li id=\"field_9_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_2'>\n                            \n                            <span id='input_9_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_2_3' id='input_9_2_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_2.3' id='input_9_2_3' value=''   aria-required='true'     aria-labelledby=\"input_9_2_3_label gfield_label_9_2\"\/>\n                                                <\/span>\n                            \n                            <span id='input_9_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_2_6' id='input_9_2_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_2.6' id='input_9_2_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_9_3\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_3' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_9_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_3_1_container' >\n                                        <label for='input_9_3_1' id='input_9_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_3.1' id='input_9_3_1' value=''    aria-required='true'    aria-labelledby=\"input_9_3_1_label gfield_label_9_3\"\/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_9_3_3_container' >\n                                    <label for='input_9_3_3' id='input_9_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_3.3' id='input_9_3_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_3.4' id='input_9_3_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_9_3_5_container' >\n                                    <label for='input_9_3_5' id='input_9_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_3.5' id='input_9_3_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_9_3_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_9_4\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_4' class='gfield_label gform-field-label' for='input_9_4'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_9_4' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_9_5\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_5' class='gfield_label gform-field-label' for='input_9_5'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_9_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                         <button type='button' id='gform_next_button_9_7' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_2' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_9_2' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_9_6\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Your family situation<\/h2><\/li><li id=\"field_9_8\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_8' class='gfield_label gform-field-label' for='input_9_8'><span class='gform-field-label__text'>What is your family situation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_9_8' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Living together \/ Couple' >Living together \/ Couple<\/option><option value='Single (with minor children)' >Single (with minor children)<\/option><option value='Single (without minor children)' >Single (without minor children)<\/option><\/select><\/div><\/li><li id=\"field_9_9\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_9' class='gfield_label gform-field-label' for='input_9_9'><span class='gform-field-label__text'>Age of policyholder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_9_9' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='0 \u2013 30 years' >0 \u2013 30 years<\/option><option value='31 - 49 years' >31 - 49 years<\/option><option value='50 years of older' >50 years of older<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_9_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_9_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_3' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_9_3' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_9_10\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Optionel<\/h2><\/li><li id=\"field_9_12\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_12' class='gfield_label gform-field-label' for='input_9_12'><span class='gform-field-label__text'>Ensure dog?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_9_12' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_9_13\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_13' class='gfield_label gform-field-label' for='input_9_13'><span class='gform-field-label__text'>Ensure cleaning lady?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_9_13' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_9_14\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_14' class='gfield_label gform-field-label' for='input_9_14'><span class='gform-field-label__text'>Ensure handyman?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_9_14' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_9_15\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_15' class='gfield_label gform-field-label' for='input_9_15'><span class='gform-field-label__text'>Ensure Baby-sit?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_9_15' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_9_16\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_16' class='gfield_label gform-field-label' for='input_9_16'><span class='gform-field-label__text'>Ensure your extra income?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_9_16' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_9_17\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_17' class='gfield_label gform-field-label' for='input_9_17'><span class='gform-field-label__text'>Ensure you as a teacher?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_9_17' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer left_label'><button type='submit' id='gform_previous_button_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='submit' id='gform_submit_button_9' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Send<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_9' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_9' id='gform_theme_9' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_9' id='gform_style_settings_9' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='vb0kr32hlGDPPk5UZXCiLQ5o8DQZjHB2NO1m4KDDx4EKeNlb6a06WUXEGRxDBQ\/cOIGDPIiClT2ZW6pVwpUzulMFVPNzqGS6iVRm0uzI1sXixOo=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><\/p>","protected":false},"excerpt":{"rendered":"Step 1 of 3 33% InstagramThis field is for validation purposes and should be left unchanged.PolicyholderName* First Last Address* Street Address City ZIP \/ Postal Code Email* Telephone* Volgende Your family situationWhat is your family situation?*Living together \/ CoupleSingle (with minor children)Single (without minor children)Age of policyholder*0 \u2013 30 years31 - 49 years50 years of older Vorige Volgende OptionelEnsure dog?NoYesEnsure...","protected":false},"author":12,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4336","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/pages\/4336","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/comments?post=4336"}],"version-history":[{"count":1,"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/pages\/4336\/revisions"}],"predecessor-version":[{"id":6745,"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/pages\/4336\/revisions\/6745"}],"wp:attachment":[{"href":"https:\/\/www.zakenkantoorgoethals.be\/en\/wp-json\/wp\/v2\/media?parent=4336"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}