{"id":6065,"date":"2019-02-11T01:20:17","date_gmt":"2019-02-11T01:20:17","guid":{"rendered":"https:\/\/sgp-sa.com\/?page_id=6065"},"modified":"2019-04-01T16:39:28","modified_gmt":"2019-04-01T16:39:28","slug":"demande-doffre-vehicule-a-moteur","status":"publish","type":"page","link":"https:\/\/sgp-sa.com\/en\/demande-doffre-vehicule-a-moteur\/","title":{"rendered":"Request a car insurance."},"content":{"rendered":"<p style=\"text-align: center;\"><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-6064\"><form id=\"wpforms-form-6064\" class=\"wpforms-validate wpforms-form\" data-formid=\"6064\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6065\" data-token=\"3e6105830b5027c34f908f98d9a25e03\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/6065\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-6064-field_17-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"17\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-6064-field_17\">Sex <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6064-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled selected='selected'>Select<\/option><option value=\"Madame \" >Madam<\/option><option value=\"Monsieur \" >Sir<\/option><\/select><\/div><div id=\"wpforms-6064-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_0\">Name and First Name  <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6064-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-6064-field_0\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6064-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-6064-field_0-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6064-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_3\">Birthday  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"99\/99\/9999\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-6064-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_4\"> Nationality  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-6064-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_5\">Date of the driving licence  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_5\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"99\/99\/9999\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-6064-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_6\">Adress and number  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-6064-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_7\">Postal code and City <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6064-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" required><label for=\"wpforms-6064-field_7\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6064-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" required><label for=\"wpforms-6064-field_7-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6064-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_8\">Car Model and Type  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-6064-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_9\">First Car registration  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_9\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"99\/99\/9999\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-6064-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_10\">Homologation ou R\u00e9ception par type ( option )<\/label><input type=\"text\" id=\"wpforms-6064-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-6064-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_11\">Registration Number ( Matricule, code18 ) <\/label><input type=\"text\" id=\"wpforms-6064-field_11\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"999.999.999\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-6064-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_18\">Num\u00e9ro de plaques d&#039;immatriculation <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_18\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"999.999.999\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-6064-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_12\">Numer of claims 5 last years  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-6064-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_13\">Number of revocation of licence 5 last years ( + 3 month ) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6064-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" required><\/div><div id=\"wpforms-6064-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_15\">Coverages<\/label><ul id=\"wpforms-6064-field_15\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6064-field_15_1\" name=\"wpforms[fields][15]\" value=\"Responsabilit\u00e9 Civile\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_15_1\">Liability<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6064-field_15_2\" name=\"wpforms[fields][15]\" value=\"Casco Partielle\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_15_2\">Partial Casco<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-6064-field_15_3\" name=\"wpforms[fields][15]\" value=\"Casco Compl\u00e8te ( collision )\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_15_3\">Casco Compl\u00e8te ( collision )<\/label><\/li><\/ul><\/div><div id=\"wpforms-6064-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_14\">Options<\/label><ul id=\"wpforms-6064-field_14\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_14_1\" name=\"wpforms[fields][14][]\" value=\"Dommages Parking\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_14_1\">Dommages Parking<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_14_2\" name=\"wpforms[fields][14][]\" value=\"Effets de Voyage ( chf 2&#039;000.- ou chf 5&#039;000.- )\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_14_2\">Effets de Voyage ( chf 2'000.- ou chf 5'000.- )<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_14_3\" name=\"wpforms[fields][14][]\" value=\"Assurance Occupant ( d\u00e9c\u00e8s, invalidit\u00e9, ind. journali\u00e8re\/hospitalisation )\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_14_3\">Assurance Occupant ( d\u00e9c\u00e8s, invalidit\u00e9, ind. journali\u00e8re\/hospitalisation )<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_14_4\" name=\"wpforms[fields][14][]\" value=\"Assistance - D\u00e9pannage \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_14_4\">Assistance - D\u00e9pannage<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_14_5\" name=\"wpforms[fields][14][]\" value=\"R\u00e9paration avec les partenaires ( rabais sur la casco )\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_14_5\">R\u00e9paration avec les partenaires ( rabais sur la casco )<\/label><\/li><\/ul><\/div><div id=\"wpforms-6064-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_1\">Adress e-mail  <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6064-field_1\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][1][primary]\" spellcheck=\"false\" required><label for=\"wpforms-6064-field_1\" class=\"wpforms-field-sublabel after\">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6064-field_1-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6064-field_1\" name=\"wpforms[fields][1][secondary]\" spellcheck=\"false\" required><label for=\"wpforms-6064-field_1-secondary\" class=\"wpforms-field-sublabel after\">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-6064-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_2\">Comment  <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6064-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/textarea><\/div><div id=\"wpforms-6064-field_16-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-6064-field_16\">I agree  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6064-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-6064-field_16_1\" name=\"wpforms[fields][16][]\" value=\"En cochant cette case, j&#039;accepte de recevoir des emailings et je reconnais avoir pris connaissance de la POLITIQUE DE CONFIDENTIALIT\u00c9\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-6064-field_16_1\">By checking this case, I accept to receive emails and acknowledge that I have taken good knowledge of the PRIVACY POLICY.<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-6064-field-hp\" class=\"wpforms-field-label\">Email<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-6064-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6064\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"2\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-6064\" class=\"wpforms-submit\" data-alt-text=\"Envoie........\" data-submit-text=\"Envoyer\" aria-live=\"assertive\" value=\"wpforms-submit\">Send<\/button><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form><\/div>  <!-- .wpforms-container --><\/p>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/pages\/6065"}],"collection":[{"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/comments?post=6065"}],"version-history":[{"count":0,"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/pages\/6065\/revisions"}],"wp:attachment":[{"href":"https:\/\/sgp-sa.com\/en\/wp-json\/wp\/v2\/media?parent=6065"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}