{"id":2742,"date":"2025-10-04T15:01:27","date_gmt":"2025-10-04T13:01:27","guid":{"rendered":"https:\/\/equipepaarden.nl\/?page_id=2742"},"modified":"2026-01-16T19:45:13","modified_gmt":"2026-01-16T18:45:13","slug":"formulaire-de-demande","status":"publish","type":"page","link":"https:\/\/equipepaarden.nl\/fr\/aanvraagformulier\/","title":{"rendered":"Formulaire de demande"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"2742\" class=\"elementor elementor-2742\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-35a62b2 e-flex e-con-boxed e-con e-parent\" data-id=\"35a62b2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;curve&quot;,&quot;shape_divider_bottom_negative&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewbox=\"0 0 1000 100\" preserveaspectratio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M500,97C126.7,96.3,0.8,19.8,0,0v100l1000,0V1C1000,19.4,873.3,97.8,500,97z\"\/>\n<\/svg>\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-48e395f e-con-full e-flex e-con e-child\" data-id=\"48e395f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d969e54 elementor-widget elementor-widget-heading\" data-id=\"d969e54\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Formulaire de demande<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-474b6af e-flex e-con-boxed e-con e-parent\" data-id=\"474b6af\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-0a394fc e-con-full e-flex e-con e-child\" data-id=\"0a394fc\" data-element_type=\"container\" data-e-type=\"container\" id=\"form-container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-24b050d elementor-widget elementor-widget-shortcode\" data-id=\"24b050d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-2717 forminator-design--default forminator-enclosed forminator_ajax draft-enabled\" data-forminator-render=\"0\" data-form=\"forminator-module-2717\" data-uid=\"6af68dccbaf40\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2717\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2717 forminator-design--default forminator-enclosed forminator_ajax draft-enabled\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"2717\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"default\" data-grid=\"enclosed\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6af68dccbaf40\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Finish\"\n\t\t\t\tdata-actual-label=\"Gegevens verzekeringnemer\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6af68dccbaf40\" id=\"forminator-field-date-1-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date de d\u00e9but souhait\u00e9e <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-1-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-46\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-46_6af68dccbaf40\" id=\"forminator-field-text-46_6af68dccbaf40-label\" class=\"forminator-label\">Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-46\" value=\"\" placeholder=\"\" id=\"forminator-field-text-46_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6af68dccbaf40\" id=\"forminator-field-text-2_6af68dccbaf40-label\" class=\"forminator-label\">Nom de famille <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6af68dccbaf40\" id=\"forminator-field-text-1_6af68dccbaf40-label\" class=\"forminator-label\">Initiales <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6af68dccbaf40\" id=\"forminator-field-text-3_6af68dccbaf40-label\" class=\"forminator-label\">Adresse <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6af68dccbaf40\" id=\"forminator-field-text-4_6af68dccbaf40-label\" class=\"forminator-label\">Code Postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6af68dccbaf40\" id=\"forminator-field-text-5_6af68dccbaf40-label\" class=\"forminator-label\">Lieu de r\u00e9sidence <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6af68dccbaf40\" id=\"forminator-field-date-2-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-2-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-2717__field--select-1_6af68dccbaf40\" id=\"forminator-form-2717__field--select-1_6af68dccbaf40-label\" class=\"forminator-label\">Genre <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2717__field--select-1_6af68dccbaf40\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecteer geslacht\" data-search=\"true\" data-search-placeholder=\"Selecteer geslacht\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2717__field--select-1_6af68dccbaf40-label\"><option value=\"\"  >S\u00e9lectionnez le sexe<\/option><option value=\"Man\"  data-calculation=\"0\">Homme<\/option><option value=\"Vrouw\"  data-calculation=\"0\">Femme<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6af68dccbaf40\" id=\"forminator-field-phone-1_6af68dccbaf40-label\" class=\"forminator-label\">T\u00e9l\u00e9phone priv\u00e9 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6af68dccbaf40\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6af68dccbaf40\" id=\"forminator-field-phone-2_6af68dccbaf40-label\" class=\"forminator-label\">T\u00e9l\u00e9phone mobile<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_6af68dccbaf40\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6af68dccbaf40\" id=\"forminator-field-email-1_6af68dccbaf40-label\" class=\"forminator-label\">E-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6af68dccbaf40\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6af68dccbaf40\" id=\"forminator-field-text-6_6af68dccbaf40-label\" class=\"forminator-label\">Compte IBAN <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"Gegevens verzekeringnemer\"\n\t\t\t\tdata-actual-label=\"Gegevens verzekerd paard\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6af68dccbaf40\" id=\"forminator-field-text-7_6af68dccbaf40-label\" class=\"forminator-label\">Nom du cheval <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6af68dccbaf40\" id=\"forminator-field-date-3-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-3-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"2010\" data-end-year=\"2026\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"2010-11-13\" data-end-date=\"2026-11-14\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6af68dccbaf40\" id=\"forminator-field-text-8_6af68dccbaf40-label\" class=\"forminator-label\">Num\u00e9ro de puce <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6af68dccbaf40\" id=\"forminator-field-text-9_6af68dccbaf40-label\" class=\"forminator-label\">Num\u00e9ro de vie <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6af68dccbaf40\" id=\"forminator-field-text-10_6af68dccbaf40-label\" class=\"forminator-label\">Couleur <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-2717__field--select-2_6af68dccbaf40\" id=\"forminator-form-2717__field--select-2_6af68dccbaf40-label\" class=\"forminator-label\">Genre <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2717__field--select-2_6af68dccbaf40\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecteer geslacht\" data-search=\"true\" data-search-placeholder=\"Selecteer geslacht\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2717__field--select-2_6af68dccbaf40-label\"><option value=\"\"  >S\u00e9lectionnez le sexe<\/option><option value=\"Hengst\"  data-calculation=\"0\">\u00c9talon<\/option><option value=\"Merrie\"  data-calculation=\"0\">Jument<\/option><option value=\"Ruin\"  data-calculation=\"0\">Ruine<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6af68dccbaf40\" id=\"forminator-field-text-11_6af68dccbaf40-label\" class=\"forminator-label\">Race\/pedigree <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-11_6af68dccbaf40-description\" class=\"forminator-description\">Par exemple\u00a0: KWPN, BWP ou Hanovrien. Inconnu\u00a0? Saisissez alors '\u00a0inconnu\u00a0'.<\/span><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-11_6af68dccbaf40-description\" \/><\/div><\/div><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6af68dccbaf40\" id=\"forminator-field-text-12_6af68dccbaf40-label\" class=\"forminator-label\">Descente<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6af68dccbaf40\" id=\"forminator-field-text-13_6af68dccbaf40-label\" class=\"forminator-label\">Hauteur au garrot<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6af68dccbaf40\" id=\"forminator-field-text-14_6af68dccbaf40-label\" class=\"forminator-label\">Adresse stable <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6af68dccbaf40\" id=\"forminator-field-textarea-1_6af68dccbaf40-label\" class=\"forminator-label\">Marquages <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6af68dccbaf40\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:60px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Gegevens verzekerd paard\"\n\t\t\t\tdata-actual-label=\"Verzekeringsvoorwaarden\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6af68dccbaf40\" id=\"forminator-field-number-1_6af68dccbaf40-label\" class=\"forminator-label\">Valeur assur\u00e9e (\u20ac) <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6af68dccbaf40\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product insurance-equipe2\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6af68dccbaf40-label\" class=\"forminator-label\">Choisissez une assurance<\/span><label id=\"forminator-field-checkbox-1-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-1-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance pour chevaux Team 2\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Equipe 2 Paardenverzekering\" id=\"forminator-field-checkbox-1-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-1-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance pour chevaux Team 2<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6af68dccbaf40-label\" class=\"forminator-label\">Assurance maladie compl\u00e9mentaire Equipe 2<\/span><label id=\"forminator-field-checkbox-2-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-2-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance maladie compl\u00e9mentaire Equipe 2\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Aanvullende Equipe 2 Ziektekostenverzekering\" id=\"forminator-field-checkbox-2-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-2-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance maladie compl\u00e9mentaire Equipe 2<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product label-hide insurance-equipe3\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6af68dccbaf40-label\" class=\"forminator-label\">Choisissez une assurance<\/span><label id=\"forminator-field-checkbox-3-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-3-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance pour chevaux Equipe 3\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Equipe 3 Paardenverzekering\" id=\"forminator-field-checkbox-3-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-3-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance pour chevaux Equipe 3<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6af68dccbaf40-label\" class=\"forminator-label\">Assurance maladie compl\u00e9mentaire Equipe 3<\/span><label id=\"forminator-field-checkbox-4-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-4-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance maladie compl\u00e9mentaire Equipe 3\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Aanvullende Equipe 3 Ziektekostenverzekering\" id=\"forminator-field-checkbox-4-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-4-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance maladie compl\u00e9mentaire Equipe 3<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product label-hide insurance-equipe4\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6af68dccbaf40-label\" class=\"forminator-label\">Choisissez une assurance<\/span><label id=\"forminator-field-checkbox-5-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-5-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance Equipe 4 pour chevaux\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Equipe 4 Paardenverzekering\" id=\"forminator-field-checkbox-5-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-5-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance Equipe 4 pour chevaux<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6af68dccbaf40-label\" class=\"forminator-label\">Equipe 4 - Equipe suppl\u00e9mentaire 4 et 4+<\/span><label id=\"forminator-field-checkbox-6-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-6-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance maladie compl\u00e9mentaire Equipe 4\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Aanvullende Equipe 4 Ziektekostenverzekering\" id=\"forminator-field-checkbox-6-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-6-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance maladie compl\u00e9mentaire Equipe 4<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6af68dccbaf40-label\" for=\"forminator-field-checkbox-6-2-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance sant\u00e9 compl\u00e9mentaire Equipe 4+ (disponible uniquement pour les valeurs assur\u00e9es de 5\u00a0000\u00a0\u20ac ou plus)\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Aanvullende-Equipe-4+-Ziektekostenverzekering-(alleen-mogelijk-vanaf-een-verzekerde-waarde-van-\u20ac-5000,-)\" id=\"forminator-field-checkbox-6-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-6-2-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance sant\u00e9 compl\u00e9mentaire Equipe 4+ (disponible uniquement pour les valeurs assur\u00e9es de 5\u00a0000\u00a0\u20ac ou plus)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6af68dccbaf40-label\" class=\"forminator-label\">Assurance sant\u00e9 d&#039;\u00e9quipe pour chevaux<\/span><label id=\"forminator-field-checkbox-7-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-7-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance sant\u00e9 d&#039;\u00e9quipe pour chevaux\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Equipe Zorgverzekering Paard\" id=\"forminator-field-checkbox-7-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-7-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance sant\u00e9 d&#039;\u00e9quipe pour chevaux<\/span><\/label><\/div><\/div><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6af68dccbaf40-label\" class=\"forminator-label\">Assurance \u00e9talon<\/span><label id=\"forminator-field-checkbox-8-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-8-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance \u00e9talon\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Dekhengstenverzekering\" id=\"forminator-field-checkbox-8-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-8-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance \u00e9talon<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6af68dccbaf40-label\" class=\"forminator-label\">assurance cr\u00e9mation<\/span><label id=\"forminator-field-checkbox-9-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-9-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"assurance cr\u00e9mation\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Crematieverzekering\" id=\"forminator-field-checkbox-9-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-9-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">assurance cr\u00e9mation<\/span><\/label><\/div><\/div><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6af68dccbaf40-label\" class=\"forminator-label\">assurance collective pour chevaux<\/span><label id=\"forminator-field-checkbox-10-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-10-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"assurance collective pour chevaux\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Collectieve paardenverzekering\" id=\"forminator-field-checkbox-10-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-10-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">assurance collective pour chevaux<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6af68dccbaf40-label\" class=\"forminator-label\">assurance f\u0153tus-poulain<\/span><label id=\"forminator-field-checkbox-11-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-11-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"assurance f\u0153tus-poulain\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Foetus-veulenverzekering\" id=\"forminator-field-checkbox-11-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-11-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">assurance f\u0153tus-poulain<\/span><\/label><\/div><\/div><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6af68dccbaf40-label\" class=\"forminator-label\">assurance poulain \u00e0 la naissance<\/span><label id=\"forminator-field-checkbox-12-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-12-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"assurance poulain \u00e0 la naissance\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Geboorte-veulenverzekering\" id=\"forminator-field-checkbox-12-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-12-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">assurance poulain \u00e0 la naissance<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12\"><span id=\"forminator-field-group-1_6af68dccbaf40-label\" class=\"forminator-label forminator-repeater-label\">Applicable uniquement \u00e0 l&#039;assurance f\u0153tus-poulain et \u00e0 l&#039;assurance naissance-poulain<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\" role=\"group\" aria-labelledby=\"forminator-field-group-1_6af68dccbaf40-label\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6af68dccbaf40\" id=\"forminator-field-date-4-picker_6af68dccbaf40-label\" class=\"forminator-label\">Quelle est la derni\u00e8re date d&#039;accouplement ?<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-4-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6af68dccbaf40\" id=\"forminator-field-text-15_6af68dccbaf40-label\" class=\"forminator-label\">Nom de l&#039;\u00e9talon<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6af68dccbaf40\" id=\"forminator-field-number-2_6af68dccbaf40-label\" class=\"forminator-label\">Quel est le prix de la saillie\u00a0?<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6af68dccbaf40\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" \/><\/div><\/div><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6af68dccbaf40\" id=\"forminator-field-text-16_6af68dccbaf40-label\" class=\"forminator-label\">Stud-book<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-1-6af68dccbaf40-label\" class=\"forminator-label\">La jument a-t-elle d\u00e9j\u00e0 \u00e9t\u00e9 enceinte ?<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-1\" value=\"Ja\" id=\"forminator-field-radio-1-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-1\" value=\"Nee\" id=\"forminator-field-radio-1-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-2-6af68dccbaf40-label\" class=\"forminator-label\">Si oui, la jument a-t-elle d\u00e9j\u00e0 eu un accouchement pr\u00e9matur\u00e9, un poulain mort-n\u00e9 ou une grossesse non men\u00e9e \u00e0 terme\u00a0?<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-2\" value=\"Ja\" id=\"forminator-field-radio-2-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-2\" value=\"Nee\" id=\"forminator-field-radio-2-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-44\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-44_6af68dccbaf40\" id=\"forminator-field-text-44_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer.<\/label><input type=\"text\" name=\"text-44\" value=\"\" placeholder=\"\" id=\"forminator-field-text-44_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-21\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-21-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-21-6af68dccbaf40-label\" class=\"forminator-label\">La jument a-t-elle connu des circonstances anormales, telles qu&#039;un accouchement anormal, une expulsion de l&#039;ut\u00e9rus, etc., avant, pendant ou apr\u00e8s la mise bas\u00a0?<\/span><label id=\"forminator-field-radio-21-label-1\" for=\"forminator-field-radio-21-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-21\" value=\"Ja\" id=\"forminator-field-radio-21-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-21-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-21-label-2\" for=\"forminator-field-radio-21-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-21\" value=\"Nee\" id=\"forminator-field-radio-21-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-21-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><label id=\"forminator-field-radio-21-label-3\" for=\"forminator-field-radio-21-3-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Troisi\u00e8me choix\"><input type=\"radio\" name=\"radio-21\" value=\"Third-Choice\" id=\"forminator-field-radio-21-3-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-21-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Troisi\u00e8me choix<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6af68dccbaf40\" id=\"forminator-field-text-17_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer.<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6af68dccbaf40\" id=\"forminator-field-text-18_6af68dccbaf40-label\" class=\"forminator-label\">Combien de juments gestantes poss\u00e9dez-vous ?<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12  label-ttl\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><p><strong>Veuillez inclure les documents ci-dessous. Vous pouvez \u00e9galement les envoyer par courriel, par t\u00e9l\u00e9copieur ou par la poste, si vous pr\u00e9f\u00e9rez.<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6af68dccbaf40\" id=\"forminator-field-upload-1_6af68dccbaf40-label\" class=\"forminator-label\">Une copie du certificat d&#039;\u00e9talon<\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_6af68dccbaf40\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6af68dccbaf40\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svgz,.cdr,.ai,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_6af68dccbaf40_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6af68dccbaf40\">Choisir un fichier<\/button><span data-empty-text=\"No file chosen\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9charg\u00e9<\/span><\/button><\/div><\/div><\/div><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_6af68dccbaf40\" id=\"forminator-field-upload-2_6af68dccbaf40-label\" class=\"forminator-label\">Facture pour les frais de saillie<\/label><div class=\"forminator-file-upload\" data-element=\"upload-2_6af68dccbaf40\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_6af68dccbaf40\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svgz,.cdr,.ai,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-2_6af68dccbaf40_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_6af68dccbaf40\">Choisir un fichier<\/button><span data-empty-text=\"No file chosen\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9charg\u00e9<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-3\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-3_6af68dccbaf40\" id=\"forminator-field-upload-3_6af68dccbaf40-label\" class=\"forminator-label\">Certificat de sant\u00e9 et de gestation r\u00e9cent d\u00e9livr\u00e9 par le v\u00e9t\u00e9rinaire (apr\u00e8s au moins 90 jours de gestation)<\/label><div class=\"forminator-file-upload\" data-element=\"upload-3_6af68dccbaf40\"><input type=\"file\" name=\"upload-3\" id=\"forminator-field-upload-3_6af68dccbaf40\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svgz,.cdr,.ai,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-3_6af68dccbaf40_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-3_6af68dccbaf40\">Choisir un fichier<\/button><span data-empty-text=\"No file chosen\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9charg\u00e9<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Ajouter un \u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Supprimer l&#039;\u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product, label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6af68dccbaf40-label\" class=\"forminator-label\">Assurance castration<\/span><label id=\"forminator-field-checkbox-13-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-13-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance castration\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Castratieverzekering\" id=\"forminator-field-checkbox-13-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-13-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance castration<\/span><\/label><\/div><\/div><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-6  insurance-product, label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6af68dccbaf40-label\" class=\"forminator-label\">Assurance contre les risques li\u00e9s \u00e0 l&#039;anesth\u00e9sie<\/span><label id=\"forminator-field-checkbox-14-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-14-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance contre les risques li\u00e9s \u00e0 l&#039;anesth\u00e9sie\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Narcoserisicoverzekering\" id=\"forminator-field-checkbox-14-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-14-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance contre les risques li\u00e9s \u00e0 l&#039;anesth\u00e9sie<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12\"><span id=\"forminator-field-group-2_6af68dccbaf40-label\" class=\"forminator-label forminator-repeater-label\">Applicable uniquement \u00e0 l&#039;assurance contre les risques li\u00e9s \u00e0 la castration et \u00e0 l&#039;anesth\u00e9sie**<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\" role=\"group\" aria-labelledby=\"forminator-field-group-2_6af68dccbaf40-label\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_6af68dccbaf40\" id=\"forminator-field-date-5-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date de castration\/anesth\u00e9sie<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-5-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-3-6af68dccbaf40-label\" class=\"forminator-label\">Sous anesth\u00e9sie g\u00e9n\u00e9rale ?<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-3\" value=\"Ja\" id=\"forminator-field-radio-3-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-3\" value=\"Nee\" id=\"forminator-field-radio-3-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-4\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-4_6af68dccbaf40\" id=\"forminator-field-upload-4_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez joindre un certificat sanitaire \u00e9tabli par votre v\u00e9t\u00e9rinaire.<\/label><div class=\"forminator-file-upload\" data-element=\"upload-4_6af68dccbaf40\"><input type=\"file\" name=\"upload-4\" id=\"forminator-field-upload-4_6af68dccbaf40\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svgz,.cdr,.ai,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-4_6af68dccbaf40_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-4_6af68dccbaf40\">Choisir un fichier<\/button><span data-empty-text=\"No file chosen\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9charg\u00e9<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12  notes-text\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><p>**Autorisation de pr\u00e9l\u00e8vement automatique.<\/p>\n<p>En signant ce formulaire de demande, le soussign\u00e9 autorise Equipe Horse Insurance \u00e0 d\u00e9biter la prime due pour cette assurance castration ou chirurgicale de son compte bancaire\/virement.<\/p><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Ajouter un \u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Supprimer l&#039;\u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product, label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6af68dccbaf40-label\" class=\"forminator-label\">assurance transport<\/span><label id=\"forminator-field-checkbox-15-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-15-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"assurance transport\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Transportverzekering\" id=\"forminator-field-checkbox-15-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-15-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">assurance transport<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12\"><span id=\"forminator-field-group-3_6af68dccbaf40-label\" class=\"forminator-label forminator-repeater-label\">**Applicable uniquement \u00e0 l&#039;assurance transport<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\" role=\"group\" aria-labelledby=\"forminator-field-group-3_6af68dccbaf40-label\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_6af68dccbaf40\" id=\"forminator-field-date-6-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date de d\u00e9part<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-6-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6af68dccbaf40\" id=\"forminator-field-text-19_6af68dccbaf40-label\" class=\"forminator-label\">Adresse de d\u00e9part<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_6af68dccbaf40\" id=\"forminator-field-date-7-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date d&#039;arriv\u00e9e \u00e0 l&#039;adresse stable<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"Jour \/ Mois \/ Ann\u00e9e\" id=\"forminator-field-date-7-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6af68dccbaf40\" id=\"forminator-field-text-21_6af68dccbaf40-label\" class=\"forminator-label\">Arriv\u00e9e \u00e0 l&#039;adresse stable<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-4-6af68dccbaf40-label\" class=\"forminator-label\">Transport par<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Camion\"><input type=\"radio\" name=\"radio-4\" value=\"Vrachtwagen\" id=\"forminator-field-radio-4-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Camion<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Avion\"><input type=\"radio\" name=\"radio-4\" value=\"Vliegtuig\" id=\"forminator-field-radio-4-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Avion<\/span><\/label><label id=\"forminator-field-radio-4-label-3\" for=\"forminator-field-radio-4-3-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Bateau\"><input type=\"radio\" name=\"radio-4\" value=\"Schip\" id=\"forminator-field-radio-4-3-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-4-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Bateau<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6af68dccbaf40\" id=\"forminator-field-text-20_6af68dccbaf40-label\" class=\"forminator-label\">D\u00e9tails du transport<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6af68dccbaf40\" id=\"forminator-field-text-22_6af68dccbaf40-label\" class=\"forminator-label\">Toute information suppl\u00e9mentaire pertinente<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12  notes-text\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><p>En cas de dommages, un certificat sanitaire \u00e9tabli par un v\u00e9t\u00e9rinaire comp\u00e9tent doit \u00eatre fourni au plus tard une semaine avant le d\u00e9but du transport.<\/p>\n<p>**Autorisation de pr\u00e9l\u00e8vement automatique<\/p>\n<p>En signant ce formulaire de demande, le soussign\u00e9 autorise Equipe Horse Insurance \u00e0 d\u00e9biter la prime due pour cette assurance transport de son compte bancaire\/compte de virement.<\/p><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Ajouter un \u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Supprimer l&#039;\u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-16\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-16-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-16-6af68dccbaf40-label\" class=\"forminator-label\">Assurance remorque<\/span><label id=\"forminator-field-checkbox-16-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-16-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance remorque\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Trailerverzekering\" id=\"forminator-field-checkbox-16-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-16-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance remorque<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12  notes-text desc\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><p>* Si vous choisissez une assurance pour votre selle et\/ou votre remorque, vous recevrez de notre part un formulaire de demande suppl\u00e9mentaire.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-17\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-17-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-17-6af68dccbaf40-label\" class=\"forminator-label\">Assurance selle<\/span><label id=\"forminator-field-checkbox-17-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-17-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance selle\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"Zadelverzekering\" id=\"forminator-field-checkbox-17-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-17-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance selle<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-8\" class=\"forminator-field-html forminator-col forminator-col-12  notes-text desc\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-8\"><p>* Si vous choisissez une assurance pour votre selle et\/ou votre remorque, vous recevrez de notre part un formulaire de demande suppl\u00e9mentaire.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-18\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product, label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-18-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-18-6af68dccbaf40-label\" class=\"forminator-label\">Assurance accident passager<\/span><label id=\"forminator-field-checkbox-18-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-18-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Assurance accident passager\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"Ongevallen-opzittendenverzekering\" id=\"forminator-field-checkbox-18-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-18-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assurance accident passager<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-9\" class=\"forminator-field-html forminator-col forminator-col-12  notes-text\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-9\"><p>Veuillez consulter les fiches d&#039;assurance sur www.equipepaarden.nl\/downloads. La fiche d&#039;assurance vous donne un aper\u00e7u des informations de couverture essentielles pour chaque produit.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12\"><span id=\"forminator-field-group-4_6af68dccbaf40-label\" class=\"forminator-label forminator-repeater-label\">Objectif d&#039;utilisation du cheval<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\" role=\"group\" aria-labelledby=\"forminator-field-group-4_6af68dccbaf40-label\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-19\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-19-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-19-6af68dccbaf40-label\" class=\"forminator-label\">Dressage<\/span><label id=\"forminator-field-checkbox-19-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-19-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Dressage\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"Dressuur\" id=\"forminator-field-checkbox-19-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-19-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dressage<\/span><\/label><\/div><\/div><div id=\"checkbox-20\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-20-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-20-6af68dccbaf40-label\" class=\"forminator-label\">sport automobile<\/span><label id=\"forminator-field-checkbox-20-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-20-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"sport automobile\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"Mensport\" id=\"forminator-field-checkbox-20-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-20-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">sport automobile<\/span><\/label><\/div><\/div><div id=\"checkbox-21\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-21-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-21-6af68dccbaf40-label\" class=\"forminator-label\">Courses de chevaux attel\u00e9s<\/span><label id=\"forminator-field-checkbox-21-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-21-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Courses de chevaux attel\u00e9s\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"Ren-drafsport\" id=\"forminator-field-checkbox-21-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-21-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Courses de chevaux attel\u00e9s<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-22\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-22-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-22-6af68dccbaf40-label\" class=\"forminator-label\">Jumping<\/span><label id=\"forminator-field-checkbox-22-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-22-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Jumping\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Springsport\" id=\"forminator-field-checkbox-22-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-22-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jumping<\/span><\/label><\/div><\/div><div id=\"checkbox-23\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-23-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-23-6af68dccbaf40-label\" class=\"forminator-label\">Concours complet<\/span><label id=\"forminator-field-checkbox-23-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-23-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Concours complet\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"Eventing\" id=\"forminator-field-checkbox-23-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-23-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Concours complet<\/span><\/label><\/div><\/div><div id=\"checkbox-24\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-24-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-24-6af68dccbaf40-label\" class=\"forminator-label\">Reproduction<\/span><label id=\"forminator-field-checkbox-24-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-24-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Reproduction\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"Fokkerij\" id=\"forminator-field-checkbox-24-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-24-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reproduction<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-25\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-25-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-25-6af68dccbaf40-label\" class=\"forminator-label\">R\u00e9cr\u00e9ation<\/span><label id=\"forminator-field-checkbox-25-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-25-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"R\u00e9cr\u00e9ation\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"Recreatie\" id=\"forminator-field-checkbox-25-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-25-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">R\u00e9cr\u00e9ation<\/span><\/label><\/div><\/div><div id=\"checkbox-30\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-30-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-30-6af68dccbaf40-label\" class=\"forminator-label\">sport occidental<\/span><label id=\"forminator-field-checkbox-30-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-30-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"sport occidental\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"Westernsport\" id=\"forminator-field-checkbox-30-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-30-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">sport occidental<\/span><\/label><\/div><\/div><div id=\"checkbox-26\" class=\"forminator-field-checkbox forminator-col forminator-col-4  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-26-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-26-6af68dccbaf40-label\" class=\"forminator-label\">Endurance<\/span><label id=\"forminator-field-checkbox-26-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-26-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Endurance\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"Endurance\" id=\"forminator-field-checkbox-26-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-26-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Endurance<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-27\" class=\"forminator-field-checkbox forminator-col forminator-col-12  insurance-product label-hide\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-27-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-27-6af68dccbaf40-label\" class=\"forminator-label\">Sinon nl.<\/span><label id=\"forminator-field-checkbox-27-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-27-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Sinon nl.\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"Anders nl.\" id=\"forminator-field-checkbox-27-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-27-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Sinon nl.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-12  label-hide\"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6af68dccbaf40\" id=\"forminator-field-text-23_6af68dccbaf40-label\" class=\"forminator-label\">Anders nl<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Ajouter un \u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Supprimer l&#039;\u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"Verzekeringsvoorwaarden\"\n\t\t\t\tdata-actual-label=\"Dierenarts\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-45\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-45_6af68dccbaf40\" id=\"forminator-field-text-45_6af68dccbaf40-label\" class=\"forminator-label\">Nom et adresse compl\u00e8te du v\u00e9t\u00e9rinaire\u00a0:<\/label><input type=\"text\" name=\"text-45\" value=\"\" placeholder=\"\" id=\"forminator-field-text-45_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_6af68dccbaf40\" id=\"forminator-field-text-24_6af68dccbaf40-label\" class=\"forminator-label\">\u00c0 combien de kilom\u00e8tres habitez-vous de l&#039;\u00e9curie ?<\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2717__field--select-3_6af68dccbaf40\" id=\"forminator-form-2717__field--select-3_6af68dccbaf40-label\" class=\"forminator-label\">Paiement de prime<\/label><select  id=\"forminator-form-2717__field--select-3_6af68dccbaf40\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2717__field--select-3_6af68dccbaf40-label\"><option value=\"Per jaar\"  data-calculation=\"0\">Par ann\u00e9e<\/option><option value=\"Per half jaar\"  data-calculation=\"0\">Tous les six mois<\/option><option value=\"Per-kwartaal\"  data-calculation=\"0\">Par trimestre<\/option><option value=\"Per-maand\"  data-calculation=\"0\">Par mois<\/option><option value=\"Eenmalig-(in-geval-van-een-Transport-,-Castratie-,-Narcoserisico--of-andere-kortlopende-verzekering)\"  data-calculation=\"0\">Assurance ponctuelle (en cas de transport, de castration, de risque anesth\u00e9sique ou autre assurance \u00e0 court terme)<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-11\" class=\"forminator-field-html forminator-col forminator-col-12  label-hide notes-text form-desc-sm\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-11\"><label class=\"forminator-label\">HTML<\/label><p>En cas de paiement trimestriel ou mensuel, une majoration de 6% sera appliqu\u00e9e \u00e0 la prime annuelle. Si vous optez pour un paiement trimestriel ou mensuel, le pr\u00e9l\u00e8vement automatique est obligatoire. Le pr\u00e9l\u00e8vement automatique est \u00e9galement obligatoire pour les contrats d&#039;assurance temporaire (notamment l&#039;assurance transport, l&#039;assurance castration et l&#039;assurance risques li\u00e9s \u00e0 l&#039;anesth\u00e9sie).<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-25\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-25_6af68dccbaf40\" id=\"forminator-field-text-25_6af68dccbaf40-label\" class=\"forminator-label\">Num\u00e9ro IBAN<\/label><input type=\"text\" name=\"text-25\" value=\"\" placeholder=\"\" id=\"forminator-field-text-25_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-12\" class=\"forminator-field-html forminator-col forminator-col-12  label-hide notes-text form-desc-sm\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-12\"><label class=\"forminator-label\">HTML<\/label><p>En cochant \"\u00a0J\u2019accepte\u00a0\", vous autorisez Equipe Paardenverzekeringen, B.P. 5, 5165 ZG Waspik (num\u00e9ro d\u2019identification\u00a0: NL41ZZZ562661700000), \u00e0 effectuer un pr\u00e9l\u00e8vement automatique aupr\u00e8s de votre banque pour le montant de la prime (incluant les frais et la taxe d\u2019assurance) de l\u2019assurance demand\u00e9e. Vous recevrez un relev\u00e9 de pr\u00e9l\u00e8vement avec votre contrat, mentionnant la r\u00e9f\u00e9rence d\u2019autorisation. Si vous contestez ce pr\u00e9l\u00e8vement, vous pouvez le faire annuler. Pour cela, veuillez contacter votre banque dans un d\u00e9lai de huit semaines \u00e0 compter de la date du pr\u00e9l\u00e8vement. Vous pouvez vous renseigner aupr\u00e8s de votre banque concernant les conditions g\u00e9n\u00e9rales de cette proc\u00e9dure.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-31\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-31-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-31-6af68dccbaf40-label\" class=\"forminator-label\">Accord avec autorisation de pr\u00e9l\u00e8vement automatique <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-31-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-31-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Accord avec autorisation de pr\u00e9l\u00e8vement automatique\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"Akkoord met machtiging voor automatische incasso\" id=\"forminator-field-checkbox-31-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-31-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Accord avec autorisation de pr\u00e9l\u00e8vement automatique<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"Dierenarts\"\n\t\t\t\tdata-actual-label=\"Paard &amp; Verzekering\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-26\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-26_6af68dccbaf40\" id=\"forminator-field-text-26_6af68dccbaf40-label\" class=\"forminator-label\">1. Depuis combien de temps poss\u00e9dez-vous ce cheval ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-26\" value=\"\" placeholder=\"\" id=\"forminator-field-text-26_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-27\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-27_6af68dccbaf40\" id=\"forminator-field-text-27_6af68dccbaf40-label\" class=\"forminator-label\">2. \u00c0 qui avez-vous achet\u00e9 le cheval ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-27\" value=\"\" placeholder=\"\" id=\"forminator-field-text-27_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-28\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-28_6af68dccbaf40\" id=\"forminator-field-text-28_6af68dccbaf40-label\" class=\"forminator-label\">3. Quel est le prix d&#039;achat du cheval ? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-28\" value=\"\" placeholder=\"\" id=\"forminator-field-text-28_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6af68dccbaf40\" id=\"forminator-field-textarea-2_6af68dccbaf40-label\" class=\"forminator-label\">4. \u00c0 quel niveau le cheval concourt-il (est-ce une estimation ou est-ce bas\u00e9 sur les r\u00e9sultats des comp\u00e9titions)\u00a0?<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6af68dccbaf40\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:40px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-5-6af68dccbaf40-label\" class=\"forminator-label\">5. Le cheval a-t-il d\u00e9j\u00e0 \u00e9t\u00e9 assur\u00e9 ailleurs\u00a0?* <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-5\" value=\"Ja\" id=\"forminator-field-radio-5-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-5\" value=\"Nee\" id=\"forminator-field-radio-5-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><label id=\"forminator-field-radio-5-label-3\" for=\"forminator-field-radio-5-3-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Je ne sais pas\"><input type=\"radio\" name=\"radio-5\" value=\"Weet ik niet\" id=\"forminator-field-radio-5-3-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-5-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Je ne sais pas<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-29\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-29_6af68dccbaf40\" id=\"forminator-field-text-29_6af68dccbaf40-label\" class=\"forminator-label\">Chez quel assureur ?<\/label><input type=\"text\" name=\"text-29\" value=\"\" placeholder=\"\" id=\"forminator-field-text-29_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-6-6af68dccbaf40-label\" class=\"forminator-label\">6. \u00cates-vous le seul propri\u00e9taire du cheval ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-6\" value=\"Ja\" id=\"forminator-field-radio-6-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-6\" value=\"Nee\" id=\"forminator-field-radio-6-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-30\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-30_6af68dccbaf40\" id=\"forminator-field-text-30_6af68dccbaf40-label\" class=\"forminator-label\">Qui est l&#039;autre propri\u00e9taire et quelle est sa part de propri\u00e9t\u00e9 du cheval\u00a0?<\/label><input type=\"text\" name=\"text-30\" value=\"\" placeholder=\"\" id=\"forminator-field-text-30_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6af68dccbaf40\" id=\"forminator-field-number-3_6af68dccbaf40-label\" class=\"forminator-label\">7. Combien de chevaux poss\u00e9dez-vous ? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_6af68dccbaf40\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-32\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-32-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-32-6af68dccbaf40-label\" class=\"forminator-label\">8. Votre cheval a-t-il d\u00e9j\u00e0 \u00e9t\u00e9 examin\u00e9 par un v\u00e9t\u00e9rinaire ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-32-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-32-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Clinique\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Klinisch\" id=\"forminator-field-checkbox-32-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-32-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Clinique<\/span><\/label><label id=\"forminator-field-checkbox-32-2-6af68dccbaf40-label\" for=\"forminator-field-checkbox-32-2-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"radiologique\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"R\u00f6ntgenologisch\" id=\"forminator-field-checkbox-32-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-32-2-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">radiologique<\/span><\/label><label id=\"forminator-field-checkbox-32-3-6af68dccbaf40-label\" for=\"forminator-field-checkbox-32-3-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"Non\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Nee\" id=\"forminator-field-checkbox-32-3-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-32-3-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_6af68dccbaf40\" id=\"forminator-field-date-8-picker_6af68dccbaf40-label\" class=\"forminator-label\">Date:<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"jj\/mm\/aaaa\" id=\"forminator-field-date-8-picker_6af68dccbaf40\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-32\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-32_6af68dccbaf40\" id=\"forminator-field-text-32_6af68dccbaf40-label\" class=\"forminator-label\">Chirurgien v\u00e9t\u00e9rinaire :<\/label><input type=\"text\" name=\"text-32\" value=\"\" placeholder=\"\" id=\"forminator-field-text-32_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-5\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-5_6af68dccbaf40\" id=\"forminator-field-upload-5_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez inclure une copie du rapport d&#039;inspection<\/label><div class=\"forminator-file-upload\" data-element=\"upload-5_6af68dccbaf40\"><input type=\"file\" name=\"upload-5\" id=\"forminator-field-upload-5_6af68dccbaf40\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svgz,.cdr,.ai,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-5_6af68dccbaf40_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-5_6af68dccbaf40\">Choisir un fichier<\/button><span data-empty-text=\"No file chosen\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9charg\u00e9<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-8-6af68dccbaf40-label\" class=\"forminator-label\">9. Un risque accru a-t-il d\u00e9j\u00e0 \u00e9t\u00e9 identifi\u00e9 chez le cheval ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-8\" value=\"Ja\" id=\"forminator-field-radio-8-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-8\" value=\"Nee\" id=\"forminator-field-radio-8-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-33\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-33_6af68dccbaf40\" id=\"forminator-field-text-33_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer<\/label><input type=\"text\" name=\"text-33\" value=\"\" placeholder=\"\" id=\"forminator-field-text-33_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-22\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-22-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-22-6af68dccbaf40-label\" class=\"forminator-label\">10. Votre cheval est-il en bonne sant\u00e9 et suit-il un entra\u00eenement complet ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-22-label-1\" for=\"forminator-field-radio-22-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-22\" value=\"Ja\" id=\"forminator-field-radio-22-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-22-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-22-label-2\" for=\"forminator-field-radio-22-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-22\" value=\"Nee\" id=\"forminator-field-radio-22-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-22-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6af68dccbaf40\" id=\"forminator-field-textarea-3_6af68dccbaf40-label\" class=\"forminator-label\">Sinon, veuillez expliquer.<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6af68dccbaf40\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:40px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-9-6af68dccbaf40-label\" class=\"forminator-label\">11. Le cheval est-il vermifug\u00e9 et vaccin\u00e9 conform\u00e9ment \u00e0 la prescription ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-9\" value=\"Ja\" id=\"forminator-field-radio-9-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-9\" value=\"Nee\" id=\"forminator-field-radio-9-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-10-6af68dccbaf40-label\" class=\"forminator-label\">12. Le cheval a-t-il d\u00e9j\u00e0 souffert de coliques ou de toute autre forme de trouble digestif ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-10\" value=\"Ja\" id=\"forminator-field-radio-10-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-10\" value=\"Nee\" id=\"forminator-field-radio-10-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-34\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-34_6af68dccbaf40\" id=\"forminator-field-text-34_6af68dccbaf40-label\" class=\"forminator-label\">Quoi et quand ? Le cheval a-t-il \u00e9t\u00e9 op\u00e9r\u00e9 pour cela ?<\/label><input type=\"text\" name=\"text-34\" value=\"\" placeholder=\"\" id=\"forminator-field-text-34_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-11\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-11-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-11-6af68dccbaf40-label\" class=\"forminator-label\">13. Le cheval a-t-il d\u00e9j\u00e0 \u00e9t\u00e9 trait\u00e9 par un v\u00e9t\u00e9rinaire, un physioth\u00e9rapeute ou un hom\u00e9opathe ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-11-label-1\" for=\"forminator-field-radio-11-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-11\" value=\"Ja\" id=\"forminator-field-radio-11-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-11-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-11-label-2\" for=\"forminator-field-radio-11-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-11\" value=\"Nee\" id=\"forminator-field-radio-11-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-11-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-35\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-35_6af68dccbaf40\" id=\"forminator-field-text-35_6af68dccbaf40-label\" class=\"forminator-label\">\u00c0 quoi cela servait-il et le cheval s&#039;en est-il compl\u00e8tement remis ?<\/label><input type=\"text\" name=\"text-35\" value=\"\" placeholder=\"\" id=\"forminator-field-text-35_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-23\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-23-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-23-6af68dccbaf40-label\" class=\"forminator-label\">14. Le cheval a-t-il d\u00e9j\u00e0 souffert de probl\u00e8mes de peau, tels que de l&#039;ecz\u00e9ma de la queue\/crini\u00e8re, des m\u00e9lanomes ou des sarco\u00efdes ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-23-label-1\" for=\"forminator-field-radio-23-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-23\" value=\"Ja\" id=\"forminator-field-radio-23-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-23-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-23-label-2\" for=\"forminator-field-radio-23-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-23\" value=\"Nee\" id=\"forminator-field-radio-23-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-23-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6af68dccbaf40\" id=\"forminator-field-textarea-4_6af68dccbaf40-label\" class=\"forminator-label\">Si oui, veuillez expliquer<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6af68dccbaf40\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:40px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-13-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-13-6af68dccbaf40-label\" class=\"forminator-label\">15. \u00c0 votre connaissance, le cheval a-t-il d\u00e9j\u00e0 souffert d&#039;une maladie, d&#039;un probl\u00e8me de sant\u00e9 ou d&#039;un accident autre que ceux mentionn\u00e9s ci-dessus\u00a0? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-13\" value=\"Ja\" id=\"forminator-field-radio-13-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-13-label-2\" for=\"forminator-field-radio-13-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-13\" value=\"Nee\" id=\"forminator-field-radio-13-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-13-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-37\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-37_6af68dccbaf40\" id=\"forminator-field-text-37_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer :<\/label><input type=\"text\" name=\"text-37\" value=\"\" placeholder=\"\" id=\"forminator-field-text-37_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-14\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-14-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-14-6af68dccbaf40-label\" class=\"forminator-label\">16. Le cheval a-t-il d\u00e9j\u00e0 montr\u00e9 une anomalie, un vice (d&#039;\u00e9curie), une r\u00e9sistance, une obstination ou un comportement de blocage ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-14-label-1\" for=\"forminator-field-radio-14-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-14\" value=\"Ja\" id=\"forminator-field-radio-14-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-14-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-14-label-2\" for=\"forminator-field-radio-14-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-14\" value=\"Nee\" id=\"forminator-field-radio-14-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-14-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-38\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-38_6af68dccbaf40\" id=\"forminator-field-text-38_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer :<\/label><input type=\"text\" name=\"text-38\" value=\"\" placeholder=\"\" id=\"forminator-field-text-38_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-15\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-15-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-15-6af68dccbaf40-label\" class=\"forminator-label\">17. Y a-t-il eu une maladie contagieuse, une infection ou un autre virus \u00e0 l&#039;adresse stable au cours des 12 derniers mois ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-15-label-1\" for=\"forminator-field-radio-15-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-15\" value=\"Ja\" id=\"forminator-field-radio-15-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-15-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-15-label-2\" for=\"forminator-field-radio-15-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-15\" value=\"Nee\" id=\"forminator-field-radio-15-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-15-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-39\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-39_6af68dccbaf40\" id=\"forminator-field-text-39_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer :<\/label><input type=\"text\" name=\"text-39\" value=\"\" placeholder=\"\" id=\"forminator-field-text-39_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-16\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-16-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-16-6af68dccbaf40-label\" class=\"forminator-label\">18. Existe-t-il d&#039;autres faits que l&#039;assureur devrait conna\u00eetre et qui pourraient \u00eatre importants pour l&#039;acceptation de l&#039;assurance et\/ou l&#039;\u00e9valuation du risque par l&#039;assureur\u00a0? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-16-label-1\" for=\"forminator-field-radio-16-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-16\" value=\"Ja\" id=\"forminator-field-radio-16-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-16-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-16-label-2\" for=\"forminator-field-radio-16-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-16\" value=\"Nee\" id=\"forminator-field-radio-16-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-16-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-40\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-40_6af68dccbaf40\" id=\"forminator-field-text-40_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer :<\/label><input type=\"text\" name=\"text-40\" value=\"\" placeholder=\"\" id=\"forminator-field-text-40_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-field-group forminator-col forminator-col-12\"><span id=\"forminator-field-group-5_6af68dccbaf40-label\" class=\"forminator-label forminator-repeater-label\">Autres circonstances<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\" role=\"group\" aria-labelledby=\"forminator-field-group-5_6af68dccbaf40-label\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"radio-18\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-18-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-18-6af68dccbaf40-label\" class=\"forminator-label\">Avez-vous, ou l&#039;une des autres parties int\u00e9ress\u00e9es, d\u00e9j\u00e0 \u00e9t\u00e9 confront\u00e9(e) \u00e0 un refus, une annulation ou une acceptation assortie de conditions restrictives concernant une police d&#039;assurance telle que celle pour laquelle vous faites actuellement une demande\u00a0? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-18-label-1\" for=\"forminator-field-radio-18-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-18\" value=\"Ja\" id=\"forminator-field-radio-18-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-18-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-18-label-2\" for=\"forminator-field-radio-18-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-18\" value=\"Nee\" id=\"forminator-field-radio-18-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-18-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-41\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-41_6af68dccbaf40\" id=\"forminator-field-text-41_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer<\/label><input type=\"text\" name=\"text-41\" value=\"\" placeholder=\"\" id=\"forminator-field-text-41_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-19\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-19-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-19-6af68dccbaf40-label\" class=\"forminator-label\">Avez-vous, ou l&#039;une des autres parties int\u00e9ress\u00e9es, d\u00e9j\u00e0 subi des dommages \u00e0 un cheval, que celui-ci soit assur\u00e9 ou non\u00a0? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-19-label-1\" for=\"forminator-field-radio-19-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-19\" value=\"Ja\" id=\"forminator-field-radio-19-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-19-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-19-label-2\" for=\"forminator-field-radio-19-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-19\" value=\"Nee\" id=\"forminator-field-radio-19-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-19-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-42\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-42_6af68dccbaf40\" id=\"forminator-field-text-42_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer :<\/label><input type=\"text\" name=\"text-42\" value=\"\" placeholder=\"\" id=\"forminator-field-text-42_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-20\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-20-6af68dccbaf40-label\"><span id=\"forminator-radiogroup-radio-20-6af68dccbaf40-label\" class=\"forminator-label\">Avez-vous, ou l&#039;une des autres parties int\u00e9ress\u00e9es, eu des d\u00e9m\u00eal\u00e9s avec la justice au cours des huit derni\u00e8res ann\u00e9es\u00a0? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-20-label-1\" for=\"forminator-field-radio-20-1-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Oui\"><input type=\"radio\" name=\"radio-20\" value=\"Ja\" id=\"forminator-field-radio-20-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-20-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-20-label-2\" for=\"forminator-field-radio-20-2-6af68dccbaf40\" class=\"forminator-radio forminator-radio-inline\" title=\"Non\"><input type=\"radio\" name=\"radio-20\" value=\"Nee\" id=\"forminator-field-radio-20-2-6af68dccbaf40\" aria-labelledby=\"forminator-field-radio-20-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-43\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-43_6af68dccbaf40\" id=\"forminator-field-text-43_6af68dccbaf40-label\" class=\"forminator-label\">Veuillez expliquer.<\/label><input type=\"text\" name=\"text-43\" value=\"\" placeholder=\"\" id=\"forminator-field-text-43_6af68dccbaf40\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-13\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-13\"><p>Si vous le souhaitez, vous pouvez transmettre ces informations de mani\u00e8re confidentielle \u00e0 la direction.<\/p><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Ajouter un \u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Supprimer l&#039;\u00e9l\u00e9ment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-2717--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-2717--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"Paard &amp; Verzekering\"\n\t\t\t\tdata-actual-label=\"Page 6\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-14\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-14\"><label class=\"forminator-label\">D\u00e9claration finale<\/label><p>En signant, le demandeur atteste que les r\u00e9ponses fournies sont exactes et compl\u00e8tes. Le soussign\u00e9 d\u00e9clare \u00e9galement souhaiter souscrire l&#039;assurance mentionn\u00e9e ci-dessus aupr\u00e8s d&#039;Equipe Horse Insurance et accepte l&#039;application des conditions g\u00e9n\u00e9rales de l&#039;assurance demand\u00e9e.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-15\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-15\"><label class=\"forminator-label\">Obligation l\u00e9gale de fournir des informations<\/label><p>Vous \u00eates tenu de r\u00e9pondre aux questions de ce formulaire de demande de la mani\u00e8re la plus compl\u00e8te possible. Ceci s&#039;applique \u00e9galement aux faits et circonstances concernant un tiers dont les int\u00e9r\u00eats sont coassur\u00e9s. De plus, vos r\u00e9ponses ne doivent pas se fonder uniquement sur vos propres connaissances, mais aussi sur celles des autres parties prenantes \u00e0 cette police d&#039;assurance. Vous devez n\u00e9anmoins r\u00e9pondre aussi compl\u00e8tement que possible aux questions dont vous supposez que la compagnie poss\u00e8de d\u00e9j\u00e0 les r\u00e9ponses. Tout manquement \u00e0 votre obligation de d\u00e9claration, ou toute d\u00e9claration incompl\u00e8te, peut entra\u00eener la limitation, voire la perte, de votre droit au paiement, ou la r\u00e9siliation de l&#039;assurance.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-16\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-16\"><label class=\"forminator-label\">donn\u00e9es personnelles<\/label><p>Lors de toute demande d&#039;assurance, des donn\u00e9es personnelles sont requises. Equipe Horse Insurance traite ces donn\u00e9es exclusivement aux fins de la conclusion et de l&#039;ex\u00e9cution de contrats, de la pr\u00e9vention et de la lutte contre la fraude envers les institutions financi\u00e8res, des analyses statistiques et du respect des obligations l\u00e9gales.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-17\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-17\"><label class=\"forminator-label\">Organismes de traitement des plaintes<\/label><p>Toute r\u00e9clamation relative \u00e0 l&#039;ex\u00e9cution du contrat d&#039;assurance doit \u00eatre adress\u00e9e en premier lieu \u00e0 Equipe Assurance Cheval. Si l&#039;\u00e9valuation de la compagnie ne vous satisfait pas, vous pouvez contacter l&#039;Institut des plaintes en mati\u00e8re de services financiers, qui tentera de r\u00e9soudre le litige par la m\u00e9diation. Si le traitement de votre r\u00e9clamation par l&#039;Institut des plaintes ne vous satisfait pas, veuillez vous r\u00e9f\u00e9rer \u00e0 la proc\u00e9dure de r\u00e9clamation figurant dans les conditions g\u00e9n\u00e9rales d&#039;Equipe.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-18\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-18\"><label class=\"forminator-label\">droit n\u00e9erlandais<\/label><p>Cette assurance est r\u00e9gie par le droit n\u00e9erlandais.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-19\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-19\"><label class=\"forminator-label\">compagnie d&#039;assurance \/ assureur<\/label><p>Cette assurance est souscrite aupr\u00e8s de Convex Europe SA. Convex Europe SA est une soci\u00e9t\u00e9 \u00e0 responsabilit\u00e9 limit\u00e9e immatricul\u00e9e au Grand-Duch\u00e9 de Luxembourg sous le num\u00e9ro B253295. Son si\u00e8ge social est situ\u00e9 au 37, boulevard Joseph II, 2e \u00e9tage, L-1840 Luxembourg, Grand-Duch\u00e9 de Luxembourg. Convex Europe SA est agr\u00e9\u00e9e et supervis\u00e9e par le Commissariat aux Assurances (CAA, r\u00e9f\u00e9rence 894500S0IQYVDCWFAR23). Tous les professionnels de l&#039;assurance au Luxembourg sont tenus au secret professionnel concernant les informations qui leur sont confi\u00e9es dans l&#039;exercice de leur mandat ou dans le cadre de leurs obligations professionnelles. Convex Europe SA sous-traite certaines prestations, activit\u00e9s ou t\u00e2ches \u00e0 des prestataires de services. Par cons\u00e9quent, les conversations, documents, donn\u00e9es personnelles et informations confidentielles que vous, vos b\u00e9n\u00e9ficiaires ou toute autre personne agissant pour votre compte dans le cadre de la relation d&#039;assurance pouvez partager avec ces prestataires de services pendant toute la dur\u00e9e du contrat d&#039;assurance. Ces prestataires de services sont tenus au secret professionnel ou \u00e0 un accord de confidentialit\u00e9. Vous trouverez de plus amples informations sur le site web de Convex Europe SA\u00a0: https:\/\/convexin.com\/location\/luxembourg\/. En signant un formulaire de demande, en souscrivant un contrat d\u2019assurance ou en discutant de quelque mani\u00e8re que ce soit de l\u2019achat d\u2019une assurance avec Convex Europe SA, vous autorisez cette derni\u00e8re \u00e0 sous-traiter des services, des activit\u00e9s et des t\u00e2ches \u00e0 des prestataires de services.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-22\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-22\"><label class=\"forminator-label\">Conditions appliqu\u00e9es<\/label><p>Si notre demande est accept\u00e9e par la compagnie d&#039;assurance, vous conclurez deux accords\u00a0: un contrat d&#039;assurance avec la compagnie d&#039;assurance et un contrat de cession de cr\u00e9ance avec Equipe Horse Insurance. Nous ex\u00e9cuterons cette cession de cr\u00e9ance au mieux de nos capacit\u00e9s, conform\u00e9ment aux Conditions G\u00e9n\u00e9rales de M\u00e9diation d&#039;Equipe Horse. En nous autorisant \u00e0 souscrire la ou les assurances en r\u00e9ponse \u00e0 ce courriel, vous acceptez \u00e9galement ces Conditions G\u00e9n\u00e9rales de M\u00e9diation d&#039;Equipe Horse. Veuillez donc les lire attentivement. Vous les trouverez en cliquant sur le lien figurant en pi\u00e8ce jointe.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-29\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-29-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-29-6af68dccbaf40-label\" class=\"forminator-label\">J&#039;accepte les conditions appliqu\u00e9es <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-29-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-29-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"J&#039;accepte les conditions appliqu\u00e9es\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"Ik ga akkoord met de toegepaste voorwaarden\" id=\"forminator-field-checkbox-29-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-29-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J&#039;accepte les conditions appliqu\u00e9es<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-21\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-21\"><label class=\"forminator-label\">Conditions g\u00e9n\u00e9rales de m\u00e9diation pour Equipe Horse Insurance<\/label><p><a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/equipepaarden.nl\/wp-content\/uploads\/2025\/11\/Bemiddelingsvoorwaarden-Equipe-Paardenverzekeringen-Yellow-Hive.pdf\">T\u00e9l\u00e9chargez et consultez nos conditions de m\u00e9diation ici.<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-33\" class=\"forminator-field-checkbox forminator-col forminator-col-12  label-hide\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-33-6af68dccbaf40-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-33-6af68dccbaf40-label\" class=\"forminator-label\">J&#039;accepte les conditions de m\u00e9diation <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-33-1-6af68dccbaf40-label\" for=\"forminator-field-checkbox-33-1-6af68dccbaf40\" class=\"forminator-checkbox\" title=\"J&#039;accepte les conditions de m\u00e9diation\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"Ik ga akkoord met de bemiddelingsvoorwaarden\" id=\"forminator-field-checkbox-33-1-6af68dccbaf40\" aria-labelledby=\"forminator-field-checkbox-33-1-6af68dccbaf40-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J&#039;accepte les conditions de m\u00e9diation<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12\"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6af68dccc0ba6\" id=\"forminator-field-ctlSignature6af68dccc0ba6-label\" class=\"forminator-label\">Votre signature \u00e9lectronique<\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6af68dccc0ba6_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Apposez votre signature \u00e9lectronique ici<\/span><div id=\"ctlSignature6af68dccc0ba6_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6af68dccc0ba6\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Votre navigateur ne prend pas en charge le champ de signature \u00e9lectronique.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6af68dccc0ba6\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-20\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-20\"><p>En remplissant et en renvoyant \u00e9lectroniquement ce formulaire de demande, vous d\u00e9clarez que les r\u00e9ponses fournies sont compl\u00e8tes et exactes. Vous acceptez \u00e9galement les conditions g\u00e9n\u00e9rales et vous vous engagez \u00e0 payer la prime et les frais applicables.&nbsp;<\/p><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Envoyez votre demande<\/button><a href=\"#\" class=\"forminator-save-draft-link disabled\" title=\"Remplissez les champs du formulaire avant de l&#039;enregistrer comme brouillon.\" formnovalidate>Enregistrez temporairement votre formulaire de candidature<\/a><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"0ce6eb8390\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/2742\" \/><input type=\"hidden\" name=\"form_id\" value=\"2717\"><input type=\"hidden\" name=\"page_id\" value=\"2742\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/equipepaarden.nl\/fr\/aanvraagformulier\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"save_draft\" value=\"false\"><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Remplissez le formulaire de demande et recevez imm\u00e9diatement un devis pour votre assurance cheval, avec une couverture et des primes clairement d\u00e9finies.<\/p>","protected":false},"author":1,"featured_media":1937,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-2742","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/pages\/2742","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/comments?post=2742"}],"version-history":[{"count":22,"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/pages\/2742\/revisions"}],"predecessor-version":[{"id":3026,"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/pages\/2742\/revisions\/3026"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/media\/1937"}],"wp:attachment":[{"href":"https:\/\/equipepaarden.nl\/fr\/wp-json\/wp\/v2\/media?parent=2742"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}