{"id":10849,"date":"2025-06-18T14:44:38","date_gmt":"2025-06-18T12:44:38","guid":{"rendered":"https:\/\/www.vdl-interass.be\/?page_id=10849"},"modified":"2025-06-18T14:44:38","modified_gmt":"2025-06-18T12:44:38","slug":"offerte-aanvraag-brand-particulieren","status":"publish","type":"page","link":"https:\/\/www.vdl-interass.be\/nl\/offerte-aanvraag-brand-particulieren\/","title":{"rendered":"Offerte-aanvraag brand particulieren"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1456px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_12' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Assutop brand particulieren<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; geeft vereiste velden aan<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/nl\/wp-json\/wp\/v2\/pages\/10849' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_admin_only exclude entry_lang field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_administrative\"  ><input name='input_80' id='input_12_80' class='gform_hidden' type='hidden' value='nl'\/><\/div><div id=\"field_12_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_76'><span class='gform-field-label__text'>Agent<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_76' id='input_12_76' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_77\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_77'><span class='gform-field-label__text'>Beheerder<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_77' id='input_12_77' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_79\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_79'><span class='gform-field-label__text'>Datum<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_79' id='input_12_79' type='text' value='25\/10\/2026' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_75\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_75'><span class='gform-field-label__text'>E-mail beheerder<\/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_75' id='input_12_75' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Gegevens verzekeringsnemer<\/h3><\/div><fieldset id=\"field_12_3\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Naam<\/span><\/legend><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_12_3'>\n                            \n                            <span id='input_12_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_12_3_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_3_3' class='gform-field-label gform-field-label--type-sub '>Achternaam<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_12_3_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_3_6' class='gform-field-label gform-field-label--type-sub '>Voornaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_12_38\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_38'><span class='gform-field-label__text'>Geboortedatum<\/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='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_12_38'\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_38'\n\t\t\t\t value=''\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_12_38' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_12_38' 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_12_38' aria-label='Geboortedatum: 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><\/div><fieldset id=\"field_12_5\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adres<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_12_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_12_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_12_5_1' id='input_12_5_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_12_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_12_5_3' id='input_12_5_3_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_5.4' id='input_12_5_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_12_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_12_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_12_5_5' id='input_12_5_5_label' class='gform-field-label gform-field-label--type-sub '>Stad<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_12_5_6' value='BE' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Ligging risico<\/h3><\/div><fieldset id=\"field_12_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ligging risico = adres vzn<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_8'>\n\t\t\t<div class='gchoice gchoice_12_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Ja'  id='choice_12_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_8_0' id='label_12_8_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Nee'  id='choice_12_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_8_1' id='label_12_8_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Type woning<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_28'>\n\t\t\t<div class='gchoice gchoice_12_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Woning'  id='choice_12_28_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_12_28\"   \/>\n\t\t\t\t\t<label for='choice_12_28_0' id='label_12_28_0' class='gform-field-label gform-field-label--type-inline'>Woning<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Appartement'  id='choice_12_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_28_1' id='label_12_28_1' class='gform-field-label gform-field-label--type-inline'>Appartement<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_12_28'>Indien speciaal risico (bv: chalet, stacaravan, building,..) gelieve VDL te contacteren.<\/div><\/fieldset><fieldset id=\"field_12_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Hoedanigheid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_32'>\n\t\t\t<div class='gchoice gchoice_12_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Eigenaar'  id='choice_12_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_32_0' id='label_12_32_0' class='gform-field-label gform-field-label--type-inline'>Eigenaar<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Huurder'  id='choice_12_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_32_1' id='label_12_32_1' class='gform-field-label gform-field-label--type-inline'>Huurder<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_9\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adres ligging risico<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_12_9' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_12_9_1' value=''    aria-required='true'    \/>\n                                        <label for='input_12_9_1' id='input_12_9_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_9_3_container' >\n                                    <input type='text' name='input_9.3' id='input_12_9_3' value=''    aria-required='true'    \/>\n                                    <label for='input_12_9_3' id='input_12_9_3_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_9.4' id='input_12_9_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_12_9_5_container' >\n                                    <input type='text' name='input_9.5' id='input_12_9_5' value=''    aria-required='true'    \/>\n                                    <label for='input_12_9_5' id='input_12_9_5_label' class='gform-field-label gform-field-label--type-sub '>Stad<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_12_9_6_container' >\n                                        <select name='input_9.6' id='input_12_9_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' selected='selected'>Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_12_9_6' id='input_12_9_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_12_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Waarborgen<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_11'><div class='gchoice gchoice_12_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Gebouw'  id='choice_12_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_1' id='label_12_11_1' class='gform-field-label gform-field-label--type-inline'>Gebouw<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Inhoud'  id='choice_12_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_2' id='label_12_11_2' class='gform-field-label gform-field-label--type-inline'>Inhoud<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Diefstal'  id='choice_12_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_3' id='label_12_11_3' class='gform-field-label gform-field-label--type-inline'>Diefstal<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Waardering gebouw<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_12'>\n\t\t\t<div class='gchoice gchoice_12_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Kapitaal'  id='choice_12_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_0' id='label_12_12_0' class='gform-field-label gform-field-label--type-inline'>Kapitaal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Plaatsenplan'  id='choice_12_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_1' id='label_12_12_1' class='gform-field-label gform-field-label--type-inline'>Plaatsenplan<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Waardering gebouw<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_44'>\n\t\t\t<div class='gchoice gchoice_12_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Kapitaal'  id='choice_12_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_0' id='label_12_44_0' class='gform-field-label gform-field-label--type-inline'>Kapitaal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Plaatsenplan'  id='choice_12_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_1' id='label_12_44_1' class='gform-field-label gform-field-label--type-inline'>Plaatsenplan<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='20x jaarlijkse huur'  id='choice_12_44_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_2' id='label_12_44_2' class='gform-field-label gform-field-label--type-inline'>20x jaarlijkse huur<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Waardering inhoud<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_23'>\n\t\t\t<div class='gchoice gchoice_12_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Kapitaal'  id='choice_12_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_23_0' id='label_12_23_0' class='gform-field-label gform-field-label--type-inline'>Kapitaal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Plaatsenplan'  id='choice_12_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_23_1' id='label_12_23_1' class='gform-field-label gform-field-label--type-inline'>Plaatsenplan<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Limiet per voorwerp (enkel AXA)'  id='choice_12_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_23_2' id='label_12_23_2' class='gform-field-label gform-field-label--type-inline'>Limiet per voorwerp (enkel AXA)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Limiet per voorwerp (ABEX 775)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_43'>\n\t\t\t<div class='gchoice gchoice_12_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='4.195,01 EUR'  id='choice_12_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_0' id='label_12_43_0' class='gform-field-label gform-field-label--type-inline'>4.195,01 EUR<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='8.390,01 EUR'  id='choice_12_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_1' id='label_12_43_1' class='gform-field-label gform-field-label--type-inline'>8.390,01 EUR<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='14.682,53 EUR'  id='choice_12_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_2' id='label_12_43_2' class='gform-field-label gform-field-label--type-inline'>14.682,53 EUR<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='20.973,54 EUR'  id='choice_12_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_3' id='label_12_43_3' class='gform-field-label gform-field-label--type-inline'>20.973,54 EUR<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_45'><span class='gform-field-label__text'>Maandelijkse huur<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_12_45' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_40'><span class='gform-field-label__text'>Gelegen op welke verdieping<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_12_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-fieldId=\"40\" class=\"spacer gfield\" style=\"grid-column: span 8;\" data-groupId=\"7e03d7db\"><\/div><div id=\"field_12_14\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_14'><span class='gform-field-label__text'>Kapitaal gebouw<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_14' id='input_12_14' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_19\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_19'><span class='gform-field-label__text'>Kapitaal inhoud<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_19' id='input_12_19' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_12_35\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Aantal plaatsen<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Slaapkamer(s)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Andere plaatsen &gt;4m\u00b2<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Bijgebouwen &gt;20 m\u00b2<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Plaats(en) in de garage<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Zolder<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Kelder<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell1 gform-grid-col' data-label='Slaapkamer(s)'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Slaapkamer(s), Rij 1' data-aria-label-template='Slaapkamer(s), Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell2 gform-grid-col' data-label='Andere plaatsen &gt;4m\u00b2'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Andere plaatsen &gt;4m\u00b2, Rij 1' data-aria-label-template='Andere plaatsen &gt;4m\u00b2, Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell3 gform-grid-col' data-label='Bijgebouwen &gt;20 m\u00b2'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Bijgebouwen &gt;20 m\u00b2, Rij 1' data-aria-label-template='Bijgebouwen &gt;20 m\u00b2, Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell4 gform-grid-col' data-label='Plaats(en) in de garage'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Plaats(en) in de garage, Rij 1' data-aria-label-template='Plaats(en) in de garage, Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell5 gform-grid-col' data-label='Zolder'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Zolder, Rij 1' data-aria-label-template='Zolder, Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell6 gform-grid-col' data-label='Kelder'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_35\" aria-label='Kelder, Rij 1' data-aria-label-template='Kelder, Rij {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Nog een rij toevoegen' onclick='gformAddListItem(this, 0)'>Toevoegen<\/button>   <button type='button'  class='delete_list_item' aria-label='Verwijder rij 1' data-aria-label-template='Verwijder rij {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Verwijder<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_12_35'>Ruimten die u niet moet meetellen:\nRuimten kleiner dan 4 m\u00b2 \/ Inkomhal, nachthal en overloop \/ Keukens \/ Woonkamers, salons en eetkamers \/ Badkamers, douches en toiletten \/ Wasplaatsen en stookplaatsen die volledig\nonder het niveau van de hoofdingang liggen \/ Tuinhuisjes, serres, pergola\u2019s, carports en nietbewoonbare bijgebouwen (indien <20m\u00b2)\n \/ De gemeenschappelijke delen in geval van\nappartement(en)<\/div><\/fieldset><fieldset id=\"field_12_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Kapitaal diefstal tov inhoud<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_20'>\n\t\t\t<div class='gchoice gchoice_12_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='25%'  id='choice_12_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_0' id='label_12_20_0' class='gform-field-label gform-field-label--type-inline'>25%<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='50%'  id='choice_12_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>50%<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='100%'  id='choice_12_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_2' id='label_12_20_2' class='gform-field-label gform-field-label--type-inline'>100%<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Belending<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_26'>\n\t\t\t<div class='gchoice gchoice_12_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Gesloten'  id='choice_12_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_26_0' id='label_12_26_0' class='gform-field-label gform-field-label--type-inline'>Gesloten<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Halfopen'  id='choice_12_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_26_1' id='label_12_26_1' class='gform-field-label gform-field-label--type-inline'>Halfopen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Alleenstaand'  id='choice_12_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_26_2' id='label_12_26_2' class='gform-field-label gform-field-label--type-inline'>Alleenstaand<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_24\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_12_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Bijpremies<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_21'><div class='gchoice gchoice_12_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Indirect verlies'  id='choice_12_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_1' id='label_12_21_1' class='gform-field-label gform-field-label--type-inline'>Indirect verlies<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Rechtsbijstand'  id='choice_12_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_2' id='label_12_21_2' class='gform-field-label gform-field-label--type-inline'>Rechtsbijstand<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Motorvoertuig(en) in rust'  id='choice_12_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_3' id='label_12_21_3' class='gform-field-label gform-field-label--type-inline'>Motorvoertuig(en) in rust<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Engelse franchise'  id='choice_12_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_4' id='label_12_21_4' class='gform-field-label gform-field-label--type-inline'>Engelse franchise<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Afstand verhaal tov huurder'  id='choice_12_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_5' id='label_12_21_5' class='gform-field-label gform-field-label--type-inline'>Afstand verhaal tov huurder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Uitsluiting juwelen en waarden'  id='choice_12_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_21_6' id='label_12_21_6' class='gform-field-label gform-field-label--type-inline'>Uitsluiting juwelen en waarden<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_22\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_22'><span class='gform-field-label__text'>Aantal voertuigen in rust<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_12_22' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_12_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Leeftijd gebouw<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_42'>\n\t\t\t<div class='gchoice gchoice_12_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Woning in opbouw'  id='choice_12_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_0' id='label_12_42_0' class='gform-field-label gform-field-label--type-inline'>Woning in opbouw<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Nieuwbouw (&lt;10 jaar)'  id='choice_12_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_1' id='label_12_42_1' class='gform-field-label gform-field-label--type-inline'>Nieuwbouw (&lt;10 jaar)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='11 tot 20 jaar'  id='choice_12_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_2' id='label_12_42_2' class='gform-field-label gform-field-label--type-inline'>11 tot 20 jaar<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='21 tot 50 jaar'  id='choice_12_42_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_3' id='label_12_42_3' class='gform-field-label gform-field-label--type-inline'>21 tot 50 jaar<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='&gt;50 jaar'  id='choice_12_42_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_4' id='label_12_42_4' class='gform-field-label gform-field-label--type-inline'>&gt;50 jaar<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Zware renovatie'  id='choice_12_42_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_5' id='label_12_42_5' class='gform-field-label gform-field-label--type-inline'>Zware renovatie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_46\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_12_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Reeds verzekerd geweest<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_47'>\n\t\t\t<div class='gchoice gchoice_12_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Ja'  id='choice_12_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_0' id='label_12_47_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Nee'  id='choice_12_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_1' id='label_12_47_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_48'><span class='gform-field-label__text'>Maatschappij<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_12_48' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_49'><span class='gform-field-label__text'>Reden opzeg<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_12_49' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/div><div id=\"field_12_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_50'><span class='gform-field-label__text'>Aantal schades laatste 5 jaar<\/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_50' id='input_12_50' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><\/select><\/div><\/div><div id=\"field_12_53\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Info schade 1<\/h3><\/div><div id=\"field_12_54\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_54'><span class='gform-field-label__text'>Datum<\/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='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_12_54'\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_54'\n\t\t\t\t value=''\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_12_54' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_12_54' 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_12_54' aria-label='Datum: 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><\/div><div id=\"field_12_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_55'><span class='gform-field-label__text'>Uitgaven<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_12_55' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_56'><span class='gform-field-label__text'>Omstandigheden<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_12_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Info schade 2<\/h3><\/div><div id=\"field_12_59\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_59'><span class='gform-field-label__text'>Datum<\/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='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_12_59'\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_59'\n\t\t\t\t value=''\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_12_59' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_12_59' 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_12_59' aria-label='Datum: 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><\/div><div id=\"field_12_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_60'><span class='gform-field-label__text'>Uitgaven<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_12_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_61'><span class='gform-field-label__text'>Omstandigheden<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_12_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Info schade 3<\/h3><\/div><div id=\"field_12_63\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_63'><span class='gform-field-label__text'>Datum<\/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='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_12_63'\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_63'\n\t\t\t\t value=''\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_12_63' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_12_63' 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_12_63' aria-label='Datum: 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><\/div><div id=\"field_12_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_64'><span class='gform-field-label__text'>Uitgaven<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_12_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_65'><span class='gform-field-label__text'>Omstandigheden<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_12_65' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_12_30\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_30'><span class='gform-field-label__text'>Opmerkingen<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_12_30' class='textarea large'  aria-describedby=\"gfield_description_12_30\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_12_30'>Bv: extra toe te voegen packs (zwembad, tuin,...)?<\/div><\/div><div id=\"field_12_31\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_31'><span class='gform-field-label__text'>Bestand<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='268435456' \/><input name='input_31' id='input_12_31' type='file' class='large' aria-describedby=\"gfield_upload_rules_12_31\" onchange='javascript:gformValidateFileSize( this, 268435456 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_12_31'>Max. bestandsgrootte: 256 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_12_31'><\/div> <\/div><\/div><div id=\"field_12_73\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Privacy clausule<\/h2><\/div><div id=\"field_12_74\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>De ondergetekende(n) geeft (geven) hiermee aan VDL-Interass NV, FSMA 23450 A-R, als verantwoordelijke voor de verwerking, toestemming om alle persoonsgegevens te verwerken voor zover dit wettelijk verplicht of toegelaten is, of voor zover dit noodzakelijk of aangewezen is voor het beheer en de uitvoering van de afgesloten overeenkomsten, de evaluatie van de cli\u00ebntenrelatie, de risicobeoordeling, het voorkomen van misbruiken en de fraudebestrijding.<\/p>\n\n<p>De ondergetekende(n) heeft (hebben) een recht op toegang tot en verbetering van zijn\/haar (hun) persoonsgegevens. Hij\/zij kan (kunnen) hiervoor een schriftelijk verzoek indienen bij VDL-Interass NV, met toevoeging van een kopie van zijn\/haar identiteitskaart. Bovendien kan (kunnen) hij\/zij het openbaarregister raadplegen bij de Commissie voor de Bescherming van de Persoonlijke Levenssfeer.<\/p>\n\n<p>(Wet van 8 december 1992 tot bescherming van de persoonlijke levenssfeer ten opzichte van de verwerking van persoonsgegevens).<\/p><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_12' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Versturen<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_12' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_12' id='gform_theme_12' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_12' id='gform_style_settings_12' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_12' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='12' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='poxpwvszmDLYyqnZ8hpSrcBaYYASeaDpzU3irkYYtDsSbdzH0wd7dGg3a80CEpVLP5Q5tF9ttZLDot55s+IIN3zfR4qjTNeiw+IPmP9f\/x4w02Q=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_12' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_12' id='gform_target_page_number_12' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_12' id='gform_source_page_number_12' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-10849","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/pages\/10849","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/comments?post=10849"}],"version-history":[{"count":2,"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/pages\/10849\/revisions"}],"predecessor-version":[{"id":10851,"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/pages\/10849\/revisions\/10851"}],"wp:attachment":[{"href":"https:\/\/www.vdl-interass.be\/nl\/wp-json\/wp\/v2\/media?parent=10849"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}