{"id":4731,"date":"2012-10-25T19:31:05","date_gmt":"2012-10-25T19:31:05","guid":{"rendered":"http:\/\/https:\/\/www.verzekeringendecoster.be\/?page_id=4481"},"modified":"2018-06-04T13:45:36","modified_gmt":"2018-06-04T13:45:36","slug":"offerte-gewaarborgd-inkomen","status":"publish","type":"page","link":"https:\/\/www.verzekeringendecoster.be\/fr\/offerte-gewaarborgd-inkomen\/","title":{"rendered":"Devis Garantie de revenus"},"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_26' style='display:none'><div id='gf_26' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_26'  action=\"\/fr\/wp-json\/wp\/v2\/pages\/4731#gf_26\" data-formid='26' novalidate>\n        <div id='gf_progressbar_wrapper_26' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>4<\/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_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_26_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_26' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_26_35\" 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_26_35' class='gfield_label gform-field-label' for='input_26_35'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container'><input name='input_35' id='input_26_35' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_26_35'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/li><li id=\"field_26_2\" 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\">Souscripteur<\/h2><\/li><li id=\"field_26_3\" 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_26_3' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/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_26_3'>\n                            \n                            <span id='input_26_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_26_3_3' id='input_26_3_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_3.3' id='input_26_3_3' value=''   aria-required='true'     aria-labelledby=\"input_26_3_3_label gfield_label_26_3\"\/>\n                                                <\/span>\n                            \n                            <span id='input_26_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_26_3_6' id='input_26_3_6_label' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_3.6' id='input_26_3_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_26_4\" 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_26_4' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/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_26_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_26_4_1_container' >\n                                        <label for='input_26_4_1' id='input_26_4_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                        <input type='text' name='input_4.1' id='input_26_4_1' value=''    aria-required='true'    aria-labelledby=\"input_26_4_1_label gfield_label_26_4\"\/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_26_4_3_container' >\n                                    <label for='input_26_4_3' id='input_26_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_4.3' id='input_26_4_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_4.4' id='input_26_4_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_26_4_5_container' >\n                                    <label for='input_26_4_5' id='input_26_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_4.5' id='input_26_4_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_26_4_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_26_5\" 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_26_5' class='gfield_label gform-field-label' for='input_26_5'><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_5' id='input_26_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_26_6\" 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_26_6' class='gfield_label gform-field-label' for='input_26_6'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/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_6' id='input_26_6' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_26_7\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_7' class='gfield_label gform-field-label' for='input_26_7'><span class='gform-field-label__text'>Date de naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_26_7'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_7'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_26_7' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_26_7' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_26_7' aria-label='Date de naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                         <button type='button' id='gform_next_button_26_1' 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_26_2' class='gform_page' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_26_2' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_26_9\" 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\">Activit\u00e9 de la personne \u00e0 assurer<\/h2><\/li><li id=\"field_26_10\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_10' class='gfield_label gform-field-label' for='input_26_10'><span class='gform-field-label__text'>Date de d\u00e9but de l\u2019activit\u00e9 ind\u00e9pendante<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_26_10'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_10'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_26_10' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_26_10' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_26_10' aria-label='Date de d\u00e9but de l\u2019activit\u00e9 ind\u00e9pendante: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_26_13\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_13' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>La personne \u00e0 assurer exerce son activit\u00e9 ind\u00e9pendante en tant que<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_13'>\n\t\t\t<li class='gchoice gchoice_26_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Activit\u00e9 principale'  id='choice_26_13_0'    \/>\n\t\t\t\t<label for='choice_26_13_0' id='label_26_13_0' class='gform-field-label gform-field-label--type-inline'>Activit\u00e9 principale<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Activit\u00e9 compl\u00e9mentaire'  id='choice_26_13_1'    \/>\n\t\t\t\t<label for='choice_26_13_1' id='label_26_13_1' class='gform-field-label gform-field-label--type-inline'>Activit\u00e9 compl\u00e9mentaire<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_26_12\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_12' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>La personne \u00e0 assurer est<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_12'>\n\t\t\t<li class='gchoice gchoice_26_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Ind\u00e9pendant d\u00e9butant (statut d\u2019ind\u00e9pendant depuis moins de 3 ans)'  id='choice_26_12_0'    \/>\n\t\t\t\t<label for='choice_26_12_0' id='label_26_12_0' class='gform-field-label gform-field-label--type-inline'>Ind\u00e9pendant d\u00e9butant (statut d\u2019ind\u00e9pendant depuis moins de 3 ans)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Ind\u00e9pendant \u00e9tabli (statut d\u2019ind\u00e9pendant depuis plus de 3 ans ou exp\u00e9rience professionnelle \u00e9quivalente en tant que salari\u00e9)'  id='choice_26_12_1'    \/>\n\t\t\t\t<label for='choice_26_12_1' id='label_26_12_1' class='gform-field-label gform-field-label--type-inline'>Ind\u00e9pendant \u00e9tabli (statut d\u2019ind\u00e9pendant depuis plus de 3 ans ou exp\u00e9rience professionnelle \u00e9quivalente en tant que salari\u00e9)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_26_14\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_14' class='gfield_label gform-field-label' for='input_26_14'><span class='gform-field-label__text'>Description pr\u00e9cise de l\u2019activit\u00e9 professionnelle<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_26_14' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_26_15\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_15' class='gfield_label gform-field-label' for='input_26_15'><span class='gform-field-label__text'>En cas d\u2019ind\u00e9pendant \u00e0 titre compl\u00e9mentaire: description de votre activit\u00e9 principale<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_26_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_26_16\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><\/br><\/br>\n<h3>Merci d\u2019indiquer la r\u00e9partition de vos t\u00e2ches entre les 5 domaines ci-dessous<\/h3>\n<p>Total = 100%<\/p>\n<\/br><\/br><\/li><li id=\"field_26_17\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_17' class='gfield_label gform-field-label' for='input_26_17'><span class='gform-field-label__text'>Administration et gestion (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_17' id='input_26_17' type='text' step='any' min='0' max='100' value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_26_17\" \/><div class='gfield_description instruction ' id='gfield_instruction_26_17'>Veuillez saisir un nombre inf\u00e9rieur ou \u00e9gal \u00e0 <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_26_18\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_18' class='gfield_label gform-field-label' for='input_26_18'><span class='gform-field-label__text'>Travail manuel (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_18' id='input_26_18' type='text' step='any' min='0' max='100' value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_26_18\" \/><div class='gfield_description instruction ' id='gfield_instruction_26_18'>Veuillez saisir un nombre inf\u00e9rieur ou \u00e9gal \u00e0 <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_26_19\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_19' class='gfield_label gform-field-label' for='input_26_19'><span class='gform-field-label__text'>Transport (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_19' id='input_26_19' type='text' step='any' min='0' max='100' value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_26_19\" \/><div class='gfield_description instruction ' id='gfield_instruction_26_19'>Veuillez saisir un nombre inf\u00e9rieur ou \u00e9gal \u00e0 <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_26_20\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_20' class='gfield_label gform-field-label' for='input_26_20'><span class='gform-field-label__text'>Travail en hauteur (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_20' id='input_26_20' type='text' step='any' min='0' max='100' value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_26_20\" \/><div class='gfield_description instruction ' id='gfield_instruction_26_20'>Veuillez saisir un nombre inf\u00e9rieur ou \u00e9gal \u00e0 <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_26_21\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_21' class='gfield_label gform-field-label' for='input_26_21'><span class='gform-field-label__text'>Autres (description + %)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_26_21' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_26_22\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_22' class='gfield_label gform-field-label' for='input_26_22'><span class='gform-field-label__text'>S\u00e9journez-vous r\u00e9guli\u00e8rement \u00e0 l\u2019\u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_26_22' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/li><li id=\"field_26_23\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_23' class='gfield_label gform-field-label' for='input_26_23'><span class='gform-field-label__text'>Pratiques-vous un sport pour lequel une protection est requise ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_26_23' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/li><li id=\"field_26_24\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_24' class='gfield_label gform-field-label' for='input_26_24'><span class='gform-field-label__text'>Sp\u00e9cifiez le(s) sport(s)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_26_24' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_26_8' 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_26_8' 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_26_3' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_26_3' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_26_26\" 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\">Protection de vos revenus<\/h2><\/li><li id=\"field_26_27\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_27' class='gfield_label gform-field-label' for='input_26_27'><span class='gform-field-label__text'>Revenu annuel net imposable de votre travail<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_27' id='input_26_27' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_26_28\" class=\"gfield gfield--type-number field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_26_28' class='gfield_label gform-field-label' for='input_26_28'><span class='gform-field-label__text'>Quel montant de votre revenu annuel net imposable souhaitez-vous assurer ?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_26_28' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_26_28\" \/><\/div><div class='gfield_description' id='gfield_description_26_28'>Max. 80% de votre revenu net imposable<\/div><\/li><li id=\"field_26_29\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_29' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Contre quelle forme d\u2019incapacit\u00e9 souhaitez-vous \u00eatre assur\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_29'>\n\t\t\t<li class='gchoice gchoice_26_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='Incapacit\u00e9 \u00e9conomique  et Invalidit\u00e9'  id='choice_26_29_0'    \/>\n\t\t\t\t<label for='choice_26_29_0' id='label_26_29_0' class='gform-field-label gform-field-label--type-inline'>Incapacit\u00e9 \u00e9conomique  et Invalidit\u00e9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='Uniquement Incapacit\u00e9 \u00e9conomique'  id='choice_26_29_1'    \/>\n\t\t\t\t<label for='choice_26_29_1' id='label_26_29_1' class='gform-field-label gform-field-label--type-inline'>Uniquement Incapacit\u00e9 \u00e9conomique<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_26_29'><u><strong>Invalidit\u00e9:<\/strong><\/u> diminution de l\u2019int\u00e9grit\u00e9 physique. (Ex. amputation d\u2019un doigt =>ind\u00e9pendamment de son influence l\u2019exercice de votre activit\u00e9 professionnelle)\n<\/br>\n<u><strong>Incapacit\u00e9 \u00e9conomique:<\/strong><\/u> diminution de votre capacit\u00e9 de travail en relation avec l\u2019invalidit\u00e9. (Ex. Chez un pianiste l\u2019amputation d\u2019un doigt a une r\u00e9percussion sur l\u2019exercice de son travail).<\/div><\/li><li id=\"field_26_30\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_30' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Maladie et accidents<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_30'>\n\t\t\t<li class='gchoice gchoice_26_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='Avantages de toute nature'  id='choice_26_30_0'    \/>\n\t\t\t\t<label for='choice_26_30_0' id='label_26_30_0' class='gform-field-label gform-field-label--type-inline'>Avantages de toute nature<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='Vie priv\u00e9e'  id='choice_26_30_1'    \/>\n\t\t\t\t<label for='choice_26_30_1' id='label_26_30_1' class='gform-field-label gform-field-label--type-inline'>Vie priv\u00e9e<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_26_25' 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_26_25' 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_26_4' class='gform_page' data-js='page-field-id-25' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_26_4' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_26_31\" 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\">Modalit\u00e9s suppl\u00e9mentaires<\/h2><\/li><li id=\"field_26_32\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_32' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>D\u00e9lai de carence<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_32'>\n\t\t\t<li class='gchoice gchoice_26_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='1 mois'  id='choice_26_32_0'    \/>\n\t\t\t\t<label for='choice_26_32_0' id='label_26_32_0' class='gform-field-label gform-field-label--type-inline'>1 mois<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='2 mois'  id='choice_26_32_1'    \/>\n\t\t\t\t<label for='choice_26_32_1' id='label_26_32_1' class='gform-field-label gform-field-label--type-inline'>2 mois<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='3 mois'  id='choice_26_32_2'    \/>\n\t\t\t\t<label for='choice_26_32_2' id='label_26_32_2' class='gform-field-label gform-field-label--type-inline'>3 mois<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='6 mois'  id='choice_26_32_3'    \/>\n\t\t\t\t<label for='choice_26_32_3' id='label_26_32_3' class='gform-field-label gform-field-label--type-inline'>6 mois<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_32_4'>\n\t\t\t\t<input name='input_32' type='radio' value='12 mois'  id='choice_26_32_4'    \/>\n\t\t\t\t<label for='choice_26_32_4' id='label_26_32_4' class='gform-field-label gform-field-label--type-inline'>12 mois<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_26_32'>P\u00e9riode \u00e9coul\u00e9e entre l\u2019accident et le versement des droits.\nA noter : plus cette p\u00e9riode est longue moins votre prime est ch\u00e8re.\n<\/div><\/li><li id=\"field_26_33\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_33' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_26_33'><li class='gchoice gchoice_26_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Rachat du d\u00e9lai de carence (uniquement possible \u00e0 partir d\u2019un mois)'  id='choice_26_33_1'    aria-labelledby=\"label_26_33_1 gfield_label_26_33\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_26_33_1' id='label_26_33_1' class='gform-field-label gform-field-label--type-inline'>Rachat du d\u00e9lai de carence (uniquement possible \u00e0 partir d\u2019un mois)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_26_34\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_26_34' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Dur\u00e9e du contrat<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_26_34'>\n\t\t\t<li class='gchoice gchoice_26_34_0'>\n\t\t\t\t<input name='input_34' type='radio' value='Jusqu\u2019\u00e0 60 ans'  id='choice_26_34_0'    \/>\n\t\t\t\t<label for='choice_26_34_0' id='label_26_34_0' class='gform-field-label gform-field-label--type-inline'>Jusqu\u2019\u00e0 60 ans<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_26_34_1'>\n\t\t\t\t<input name='input_34' type='radio' value='Jusqu\u2019\u00e0 65 ans'  id='choice_26_34_1'    \/>\n\t\t\t\t<label for='choice_26_34_1' id='label_26_34_1' class='gform-field-label gform-field-label--type-inline'>Jusqu\u2019\u00e0 65 ans<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer left_label'><button type='submit' id='gform_previous_button_26' 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_26' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Envoyer<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_26' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_26' id='gform_theme_26' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_26' id='gform_style_settings_26' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_26' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='26' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' 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\u00e0...","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4731","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/pages\/4731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/comments?post=4731"}],"version-history":[{"count":0,"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/pages\/4731\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.verzekeringendecoster.be\/fr\/wp-json\/wp\/v2\/media?parent=4731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}