{"id":4280,"date":"2012-09-10T21:19:41","date_gmt":"2012-09-10T21:19:41","guid":{"rendered":"http:\/\/@WEBSITE_1@\/?page_id=4280"},"modified":"2018-06-02T08:03:52","modified_gmt":"2018-06-02T08:03:52","slug":"offerte_personenwagen","status":"publish","type":"page","link":"https:\/\/cbcvandermarliere.be\/fr\/offerte_personenwagen\/","title":{"rendered":"Devis V\u00e9hicule de tourisme"},"content":{"rendered":"<p>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_5' style='display:none'><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action=\"\/fr\/wp-json\/wp\/v2\/pages\/4280#gf_5\" data-formid='5' novalidate>\n        <div id='gf_progressbar_wrapper_5' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>10<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_10' style='width:10%;'><span>10%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_5_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_5' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_55\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_55' class='gfield_label gform-field-label' for='input_5_55'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_55' id='input_5_55' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_55'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/li><li id=\"field_5_5\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Souscripteur<\/h2><\/li><li id=\"field_5_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_5_1_3' id='input_5_1_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'     aria-labelledby=\"input_5_1_3_label gfield_label_5_1\"\/>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_5_1_6' id='input_5_1_6_label' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_5_2\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_5_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_2_1_container' >\n                                        <label for='input_5_2_1' id='input_5_2_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                        <input type='text' name='input_2.1' id='input_5_2_1' value=''    aria-required='true'    aria-labelledby=\"input_5_2_1_label gfield_label_5_2\"\/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_2_3_container' >\n                                    <label for='input_5_2_3' id='input_5_2_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_2.3' id='input_5_2_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_2.4' id='input_5_2_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_5_2_5_container' >\n                                    <label for='input_5_2_5' id='input_5_2_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_2.5' id='input_5_2_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_5_2_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_5_3\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_3' class='gfield_label gform-field-label' for='input_5_3'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_5_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_5_4\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_4' class='gfield_label gform-field-label' for='input_5_4'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_5_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                         <button type='button' id='gform_next_button_5_12' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_2' class='gform_page' data-js='page-field-id-12' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_2' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_7\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Votre type de contrat<\/h2><\/li><li id=\"field_5_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_5_9' class='gfield_label gform-field-label screen-reader-text' ><span class='gform-field-label__text'><\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_9'>\n\t\t\t<li class='gchoice gchoice_5_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='Premier contrat (en nom propre)'  id='choice_5_9_0'    \/>\n\t\t\t\t<label for='choice_5_9_0' id='label_5_9_0' class='gform-field-label gform-field-label--type-inline'>Premier contrat (en nom propre)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='Remplacement de v\u00e9hicule (dans le cadre d\u2019un contrat KBC existant)'  id='choice_5_9_1'    \/>\n\t\t\t\t<label for='choice_5_9_1' id='label_5_9_1' class='gform-field-label gform-field-label--type-inline'>Remplacement de v\u00e9hicule (dans le cadre d\u2019un contrat KBC existant)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_9_2'>\n\t\t\t\t<input name='input_9' type='radio' value='Reprise de contrat (d\u2019une autre soci\u00e9t\u00e9)'  id='choice_5_9_2'    \/>\n\t\t\t\t<label for='choice_5_9_2' id='label_5_9_2' class='gform-field-label gform-field-label--type-inline'>Reprise de contrat (d\u2019une autre soci\u00e9t\u00e9)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_9_3'>\n\t\t\t\t<input name='input_9' type='radio' value='V\u00e9hicule suppl\u00e9mentaire dans la famille'  id='choice_5_9_3'    \/>\n\t\t\t\t<label for='choice_5_9_3' id='label_5_9_3' class='gform-field-label gform-field-label--type-inline'>V\u00e9hicule suppl\u00e9mentaire dans la famille<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_13' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_3' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_10\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Quelles polices d\u2019assurances avez vous d\u00e9j\u00e0 souscrites chez KBC?<\/h2><\/li><li id=\"field_5_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_5_11' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_5_11'><li class='gchoice gchoice_5_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Incendie (&gt; 180 \u20ac \/ an)'  id='choice_5_11_1'    aria-labelledby=\"label_5_11_1 gfield_label_5_11\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_11_1' id='label_5_11_1' class='gform-field-label gform-field-label--type-inline'>Incendie (> 180 \u20ac \/ an)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Assurance familiale (Familiale)'  id='choice_5_11_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_11_2' id='label_5_11_2' class='gform-field-label gform-field-label--type-inline'>Assurance familiale (Familiale)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Assurance accidents'  id='choice_5_11_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_11_3' id='label_5_11_3' class='gform-field-label gform-field-label--type-inline'>Assurance accidents<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_14' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_14' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-14' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_4' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_16\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Donn\u00e9es du v\u00e9hicule<\/h2><\/li><li id=\"field_5_17\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_17' class='gfield_label gform-field-label' for='input_5_17'><span class='gform-field-label__text'>Type de v\u00e9hicule<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_5_17' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='V\u00e9hicule de tourisme' >V\u00e9hicule de tourisme<\/option><option value='V\u00e9hicule utilitaire l\u00e9ger' >V\u00e9hicule utilitaire l\u00e9ger<\/option><\/select><\/div><\/li><li id=\"field_5_18\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_18' class='gfield_label gform-field-label' for='input_5_18'><span class='gform-field-label__text'>Marque<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_5_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_19\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_19' class='gfield_label gform-field-label' for='input_5_19'><span class='gform-field-label__text'>Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_5_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_20\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_20' class='gfield_label gform-field-label' for='input_5_20'><span class='gform-field-label__text'>Capacit\u00e9 moteur (CC)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_5_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_21\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_21' class='gfield_label gform-field-label' for='input_5_21'><span class='gform-field-label__text'>Puissance (KW)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_5_21' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_22\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_22' class='gfield_label gform-field-label' for='input_5_22'><span class='gform-field-label__text'>Carburant<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_5_22' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Essence' >Essence<\/option><option value='Diesel' >Diesel<\/option><option value='GPL' >GPL<\/option><option value='GCN' >GCN<\/option><option value='Electrique' >Electrique<\/option><option value='Hydrog\u00e8ne' >Hydrog\u00e8ne<\/option><\/select><\/div><\/li><li id=\"field_5_23\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_23' class='gfield_label gform-field-label' for='input_5_23'><span class='gform-field-label__text'>Premi\u00e8re mise en circulation<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_5_23'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_23'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_23' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_23' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_23' aria-label='Premi\u00e8re mise en circulation: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_24\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_24' class='gfield_label gform-field-label' for='input_5_24'><span class='gform-field-label__text'>Immatriculation<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_5_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_25\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_25' class='gfield_label gform-field-label' for='input_5_25'><span class='gform-field-label__text'>Num\u00e9ro de ch\u00e2ssis<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_5_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_5' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_26\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Utilisation du v\u00e9hicule<\/h2><\/li><li id=\"field_5_27\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_5_27' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_5_27'><li class='gchoice gchoice_5_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='&lt; 10.000 km\/an'  id='choice_5_27_1'    aria-labelledby=\"label_5_27_1 gfield_label_5_27\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_27_1' id='label_5_27_1' class='gform-field-label gform-field-label--type-inline'>< 10.000 km\/an<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_27_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.2' type='checkbox'  value='Remorque (&gt; 750 kg)'  id='choice_5_27_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_27_2' id='label_5_27_2' class='gform-field-label gform-field-label--type-inline'>Remorque (> 750 kg)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_27_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.3' type='checkbox'  value='Trajet domicile - travail'  id='choice_5_27_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_27_3' id='label_5_27_3' class='gform-field-label gform-field-label--type-inline'>Trajet domicile - travail<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_27_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.4' type='checkbox'  value='Usage professionnel'  id='choice_5_27_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_27_4' id='label_5_27_4' class='gform-field-label gform-field-label--type-inline'>Usage professionnel<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_27_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.5' type='checkbox'  value='Contrat de leasing\/location'  id='choice_5_27_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_27_5' id='label_5_27_5' class='gform-field-label gform-field-label--type-inline'>Contrat de leasing\/location<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_6' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_29\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Conducteurs du v\u00e9hicule<\/h2><\/li><li id=\"field_5_30\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_30' class='gfield_label gform-field-label' for='input_5_30'><span class='gform-field-label__text'>Conducteurs habituels<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_5_30' class='textarea large'  aria-describedby=\"gfield_description_5_30\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_5_30'><strong>(pour chacun nom+ date de naissance+ date du permis de conduire)<\/strong><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_31' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_7' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_7' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_32\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Garanties \u00e0 assurer<\/h2><\/li><li id=\"field_5_54\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_5_54' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_5_54'><li class='gchoice gchoice_5_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='Responsabilit\u00e9 civile (RC)'  id='choice_5_54_1'    aria-labelledby=\"label_5_54_1 gfield_label_5_54\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_1' id='label_5_54_1' class='gform-field-label gform-field-label--type-inline'>Responsabilit\u00e9 civile (RC)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='Assistance juridique (AJ)'  id='choice_5_54_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_2' id='label_5_54_2' class='gform-field-label gform-field-label--type-inline'>Assistance juridique (AJ)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='Omnium complet'  id='choice_5_54_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_3' id='label_5_54_3' class='gform-field-label gform-field-label--type-inline'>Omnium complet<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_54_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.4' type='checkbox'  value='Omnium partiel'  id='choice_5_54_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_4' id='label_5_54_4' class='gform-field-label gform-field-label--type-inline'>Omnium partiel<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_54_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.5' type='checkbox'  value='Assistance (VTB-VAB, v\u00e9hicule de remplacement,...)'  id='choice_5_54_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_5' id='label_5_54_5' class='gform-field-label gform-field-label--type-inline'>Assistance (VTB-VAB, v\u00e9hicule de remplacement,...)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_5_54_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.6' type='checkbox'  value='Assurance accident (conducteur)'  id='choice_5_54_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_54_6' id='label_5_54_6' class='gform-field-label gform-field-label--type-inline'>Assurance accident (conducteur)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_35' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_35' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_8' class='gform_page' data-js='page-field-id-35' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_8' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_34\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Si Omnium, \u00e0 assurer<\/h2><\/li><li id=\"field_5_36\" class=\"gfield gfield--type-text field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_36' class='gfield_label gform-field-label' for='input_5_36'><span class='gform-field-label__text'>Prix facture<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_5_36' type='text' value='' class='medium'  aria-describedby=\"gfield_description_5_36\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_36'><strong>(incl. BTW) zonder vermindering van een eventuele overnameprijs! <\/strong><\/div><\/li><li id=\"field_5_37\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_37' class='gfield_label gform-field-label' for='input_5_37'><span class='gform-field-label__text'>Date de facture<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_5_37'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_37'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_37' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_37' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_37' aria-label='Date de facture: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_38\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_38' class='gfield_label gform-field-label' for='input_5_38'><span class='gform-field-label__text'>Franchise<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_5_38' class='medium gfield_select'     aria-invalid=\"false\" ><option value='\u20ac250' >\u20ac250<\/option><option value='\u20ac500' >\u20ac500<\/option><option value='\u20ac750' >\u20ac750<\/option><option value='\u20ac1000' >\u20ac1000<\/option><option value='\u20ac1250' >\u20ac1250<\/option><\/select><\/div><\/li><li id=\"field_5_39\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_39' class='gfield_label gform-field-label' for='input_5_39'><span class='gform-field-label__text'>Franchise vol<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_39' id='input_5_39' class='medium gfield_select'     aria-invalid=\"false\" ><option value='\u20ac0' >\u20ac0<\/option><option value='\u20ac250' >\u20ac250<\/option><option value='\u20ac500' >\u20ac500<\/option><option value='\u20ac750' >\u20ac750<\/option><option value='\u20ac1000' >\u20ac1000<\/option><option value='\u20ac1250' >\u20ac1250<\/option><\/select><\/div><\/li><li id=\"field_5_40\" class=\"gfield gfield--type-select field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_40' class='gfield_label gform-field-label' for='input_5_40'><span class='gform-field-label__text'>R\u00e9cup\u00e9ration de TVA<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_40' id='input_5_40' class='medium gfield_select'  aria-describedby=\"gfield_description_5_40\"   aria-invalid=\"false\" ><option value='0%' >0%<\/option><option value='50%' >50%<\/option><option value='100%' >100%<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_5_40'><strong>(ind\u00e9pendants uniquement)<\/strong><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_41' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_41' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_9' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_9' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_42\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Si vous n\u2019\u00eates pas encore assur\u00e9 chez nous:<\/h2><\/li><li id=\"field_5_43\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_43' class='gfield_label gform-field-label' for='input_5_43'><span class='gform-field-label__text'>Conducteur habituel?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_5_43' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/li><li id=\"field_5_44\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_44' class='gfield_label gform-field-label' for='input_5_44'><span class='gform-field-label__text'>Chez quelle compagnie?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_5_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_46\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_46' class='gfield_label gform-field-label' for='input_5_46'><span class='gform-field-label__text'>Depuis combien d\u2019ann\u00e9es \u00eates-vous assur\u00e9 en tant que conducteur habituel?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_5_46' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_5_47\" class=\"gfield gfield--type-number field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_47' class='gfield_label gform-field-label' for='input_5_47'><span class='gform-field-label__text'>Nombres d\u2019accidents responsables?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_5_47' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_5_47\" \/><\/div><div class='gfield_description' id='gfield_description_5_47'>(5 derni\u00e8res ann\u00e9es)<\/div><\/li><li id=\"field_5_48\" class=\"gfield gfield--type-number field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_48' class='gfield_label gform-field-label' for='input_5_48'><span class='gform-field-label__text'>Nombres d\u2019accidents non-responsables?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_5_48' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_5_48\" \/><\/div><div class='gfield_description' id='gfield_description_5_48'>(5 derni\u00e8res ann\u00e9es)<\/div><\/li><li id=\"field_5_49\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_49' class='gfield_label gform-field-label' for='input_5_49'><span class='gform-field-label__text'>Bonus\/Malus actuel?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_5_49' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_5_50' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_5_50' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_10' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_5_10' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_5_51\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Extra<\/h2><\/li><li id=\"field_5_52\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_52' class='gfield_label gform-field-label' for='input_5_52'><span class='gform-field-label__text'>Autres remarques<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_5_52' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer left_label'><button type='submit' id='gform_previous_button_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Envoyer<\/button> \n     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<\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><\/p>","protected":false},"excerpt":{"rendered":"\u00c9tape 1 sur 10 10% CompanyCe champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.SouscripteurNom* Pr\u00e9nom Nom Adresse* Adresse postale Ville Code postal Email* T\u00e9l\u00e9phone* Volgende Votre type de contrat* Premier contrat (en nom propre) Remplacement de v\u00e9hicule (dans le cadre d\u2019un contrat KBC existant) Reprise de contrat (d\u2019une autre soci\u00e9t\u00e9) V\u00e9hicule suppl\u00e9mentaire dans la famille Vorige...","protected":false},"author":12,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4280","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/pages\/4280","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/comments?post=4280"}],"version-history":[{"count":0,"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/pages\/4280\/revisions"}],"wp:attachment":[{"href":"https:\/\/cbcvandermarliere.be\/fr\/wp-json\/wp\/v2\/media?parent=4280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}