{"id":862,"date":"2026-08-08T21:58:28","date_gmt":"2026-08-08T21:58:28","guid":{"rendered":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/?page_id=862"},"modified":"2026-09-18T18:07:36","modified_gmt":"2026-09-18T18:07:36","slug":"soknadsskjema","status":"publish","type":"page","link":"https:\/\/elysiumfuneralplans.com\/nb\/application-form\/","title":{"rendered":"Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"862\" class=\"elementor elementor-862\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3d0f727 e-flex e-con-boxed e-con e-parent\" data-id=\"3d0f727\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1a09402 elementor-widget-mobile__width-inherit elementor-widget elementor-widget-heading\" data-id=\"1a09402\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SELECT YOUR LOCATION:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8f2ff7d gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"8f2ff7d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-size-sm\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Spain<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5684cb5 gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"5684cb5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/elysiumfuneralplans.com\/application-form-portugal\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Portugal<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3f61164 gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"3f61164\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/elysiumfuneralplans.com\/application-form-cyprus\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Cyprus<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-141e564 e-flex e-con-boxed e-con e-parent\" data-id=\"141e564\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-969a117 e-con-full e-flex e-con e-child\" data-id=\"969a117\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a066d57 elementor-widget elementor-widget-heading\" data-id=\"a066d57\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Elysium Funeral Plan  - Spain<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb954f5 elementor-widget elementor-widget-text-editor\" data-id=\"cb954f5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>CONTRACT\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f173f68 e-con-full e-flex e-con e-child\" data-id=\"f173f68\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d47f309 elementor-widget elementor-widget-shortcode\" data-id=\"d47f309\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar 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enctype='multipart\/form-data'  id='gform_4'  action='\/nb\/wp-json\/wp\/v2\/pages\/862' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_193\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_193'><span class='gform-field-label__text'>X\/Twitter<\/span><\/label><div class='ginput_container'><input name='input_193' id='input_4_193' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_4_193'>Dette feltet er for valideringsform\u00e5l og skal st\u00e5 uendret.<\/div><\/div><div id=\"field_4_70\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\njQuery(document).ready(function($) {\n    function toggleCustomBoxes() {\n        $('.custom-gf-box').each(function() {\n            var $wrapper = $(this);\n            \n            var hasVisibleFields = $wrapper.children().not('legend').filter(function() {\n                return $(this).css('display') !== 'none';\n            }).length > 0;\n\n            if (hasVisibleFields) {\n                $wrapper.removeClass('custom-gf-box-hidden');\n            } else {\n                $wrapper.addClass('custom-gf-box-hidden');\n            }\n        });\n    }\n\n    $(document).on('gform_post_render', function(event, form_id, current_page){\n        $('#gform_wrapper_' + form_id + ' .gfield--type-section').each(function() {\n            var $section = $(this);\n            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       \n            $wrapper.append($legend);\n            $section.before($wrapper);\n            $wrapper.append($fields);\n            $section.hide();\n        });\n\n        toggleCustomBoxes();\n    });\n\n    $(document).on('gform_post_conditional_logic', function(event, form_id, fields, isInit) {\n        toggleCustomBoxes();\n    });\n});\n<\/script><\/div><div id=\"field_4_69\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Contract Info<\/h3><\/div><div id=\"field_4_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_2'><span class='gform-field-label__text'>Funeral Plan No:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_4_2' type='text' value='7023S' class='medium'  aria-describedby=\"gfield_description_4_2\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_2'>(Auto fills)<\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_4'\n\t\t\t\t\tclass='datepicker 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gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">The Parties to the Contract: The Company<\/h3><\/div><div id=\"field_4_189\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n    .elysium-company-box {\n        background-color: #050058 !important;\n        color: #FFFFFF !important;\n        padding: 24px !important;\n        border-radius: 8px !important;\n        font-family: -apple-system, BlinkMacSystemFont, \"Segoe UI\", Roboto, Arial, sans-serif !important;\n        font-size: 14px !important;\n        line-height: 1.6 !important;\n        text-align: left !important;\n        max-width: 100% !important;\n        box-sizing: border-box !important;\n        margin: 0 !important;\n    }\n\n    .elysium-company-box div, \n    .elysium-company-box span {\n        text-align: left !important;\n        color: #FFFFFF !important;\n    }\n\n    .elysium-box-title {\n        font-size: 16px !important;\n        font-weight: 700 !important;\n        margin-bottom: 15px !important;\n        display: block !important;\n    }\n\n    .elysium-box-label {\n        font-weight: 700 !important;\n        color: #FFFFFF !important; \n        display: inline !important;\n    }\n\n    .elysium-box-section {\n        margin-bottom: 20px !important;\n        display: block !important;\n    }\n\n    .elysium-box-disclaimer {\n        color: #F1F5F9 !important;\n        font-size: 13px !important;\n        margin-top: 25px !important;\n        display: block !important;\n    }\n\n    .elysium-company-box a {\n        color: #FFFFFF !important;\n        text-decoration: none !important;\n    }\n\n    .elysium-company-box a.elysium-email-link {\n        text-decoration: underline !important;\n    }\n<\/style>\n\n<div class=\"elysium-company-box\">\n    <div class=\"elysium-box-title\">ELYSIUM FUNERAL PLANS SL<\/div>\n    \n    <div class=\"elysium-box-section\">\n        <span class=\"elysium-box-label\">Registered Office:<\/span><br>\n        Calle Carlos Cervera 14,<br>\n        Bajo,<br>\n        Valencia, 46006,<br>\n        Spain\n    <\/div>\n    \n    <div class=\"elysium-box-section\">\n        <span class=\"elysium-box-label\">CIF No.:<\/span> B19931633<br>\n        <span class=\"elysium-box-label\">Tel:<\/span> <a href=\"tel:+34960730230\">+34 960 730 230<\/a><br>\n        <span class=\"elysium-box-label\">Email:<\/span> <a href=\"mailto:clientcare@elysiumfuneralplans.com\" class=\"elysium-email-link\">clientcare@elysiumfuneralplans.com<\/a>\n    <\/div>\n    \n    <div class=\"elysium-box-disclaimer\">\n        Hereinafter called \u201cTHE PLAN HOLDER\u201d.\n    <\/div>\n<\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">The Parties to this Contract: Applicant 1<\/h3><\/div><fieldset id=\"field_4_133\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_133'>\n                            <span id='input_4_133_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_133.2' id='input_4_133_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_133_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_133_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_133.3' id='input_4_133_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_133_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_133_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_133.4' id='input_4_133_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_133_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_133_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_133.6' id='input_4_133_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_133_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_4_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_7_1' id='input_4_7_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_4_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_7_2' id='input_4_7_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_4_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_7_3' id='input_4_7_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_7.4' id='input_4_7_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_4_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_7_5' id='input_4_7_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_7_6_container' >\n                                        <select name='input_7.6' id='input_4_7_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_7_6' id='input_4_7_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_8\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_8'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_8'\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_8'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_8' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_8' 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_4_8' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_4_9' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_10'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_4_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_4_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_12'><span class='gform-field-label__text'>ID (TIE \/ NIE)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_4_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_141\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_141'><span class='gform-field-label__text'>PASSPORT ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_4_141' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_13\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_13'><span class='gform-field-label__text'>Upload your TIE \/ NIE &amp; PASSPORT<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_13' id='input_4_13' type='file' class='large' aria-describedby=\"gfield_upload_rules_4_13 gfield_description_4_13\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_13'>Godkjente filtyper: jpg, jpeg, png, pdf, Max. file size: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_13'><\/div> <\/div><div class='gfield_description' id='gfield_description_4_13'>TIE\/CDR\/MEU21\/2\/PASSPORT<\/div><\/div><div id=\"field_4_129\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_129'><span class='gform-field-label__text'>Religion<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_129' id='input_4_129' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_71\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >\n<p style=\"margin-top:10px\"><strong>Hereinafter called \u2018The PLAN HOLDER\u2019<\/strong><\/p><\/div><fieldset id=\"field_4_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is there a second Applicant?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_14'>\n\t\t\t<div class='gchoice gchoice_4_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_4_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_0' id='label_4_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_4_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_1' id='label_4_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Applicant 2<\/h3><\/div><fieldset id=\"field_4_134\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_134'>\n                            <span id='input_4_134_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_134.2' id='input_4_134_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_134_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_134_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.3' id='input_4_134_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_134_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_134_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.4' id='input_4_134_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_134_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_134_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.6' id='input_4_134_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_134_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_4_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_17_1' id='input_4_17_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_4_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_17_2' id='input_4_17_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_4_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_17_3' id='input_4_17_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_4_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_4_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_17_5' id='input_4_17_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_17_6_container' >\n                                        <select name='input_17.6' id='input_4_17_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_17_6' id='input_4_17_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_18\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_18'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_18'\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_18'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_18' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_18' 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_4_18' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_19\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_19'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_19' id='input_4_19' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_20\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_20'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_4_20' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_21'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_4_21' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'><span class='gform-field-label__text'>ID Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_4_22' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_142\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_142'><span class='gform-field-label__text'>PASSPORT ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_4_142' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_72\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_72'><span class='gform-field-label__text'>Upload your ID Copy<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_72' id='input_4_72' type='file' class='large' aria-describedby=\"gfield_upload_rules_4_72 gfield_description_4_72\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_72'>Godkjente filtyper: jpg, jpeg, png, pdf, Max. file size: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_72'><\/div> <\/div><div class='gfield_description' id='gfield_description_4_72'>TIE\/CDR\/MEU21\/2\/PASSPORT<\/div><\/div><div id=\"field_4_143\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_143'><span class='gform-field-label__text'>Religion<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_4_143' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_192\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"margin-top:10px\"><strong>Hereinafter called \u2018The PLAN HOLDER\u2019<\/strong><\/p><\/div><div id=\"field_4_24\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Next of Kin Applicant 1<\/h3><\/div><fieldset id=\"field_4_135\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_135'>\n                            <span id='input_4_135_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_135.2' id='input_4_135_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_135_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_135_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.3' id='input_4_135_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_135_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_135_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.4' id='input_4_135_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_135_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_135_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.6' id='input_4_135_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_135_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_26\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_26' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_26_1_container' >\n                                        <input type='text' name='input_26.1' id='input_4_26_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_26_1' id='input_4_26_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_26_2_container' >\n                                        <input type='text' name='input_26.2' id='input_4_26_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_26_2' id='input_4_26_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_26_3_container' >\n                                    <input type='text' name='input_26.3' id='input_4_26_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_26_3' id='input_4_26_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_26.4' id='input_4_26_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_26_5_container' >\n                                    <input type='text' name='input_26.5' id='input_4_26_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_26_5' id='input_4_26_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_26_6_container' >\n                                        <select name='input_26.6' id='input_4_26_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_26_6' id='input_4_26_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_27\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_27'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_27'\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_27'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_27' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_27' 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_4_27' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_28\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_28'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_28' id='input_4_28' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_29\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_29'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_4_29' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_30'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_4_30' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Plan Holder has confirmed they are aware they have been chosen as Next of Kin.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_31'>\n\t\t\t<div class='gchoice gchoice_4_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_4_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_0' id='label_4_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_4_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_1' id='label_4_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Next of Kin Applicant 2<\/h3><\/div><fieldset id=\"field_4_147\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Same Next of Kin as Applicant 1<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_147'><div class='gchoice gchoice_4_147_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.1' type='checkbox'  value='Yes'  id='choice_4_147_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_147_1' id='label_4_147_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_148\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\njQuery(document).on('gform_post_render', function(event, form_id, current_page) {\n    \/\/ Ensure this only runs on Form ID 4\n    if (form_id == 4) {\n        \n        \/\/ Targets your new Checkbox Field (Field ID 147, Choice 1)\n        var checkboxSelector = '#choice_4_147_1';\n\n        \/\/ Unbind and rebind to prevent double-firing on AJAX form loads\n        jQuery(document).off('change', checkboxSelector).on('change', checkboxSelector, function() {\n            var isChecked = jQuery(this).is(':checked');\n\n            if (isChecked) {\n                \/\/ ==========================================\n                \/\/ 1. COPY TEXT, EMAIL, PHONE, DATE & SELECT DROPDOWNS\n                \/\/ ==========================================\n                var textFields = [\n                    { src: '#input_4_135_2', target: '#input_4_136_2' }, \/\/ Prefix (Dropdown)\n                    { src: '#input_4_135_3', target: '#input_4_136_3' }, \/\/ First Name\n                    { src: '#input_4_135_4', target: '#input_4_136_4' }, \/\/ Middle Name\n                    { src: '#input_4_135_6', target: '#input_4_136_6' }, \/\/ Last Name\n                    { src: '#input_4_26_1',  target: '#input_4_34_1'  }, \/\/ Address Line 1\n                    { src: '#input_4_26_2',  target: '#input_4_34_2'  }, \/\/ Address Line 2\n                    { src: '#input_4_26_3',  target: '#input_4_34_3'  }, \/\/ City\n                    { src: '#input_4_26_5',  target: '#input_4_34_5'  }, \/\/ Zip Code\n                    { src: '#input_4_26_6',  target: '#input_4_34_6'  }, \/\/ Country Dropdown\n                    { src: '#input_4_27',    target: '#input_4_35'    }, \/\/ Date of Birth\n                    { src: '#input_4_28',    target: '#input_4_36'    }, \/\/ Email\n                    { src: '#input_4_29',    target: '#input_4_37'    }, \/\/ Phone\n                    { src: '#input_4_30',    target: '#input_4_38'    }  \/\/ Relationship\n                ];\n\n                textFields.forEach(function(field) {\n                    var val = jQuery(field.src).val();\n                    jQuery(field.target).val(val).trigger('change');\n                });\n\n                \/\/ Fallback: Just in case the theme ever renders the Prefix as Radio buttons\n                var prefixRadioVal = jQuery('input[name=\"input_135.2\"]:checked').val();\n                if(prefixRadioVal) {\n                    jQuery('input[name=\"input_136.2\"][value=\"' + prefixRadioVal + '\"]').prop('checked', true).trigger('change');\n                }\n\n                \/\/ ==========================================\n                \/\/ 2. COPY NEXT OF KIN CONFIRMATION RADIO (Yes\/No)\n                \/\/ ==========================================\n                var confirmVal = jQuery('#field_4_31 input[type=\"radio\"]:checked').val();\n                if(confirmVal) {\n                    jQuery('#field_4_39 input[type=\"radio\"][value=\"' + confirmVal + '\"]').prop('checked', true).trigger('change').trigger('click');\n                }\n\n            } else {\n                \/\/ ==========================================\n                \/\/ CLEAR ALL FIELDS IF UNCHECKED\n                \/\/ ==========================================\n                var clearFields = [\n                    '#input_4_136_2', '#input_4_136_3', '#input_4_136_4', '#input_4_136_6',\n                    '#input_4_34_1', '#input_4_34_2', '#input_4_34_3',\n                    '#input_4_34_5', '#input_4_34_6', '#input_4_35',\n                    '#input_4_36', '#input_4_37', '#input_4_38'\n                ];\n                \n                clearFields.forEach(function(selector) {\n                    jQuery(selector).val('').trigger('change');\n                });\n\n                \/\/ Clear Radio Buttons\n                jQuery('input[name=\"input_136.2\"]').prop('checked', false).trigger('change');\n                jQuery('#field_4_39 input[type=\"radio\"]').prop('checked', false).trigger('change');\n            }\n        });\n    }\n});\n<\/script><\/div><fieldset id=\"field_4_136\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_136'>\n                            <span id='input_4_136_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_136.2' id='input_4_136_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_136_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_136_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.3' id='input_4_136_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_136_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_136_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.4' id='input_4_136_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_136_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_136_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.6' id='input_4_136_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_136_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_34\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_34' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_34_1_container' >\n                                        <input type='text' name='input_34.1' id='input_4_34_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_34_1' id='input_4_34_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_34_2_container' >\n                                        <input type='text' name='input_34.2' id='input_4_34_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_34_2' id='input_4_34_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_34_3_container' >\n                                    <input type='text' name='input_34.3' id='input_4_34_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_34_3' id='input_4_34_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_34.4' id='input_4_34_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_34_5_container' >\n                                    <input type='text' name='input_34.5' id='input_4_34_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_34_5' id='input_4_34_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_34_6_container' >\n                                        <select name='input_34.6' id='input_4_34_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_34_6' id='input_4_34_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_35\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_35'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_35'\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_35'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_35' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_35' 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_4_35' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_36\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_36'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_36' id='input_4_36' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_37\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_37'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_37' id='input_4_37' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_38'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_4_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Plan Holder has confirmed they are aware they have been chosen as Next of Kin.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_39'>\n\t\t\t<div class='gchoice gchoice_4_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Yes'  id='choice_4_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_39_0' id='label_4_39_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='No'  id='choice_4_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_39_1' id='label_4_39_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Purpose &amp; Scope<\/h3><\/div><div id=\"field_4_40\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>1. PURPOSE OF THE CONTRACT<\/h4>\n<p>The purpose of this contract is the provision and guarantee of funeral services by <strong> Elysium Funeral Plans SL, Hereinafter called THE COMPANY<\/strong>  <br>\n<strong>THE COMPANY<\/strong> in accordance with the plan selected by <strong>THE PLAN HOLDER.<\/strong><\/p>\n<p><strong>THE COMPANY<\/strong> undertakes to:<\/p>\n<ul>\n<li>Organise and manage the funeral service.<\/li>\n<li>Co-ordinate all necessary third parties.<\/li>\n<li>Guarantee the proper provision of the contracted services at the time of enactment.<\/li>\n<\/ul><\/div><div id=\"field_4_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>2. SCOPE OF THE SERVICE<\/h4>\n<p>The service includes only the items detailed in this contract.<\/p>\n<p><strong>The following is expressly INCLUDED:<\/strong><\/p>\n<ul>\n<li>Full organisation of the funeral service.<\/li>\n<li>Basic funeral services in accordance with the plan taken out.<\/li>\n<li>Administrative management.<\/li>\n<\/ul>\n<p><strong>The following is expressly EXCLUDED:<\/strong><\/p>\n<ul>\n<li>Additional flowers unless specified in a plan.<\/li>\n<li>Obituaries.<\/li>\n<li>Catering.<\/li>\n<li>Headstones.<\/li>\n<li>Niche or burial plots.<\/li>\n<li>Burial taxes.<\/li>\n<li>Municipal fees.<\/li>\n<li>International repatriation unless specified in a plan.<\/li>\n<li>Services not specified in this contract.<\/li>\n<\/ul>\n<p>Any additional services requested will be quoted for separately and must be paid for in full prior to the enactment.<\/p><\/div><div id=\"field_4_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Plan Purchased - Applicant 1<\/h3><\/div><div id=\"field_4_100\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n\n    .elysium-master-container {\n        width: 100vw;\n        font-family: 'Inter', system-ui, -apple-system, sans-serif !important;\n        background-color: #FFFFFF !important;\n        border: 1px solid #E2E8F0 !important;\n        border-radius: 20px !important;\n        max-width: 100% !important;\n        margin: 0 auto !important;\n        overflow: hidden !important;\n        box-shadow: 0 4px 12px rgba(0, 0, 0, 0.05) !important;\n        box-sizing: border-box !important;\n    }\n\n    \/* Solid Header Banner Colors *\/\n    .elysium-master-header {\n        background-color: #050058 !important; \/* Solid Elysium Navy *\/\n        color: #FFFFFF !important;\n        padding: 30px 24px !important;\n        text-align: center !important;\n        border-bottom: 4px solid #E40B5C !important; \/* Solid Elysium Pink *\/\n        box-sizing: border-box !important;\n    }\n\n    .elysium-master-title {\n        font-family: 'Playfair Display', Georgia, serif !important;\n        font-size: 26px !important;\n        font-weight: normal !important;\n        margin: 0 0 6px 0 !important;\n        color: #FFFFFF !important;\n        letter-spacing: 0.5px !important;\n        line-height: 1.2 !important;\n    }\n\n    .elysium-master-subtitle {\n        font-size: 13px !important;\n        color: #94A3B8 !important;\n        margin: 0 !important;\n        font-weight: 500 !important;\n        line-height: 1.4 !important;\n    }\n\n    \/* Grid layout *\/\n    .elysium-master-grid {\n        display: grid !important;\n        grid-template-columns: 1.2fr 1fr !important;\n    }\n\n    @media (max-width: 767px) {\n        .elysium-master-grid {\n            grid-template-columns: 1fr !important;\n        }\n    }\n\n    \/* Inputs column *\/\n    .elysium-master-inputs {\n        padding: 30px !important;\n        background-color: #FFFFFF !important;\n        box-sizing: border-box !important;\n    }\n\n    .elysium-master-group {\n        margin-bottom: 24px !important;\n    }\n\n    .elysium-master-label {\n        display: block !important;\n        font-size: 11px !important;\n        font-weight: 700 !important;\n        text-transform: uppercase !important;\n        letter-spacing: 1px !important;\n        color: #64748B !important;\n        margin-bottom: 8px !important;\n    }\n\n    \/* Plan Dropdown Form Styling *\/\n    .elysium-dropdown-wrapper {\n        position: relative !important;\n        background-color: #FFFFFF !important;\n        border: 1px solid #CBD5E1 !important;\n        border-radius: 10px !important;\n        overflow: hidden !important;\n    }\n\n    .elysium-master-select {\n        width: 100% !important;\n        padding: 12px 16px !important;\n        font-size: 15px !important;\n        font-weight: 600 !important;\n        color: #1E293B !important;\n        background-color: transparent !important;\n        border: none !important;\n        outline: none !important;\n        box-shadow: none !important;\n        cursor: pointer !important;\n        box-sizing: border-box !important;\n        -webkit-appearance: none !important;\n        appearance: none !important;\n    }\n\n    \/* Segmented Selection Toggle *\/\n    .elysium-location-toggle {\n        display: flex !important;\n        border: 1px solid #CBD5E1 !important;\n        border-radius: 12px !important;\n        overflow: hidden !important;\n        background-color: #F8FAFC !important;\n        box-sizing: border-box !important;\n    }\n\n    .elysium-toggle-btn {\n        flex: 1 !important;\n        background: none !important;\n        border: none !important;\n        padding: 12px 14px !important;\n        font-family: inherit !important;\n        cursor: pointer !important;\n        display: flex !important;\n        flex-direction: column !important;\n        align-items: center !important;\n        justify-content: center !important;\n        transition: all 0.2s ease !important;\n        outline: none !important;\n        margin: 0 !important;\n    }\n\n    .elysium-toggle-btn.active {\n        background-color: #050058 !important; \/* Solid Navy *\/\n    }\n\n    .elysium-toggle-btn.active .elysium-toggle-lbl {\n        color: #FFFFFF !important;\n    }\n\n    .elysium-toggle-btn.active .elysium-toggle-price {\n        color: #E40B5C !important; \/* Solid Pink *\/\n    }\n\n    .elysium-toggle-lbl {\n        font-size: 10px !important;\n        font-weight: 700 !important;\n        text-transform: uppercase !important;\n        letter-spacing: 0.5px !important;\n        color: #64748B !important;\n        margin-bottom: 3px !important;\n    }\n\n    .elysium-toggle-price {\n        font-size: 15px !important;\n        font-weight: 700 !important;\n        color: #050058 !important;\n    }\n\n    @media (max-width: 480px) {\n        .elysium-location-toggle {\n            flex-direction: column !important;\n        }\n        .elysium-toggle-btn {\n            border-bottom: 1px solid #CBD5E1 !important;\n        }\n        .elysium-toggle-btn:last-child {\n            border-bottom: none !important;\n        }\n    }\n\n    \/* Advisory Box styles *\/\n    .elysium-advisory-card {\n        background-color: #FEF2F2 !important;\n        border: 1px solid #FCA5A5 !important;\n        border-left: 4px solid #E40B5C !important;\n        border-radius: 12px !important;\n        padding: 20px !important;\n        margin-bottom: 24px !important;\n        box-sizing: border-box !important;\n    }\n\n    .elysium-advisory-card.hide {\n        display: none !important;\n    }\n\n    .elysium-advisory-header {\n        font-size: 13px !important;\n        font-weight: 700 !important;\n        color: #E40B5C !important;\n        text-transform: uppercase !important;\n        margin-bottom: 6px !important;\n    }\n\n    .elysium-advisory-text {\n        font-size: 12px !important;\n        line-height: 1.5 !important;\n        color: #7F1D1D !important;\n        margin: 0 0 12px 0 !important;\n    }\n\n    .elysium-advisory-alternative {\n        font-size: 11px !important;\n        color: #991B1B !important;\n        margin: 0 !important;\n    }\n\n    \/* Sliders styling *\/\n    .elysium-master-label-row {\n        display: flex !important;\n        justify-content: space-between !important;\n        align-items: center !important;\n        margin-bottom: 8px !important;\n    }\n\n    .elysium-master-value-highlight {\n        font-size: 15px !important;\n        font-weight: 700 !important;\n        color: #E40B5C !important;\n    }\n\n    .elysium-master-slider {\n        -webkit-appearance: none !important;\n        appearance: none !important;\n        width: 100% !important;\n        height: 6px !important;\n        border-radius: 3px !important;\n        background: #E2E8F0 !important;\n        outline: none !important;\n        margin: 14px 0 !important;\n        padding: 0 !important;\n        border: none !important;\n    }\n\n    .elysium-master-slider::-webkit-slider-thumb {\n        -webkit-appearance: none !important;\n        appearance: none !important;\n        width: 20px !important;\n        height: 20px !important;\n        border-radius: 50% !important;\n        background-color: #E40B5C !important;\n        border: 3px solid #FFFFFF !important;\n        cursor: pointer !important;\n        box-shadow: 0 2px 4px rgba(0,0,0,0.15) !important;\n    }\n\n    .elysium-master-slider::-moz-range-thumb {\n        width: 20px !important;\n        height: 20px !important;\n        border-radius: 50% !important;\n        background-color: #E40B5C !important;\n        border: 3px solid #FFFFFF !important;\n        cursor: pointer !important;\n        box-shadow: 0 2px 4px rgba(0,0,0,0.15) !important;\n    }\n\n    \/* Summary Pane styling *\/\n    .elysium-master-summary {\n        background-color: #F8FAFC !important;\n        padding: 30px !important;\n        display: flex !important;\n        flex-direction: column !important;\n        justify-content: space-between !important;\n        border-left: 1px solid #E2E8F0 !important;\n        box-sizing: border-box !important;\n        font-size: 14px !important;\n    }\n\n    @media (max-width: 767px) {\n        .elysium-master-summary {\n            border-left: none !important;\n            border-top: 1px solid #E2E8F0 !important;\n        }\n    }\n\n    .elysium-master-summary-title {\n        font-size: 11px !important;\n        font-weight: 700 !important;\n        text-transform: uppercase !important;\n        letter-spacing: 1px !important;\n        color: #94A3B8 !important;\n        margin: 0 0 20px 0 !important;\n    }\n\n    .elysium-master-row {\n        display: flex !important;\n        justify-content: space-between !important;\n        align-items: center !important;\n        padding: 8px 0 !important;\n    }\n\n    .elysium-master-row.border-top {\n        border-top: 1px solid #E2E8F0 !important;\n        margin-top: 12px !important;\n        padding-top: 12px !important;\n    }\n\n    .elysium-master-row-label {\n        font-size: 13px !important;\n        color: #64748B !important;\n    }\n\n    .elysium-master-row-label.font-bold {\n        font-weight: 700 !important;\n        color: #1E293B !important;\n    }\n\n    .elysium-master-row-value {\n        font-size: 14px !important;\n        font-weight: 600 !important;\n        color: #334155 !important;\n    }\n\n    .elysium-master-row-value.font-bold {\n        font-weight: 700 !important;\n        color: #1E293B !important;\n    }\n\n    .elysium-master-row-value.highlight-pink,\n    .highlight-pink {\n        color: #E40B5C !important;\n        font-weight: 700 !important;\n    }\n\n    .elysium-master-row-value.highlight-navy {\n        color: #050058 !important;\n        font-size: 16px !important;\n        font-weight: 700 !important;\n    }\n\n    \/* Accordion Table styling *\/\n    .elysium-master-accordion {\n        border-top: 1px solid #E2E8F0 !important;\n    }\n\n    .elysium-master-accordion-btn {\n        width: 100% !important;\n        padding: 16px 24px !important;\n        background-color: #F1F5F9 !important;\n        border: none !important;\n        display: flex !important;\n        justify-content: space-between !important;\n        align-items: center !important;\n        font-size: 12px !important;\n        font-weight: 700 !important;\n        text-transform: uppercase !important;\n        letter-spacing: 1px !important;\n        color: #050058 !important;\n        cursor: pointer !important;\n        outline: none !important;\n        margin: 0 !important;\n    }\n\n    .elysium-master-accordion-btn:hover {\n        background-color: #E2E8F0 !important;\n    }\n\n    .elysium-master-schedule-container {\n        display: none;\n        padding: 20px;\n        overflow-y: auto !important;\n        overflow-x: hidden !important;\n        border-top: 1px solid #E2E8F0 !important;\n        background-color: #FFFFFF !important;\n    }\n\n    .elysium-master-table {\n        width: 100% !important;\n        border-collapse: collapse !important;\n        text-align: left !important;\n        font-size: 13px !important;\n        margin: 0 !important;\n        table-layout: fixed !important;\n    }\n\n    .elysium-master-table th {\n        background-color: #F8FAFC !important;\n        color: #475569 !important;\n        font-weight: 600 !important;\n        padding: 14px 24px !important;\n        border-bottom: 1px solid #E2E8F0 !important;\n    }\n\n    .elysium-master-table td {\n        padding: 12px 24px !important;\n        border-bottom: 1px solid #F1F5F9 !important;\n        color: #475569 !important;\n        background-color: #FFFFFF !important;\n    }\n\n    .hide {\n        display: none !important;\n    }\n\n<\/style>\n\n<div class=\"elysium-master-container\">\n    \n    <div class=\"elysium-master-header\">\n        <h2 class=\"elysium-master-title\">The Elysium Funeral Plan Payment Calculator (Applicant 1)<\/h2>\n        <p class=\"elysium-master-subtitle\">Select your plan and customise it to suit your budget.<\/p>\n    <\/div>\n\n    <div class=\"elysium-master-grid\">\n        <div class=\"elysium-master-inputs\">\n            <!-- Plan Selector -->\n            <div class=\"elysium-master-group\">\n                <label for=\"elysium1-planSelect\" class=\"elysium-master-label\">Select Funeral Plan<\/label>\n                <div class=\"elysium-dropdown-wrapper\">\n                    <select id=\"elysium1-planSelect\" class=\"elysium-master-select\" onchange=\"handlePlanChange1()\">\n                        <option value=\"\" disabled selected>Please select a plan...<\/option>\n                        <option value=\"assist\">The Elysium Assist Plan (\u20ac1,800.00)<\/option>\n                        <option value=\"clarity\">The Clarity Plan (From \u20ac2,200.00)<\/option>\n                        <option value=\"tranquility\">The Tranquility Plan (\u20ac2,950.00)<\/option>\n                        <option value=\"serenity\">The Serenity Plan (\u20ac3,350.00)<\/option>\n                        <option value=\"unity\">The Unity Repatriation Plan (\u20ac7,800.00)<\/option>\n                        <option value=\"nonresident\">The Elysium Non-Resident Plan (\u20ac500.00 Deposit)<\/option>\n                    <\/select>\n                <\/div>\n            <\/div>\n\n            <!-- Funeral \/ Service Type Selector (Burial \/ Cremation \/ Repatriation) -->\n            <div id=\"elysium1-service-group\" class=\"elysium-master-group\" style=\"display: none;\">\n                <label class=\"elysium-master-label\">Funeral Type<\/label>\n                <div class=\"elysium-location-toggle\">\n                    <button type=\"button\" id=\"elysium1-btn-cremation\" class=\"elysium-toggle-btn active\" onclick=\"setElysiumServiceType1('Cremation')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Cremation<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium1-btn-burial\" class=\"elysium-toggle-btn\" onclick=\"setElysiumServiceType1('Burial')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Burial<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium1-btn-repatriation\" class=\"elysium-toggle-btn hide\" onclick=\"setElysiumServiceType1('Repatriation')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Repatriation<\/span>\n                    <\/button>\n                <\/div>\n            <\/div>\n\n            <!-- Location Selector -->\n            <div id=\"elysium1-location-group\" class=\"elysium-master-group\" style=\"display: none;\">\n                <label class=\"elysium-master-label\">Select Your Location<\/label>\n                <div class=\"elysium-location-toggle\">\n                    <button type=\"button\" id=\"elysium1-btn-mainland\" class=\"elysium-toggle-btn active\" onclick=\"setElysiumLocation1('mainland')\">\n                        <span class=\"elysium-toggle-lbl\">Mainland Spain<\/span>\n                        <span class=\"elysium-toggle-price\">\u20ac2,200.00<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium1-btn-islands\" class=\"elysium-toggle-btn\" onclick=\"setElysiumLocation1('islands')\">\n                        <span class=\"elysium-toggle-lbl\">Canary & Balearic Islands<\/span>\n                        <span class=\"elysium-toggle-price\">\u20ac2,400.00<\/span>\n                    <\/button>\n                <\/div>\n            <\/div>\n\n            <div id=\"elysium1-assist-advisory\" class=\"elysium-advisory-card hide\">\n                <div class=\"elysium-advisory-header\">Important Plan Notice<\/div>\n                <p class=\"elysium-advisory-text\">The Elysium Assist Plan is available exclusively to clients <b>over 75 years of age<\/b> and is payable <b>in full<\/b> (Cremation only).<\/p>\n            <\/div>\n\n            <div id=\"elysium1-nonresident-advisory\" class=\"elysium-advisory-card hide\">\n                <div class=\"elysium-advisory-header\">Non-Resident Plan Notice<\/div>\n                <p class=\"elysium-advisory-text\">\n                    Secure today\u2019s agreed price with a <b>\u20ac500.00 deposit today<\/b>. The remaining balance of your chosen plan is payable on <b>Enactment of the Plan<\/b>.\n                <\/p>\n                <p class=\"elysium-advisory-alternative\">\n                    This plan is country-specific and provides funeral arrangements exclusively in the country where the plan is held.\n                <\/p>\n            <\/div>\n\n            <div id=\"elysium1-interactive-sliders\" style=\"display: none;\">\n                <!-- Slider: Deposit -->\n                <div class=\"elysium-master-group\">\n                    <div class=\"elysium-master-label-row\">\n                        <label for=\"elysium1-deposit\" class=\"elysium-master-label\">Deposit (\u20ac)<\/label>\n                        <span id=\"elysium1-depositVal\" class=\"elysium-master-value-highlight\">\u20ac500.00<\/span>\n                    <\/div>\n                    <input type=\"range\" id=\"elysium1-deposit\" min=\"500\" max=\"1000\" step=\"50\" value=\"500\" class=\"elysium-master-slider\">\n                <\/div>\n\n                <!-- Slider: Term -->\n                <div class=\"elysium-master-group\">\n                    <div class=\"elysium-master-label-row\">\n                        <label for=\"elysium1-term\" class=\"elysium-master-label\">Term (Months)<\/label>\n                        <span id=\"elysium1-termVal\" class=\"elysium-master-value-highlight\">12 months<\/span>\n                    <\/div>\n                    <input type=\"range\" id=\"elysium1-term\" min=\"12\" max=\"120\" step=\"1\" value=\"12\" class=\"elysium-master-slider\">\n                <\/div>\n            <\/div>\n        <\/div>\n\n        <!-- Summary -->\n        <div class=\"elysium-master-summary\">\n            <div>\n                <h3 class=\"elysium-master-summary-title\">Payment Summary<\/h3>\n                <div class=\"elysium-master-row\">\n                    <span class=\"elysium-master-row-label font-bold\" id=\"elysium1-label-planName\">Please select a plan...<\/span>\n                    <span id=\"elysium1-planTotalVal\" class=\"elysium-master-row-value font-bold\">\u20ac0.00<\/span>\n                <\/div>\n                <div class=\"elysium-master-row\" id=\"elysium1-row-serviceType\" style=\"display: none;\">\n                    <span>Funeral Service<\/span>\n                    <span id=\"elysium1-selectedServiceDisplay\" class=\"font-bold\" style=\"color: #050058;\">Cremation<\/span>\n                <\/div>\n                <div id=\"elysium1-breakdown-rows\" style=\"display: none;\">\n                    <div class=\"elysium-master-row border-top\">\n                        <span>Balance<\/span>\n                        <span id=\"elysium1-amountFinanced\">\u20ac0.00<\/span>\n                    <\/div>\n                    <div class=\"elysium-master-row\">\n                        <span>Month 1 Payment<\/span>\n                        <span id=\"elysium1-month1Payment\" class=\"highlight-pink\">\u20ac0.00<\/span>\n                    <\/div>\n                    <div class=\"elysium-master-row\">\n                        <span>Months 2+ Payment<\/span>\n                        <span id=\"elysium1-months2PlusPayment\">\u20ac0.00<\/span>\n                    <\/div>\n                <\/div>\n\n                <!-- Custom Row for Non-Resident Balance -->\n                <div id=\"elysium1-enactment-row\" class=\"elysium-master-row border-top hide\">\n                    <span>Plan Balance<\/span>\n                    <span class=\"font-bold\" style=\"color: #050058;\">Payable on Enactment<\/span>\n                <\/div>\n\n                <div class=\"elysium-master-row border-top\">\n                    <span class=\"font-bold\" id=\"elysium1-totalPaidLabel\">Total Price (incl. Deposit)<\/span>\n                    <span id=\"elysium1-totalPaid\" class=\"highlight-navy\" style=\"font-size: 14px !important; font-weight: 700;\">\u20ac0.00<\/span>\n                <\/div>\n\n                <div id=\"elysium1-payment-selection-container\" style=\"display: none; margin-top: 20px; border-top: 1px dashed #cbd5e1; padding-top: 15px;\">\n                    <label style=\"font-weight:600; color:#050058; display:block; margin-bottom:8px;\">Select amount to pay today:<\/label>\n                    <div style=\"display: flex; flex-direction: column; gap: 8px;\">\n                        <label id=\"elysium1-option-deposit-label\" style=\"display:flex; align-items:center; gap:10px; background:#f8fafc; padding:10px; border-radius:6px; border:1px solid #e2e8f0; cursor:pointer;\">\n                            <input type=\"radio\" name=\"elysium1_payment_type\" value=\"deposit\" checked onchange=\"handlePaymentSelectionChange1()\">\n                            <span>Pay Deposit Only (<span id=\"elysium1-choice-deposit\">\u20ac0.00<\/span>)<\/span>\n                        <\/label>\n                        <label id=\"elysium1-option-full-label\" style=\"display:flex; align-items:center; gap:10px; background:#f8fafc; padding:10px; border-radius:6px; border:1px solid #e2e8f0; cursor:pointer;\">\n                            <input type=\"radio\" name=\"elysium1_payment_type\" value=\"full\" onchange=\"handlePaymentSelectionChange1()\">\n                            <span><span id=\"elysium1-choice-full-text\">Pay Total Price<\/span> (<span id=\"elysium1-choice-full\">\u20ac0.00<\/span>)<\/span>\n                        <\/label>\n                    <\/div>\n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n\n    <!-- Accordion Schedule -->\n    <div id=\"elysium1-accordion-wrapper\" class=\"elysium-master-accordion\" style=\"display: none;\">\n        <button type=\"button\" onclick=\"toggleElysiumSchedule1()\" class=\"elysium-master-accordion-btn\">\n            <span>View Full Payment Breakdown<\/span>\n        <\/button>\n        <div id=\"elysium1-scheduleContainer\" class=\"elysium-master-schedule-container\">\n            <table class=\"elysium-master-table\">\n                <thead>\n                    <tr><th>Installment<\/th><th>Payment Amount<\/th><th>Remaining Balance<\/th><\/tr>\n                <\/thead>\n                <tbody id=\"elysium1-scheduleBody\"><\/tbody>\n            <\/table>\n        <\/div>\n    <\/div>\n<\/div>\n\n<script>\n    (function() {\n        const planSelect = document.getElementById('elysium1-planSelect');\n        const depositSlider = document.getElementById('elysium1-deposit');\n        const termSlider = document.getElementById('elysium1-term');\n        if (!planSelect || !depositSlider || !termSlider) return;\n\n        const GF_FORM_ID = 4;\n        const GF_PRICE_FIELD_ID = 104; \n        const GF_PLAN_FIELD_ID = 110;  \n        const GF_PAYTYPE_FIELD_ID = 145;        \n        const GF_SERVICE_TYPE_FIELD_ID = 103;   \n        const GF_TERM_FIELD_ID = 114;   \n        const GF_BAL_FIELD_ID = 118;            \n        const GF_M1_FIELD_ID = 119;             \n        const GF_M2_FIELD_ID = 120;             \n\n        const plans = {\n            assist: { name: \"The Elysium Assist Plan\", price: 1800, hasInstallments: false, hasLocations: false, serviceTypeMode: \"cremation_only\" },\n            clarity: { name: \"The Clarity Plan\", price: 2200, hasInstallments: true, hasLocations: true, serviceTypeMode: \"choice\" },\n            tranquility: { name: \"The Tranquility Plan\", price: 2950, hasInstallments: true, hasLocations: false, serviceTypeMode: \"choice\" },\n            serenity: { name: \"The Serenity Plan\", price: 3350, hasInstallments: true, hasLocations: false, serviceTypeMode: \"choice\" },\n            unity: { name: \"The Unity Repatriation Plan\", price: 7800, hasInstallments: true, hasLocations: false, serviceTypeMode: \"repatriation_only\" },\n            nonresident: { name: \"The Elysium Non-Resident Plan\", price: 500, hasInstallments: false, hasLocations: false, serviceTypeMode: \"choice\" }\n        };\n\n        let selectedPlan = '';\n        let location = 'mainland';\n        let serviceType = 'Cremation';\n\n        function formatToEuro(n) {\n            return new Intl.NumberFormat('en-IE', { style: 'currency', currency: 'EUR' }).format(n);\n        }\n\n        function saveCalculatorState1() {\n            try {\n                \/\/ Do not save if plan is empty (prevents erasing data on reload)\n                if (!planSelect || !planSelect.value) return;\n\n                const checkedRadio = document.querySelector('input[name=\"elysium1_payment_type\"]:checked');\n                const state = {\n                    plan: planSelect.value,\n                    location: location,\n                    serviceType: serviceType,\n                    deposit: depositSlider.value,\n                    term: termSlider.value,\n                    paymentType: checkedRadio ? checkedRadio.value : 'deposit'\n                };\n                sessionStorage.setItem('elysium1_calc_state', JSON.stringify(state));\n            } catch (e) {\n                \/\/ Ignore storage restrictions\n            }\n        }\n\n        function loadCalculatorState1() {\n            try {\n                planSelect.setAttribute('autocomplete', 'off');\n                depositSlider.setAttribute('autocomplete', 'off');\n                termSlider.setAttribute('autocomplete', 'off');\n\n                \/\/ Check for validation error using multiple Gravity Forms indicators\n                const hasValidationError = !!(\n                    document.getElementById('gform_' + GF_FORM_ID + '_validation_container') ||\n                    document.querySelector('#gform_' + GF_FORM_ID + ' .gform_validation_errors') ||\n                    document.querySelector('#gform_' + GF_FORM_ID + ' .validation_error') ||\n                    document.querySelector('#gform_' + GF_FORM_ID + ' .gfield_error') ||\n                    document.querySelector('.gfield_error')\n                );\n                \n                if (!hasValidationError) {\n                    sessionStorage.removeItem('elysium1_calc_state');\n                    planSelect.value = \"\";\n                    depositSlider.value = \"500\";\n                    termSlider.value = \"12\";\n                    serviceType = 'Cremation';\n                    const depRadio = document.querySelector('input[name=\"elysium1_payment_type\"][value=\"deposit\"]');\n                    if (depRadio) depRadio.checked = true;\n                    selectedPlan = \"\";\n                    return;\n                }\n\n                const saved = sessionStorage.getItem('elysium1_calc_state');\n                if (saved) {\n                    const state = JSON.parse(saved);\n                    if (state.plan !== undefined && state.plan !== \"\") {\n                        planSelect.value = state.plan;\n                        selectedPlan = state.plan;\n                    }\n                    if (state.location !== undefined) {\n                        location = state.location;\n                        const btnMainland = document.getElementById('elysium1-btn-mainland');\n                        const btnIslands = document.getElementById('elysium1-btn-islands');\n                        if (btnMainland) btnMainland.classList.toggle('active', location === 'mainland');\n                        if (btnIslands) btnIslands.classList.toggle('active', location === 'islands');\n                    }\n                    if (state.serviceType !== undefined) {\n                        serviceType = state.serviceType;\n                    }\n                    if (state.deposit !== undefined) {\n                        depositSlider.value = state.deposit;\n                    }\n                    if (state.term !== undefined) {\n                        termSlider.value = state.term;\n                    }\n                    if (state.paymentType !== undefined) {\n                        const radio = document.querySelector(`input[name=\"elysium1_payment_type\"][value=\"${state.paymentType}\"]`);\n                        if (radio) radio.checked = true;\n                    }\n                }\n            } catch (e) {\n                \/\/ Ignore storage restrictions\n            }\n        }\n\n        window.setElysiumLocation1 = function(loc) {\n            location = loc;\n            const btnMainland = document.getElementById('elysium1-btn-mainland');\n            const btnIslands = document.getElementById('elysium1-btn-islands');\n            if (btnMainland) btnMainland.classList.toggle('active', loc === 'mainland');\n            if (btnIslands) btnIslands.classList.toggle('active', loc === 'islands');\n            runCalculations1();\n        };\n\n        window.setElysiumServiceType1 = function(type) {\n            serviceType = type;\n            updateServiceButtonsUI();\n            runCalculations1();\n        };\n\n        function updateServiceButtonsUI() {\n            const btnCremation = document.getElementById('elysium1-btn-cremation');\n            const btnBurial = document.getElementById('elysium1-btn-burial');\n            const btnRepat = document.getElementById('elysium1-btn-repatriation');\n            const serviceDisplay = document.getElementById('elysium1-selectedServiceDisplay');\n\n            if (btnCremation) btnCremation.classList.toggle('active', serviceType === 'Cremation');\n            if (btnBurial) btnBurial.classList.toggle('active', serviceType === 'Burial');\n            if (btnRepat) btnRepat.classList.toggle('active', serviceType === 'Repatriation');\n            if (serviceDisplay) serviceDisplay.textContent = serviceType;\n        }\n\n        window.handlePlanChange1 = function() {\n            selectedPlan = planSelect.value;\n            const config = plans[selectedPlan];\n            const planLabel = document.getElementById('elysium1-label-planName');\n\n            const serviceGroup = document.getElementById('elysium1-service-group');\n            const btnCremation = document.getElementById('elysium1-btn-cremation');\n            const btnBurial = document.getElementById('elysium1-btn-burial');\n            const btnRepat = document.getElementById('elysium1-btn-repatriation');\n            const serviceRow = document.getElementById('elysium1-row-serviceType');\n\n            const locGroup = document.getElementById('elysium1-location-group');\n            const assistAdv = document.getElementById('elysium1-assist-advisory');\n            const nonresidentAdv = document.getElementById('elysium1-nonresident-advisory');\n            const sliders = document.getElementById('elysium1-interactive-sliders');\n            const breakdown = document.getElementById('elysium1-breakdown-rows');\n            const enactmentRow = document.getElementById('elysium1-enactment-row');\n            const accordion = document.getElementById('elysium1-accordion-wrapper');\n            const depLabel = document.getElementById('elysium1-option-deposit-label');\n            const fullLabel = document.getElementById('elysium1-option-full-label');\n            const paySelectionContainer = document.getElementById('elysium1-payment-selection-container');\n\n            if (!config) {\n                if (planLabel) planLabel.textContent = \"Please select a plan...\";\n                if (serviceGroup) serviceGroup.style.setProperty('display', 'none', 'important');\n                if (serviceRow) serviceRow.style.setProperty('display', 'none', 'important');\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'none', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                \n                const planTotalVal = document.getElementById('elysium1-planTotalVal');\n                const totalPaid = document.getElementById('elysium1-totalPaid');\n                if (planTotalVal) planTotalVal.textContent = \"\u20ac0.00\";\n                if (totalPaid) totalPaid.textContent = \"\u20ac0.00\";\n\n                if (window.jQuery) {\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_PRICE_FIELD_ID}`).val(\"0\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_PLAN_FIELD_ID}`).val(\"\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_PAYTYPE_FIELD_ID}`).val(\"\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_SERVICE_TYPE_FIELD_ID}`).val(\"\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_TERM_FIELD_ID}`).val(\"0\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_BAL_FIELD_ID}`).val(\"0\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_M1_FIELD_ID}`).val(\"0\").trigger('change');\n                    window.jQuery(`#input_${GF_FORM_ID}_${GF_M2_FIELD_ID}`).val(\"0\").trigger('change');\n                    \n                    var el = document.getElementById(`input_${GF_FORM_ID}_${GF_PLAN_FIELD_ID}`);\n                    if(el) el.dispatchEvent(new Event('change', { bubbles: true }));\n                }\n                \/\/ DO NOT save state when config is empty so saved session data is not destroyed\n                return;\n            }\n\n            if (planLabel) planLabel.textContent = config.name;\n\n            if (serviceGroup) serviceGroup.style.setProperty('display', 'block', 'important');\n            if (serviceRow) serviceRow.style.setProperty('display', 'flex', 'important');\n\n            if (config.serviceTypeMode === 'cremation_only') {\n                serviceType = 'Cremation';\n                if (btnCremation) btnCremation.classList.remove('hide');\n                if (btnBurial) btnBurial.classList.add('hide');\n                if (btnRepat) btnRepat.classList.add('hide');\n            } else if (config.serviceTypeMode === 'repatriation_only') {\n                serviceType = 'Repatriation';\n                if (btnCremation) btnCremation.classList.add('hide');\n                if (btnBurial) btnBurial.classList.add('hide');\n                if (btnRepat) btnRepat.classList.remove('hide');\n            } else {\n                if (serviceType === 'Repatriation') serviceType = 'Cremation';\n                if (btnCremation) btnCremation.classList.remove('hide');\n                if (btnBurial) btnBurial.classList.remove('hide');\n                if (btnRepat) btnRepat.classList.add('hide');\n            }\n            updateServiceButtonsUI();\n\n            if (selectedPlan === 'assist') {\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.remove('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                const fullRadio = document.querySelector('input[name=\"elysium1_payment_type\"][value=\"full\"]');\n                if (fullRadio) fullRadio.checked = true;\n            } else if (selectedPlan === 'nonresident') {\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.remove('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.remove('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                const depRadio = document.querySelector('input[name=\"elysium1_payment_type\"][value=\"deposit\"]');\n                if (depRadio) depRadio.checked = true;\n            } else {\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'block', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'block', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'block', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'flex', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'block', 'important');\n                if (locGroup) locGroup.style.setProperty('display', config.hasLocations ? 'block' : 'none', 'important');\n            }\n            runCalculations1();\n        };\n\n        window.handlePaymentSelectionChange1 = function() {\n            runCalculations1();\n        };\n\n        function runCalculations1() {\n            const config = plans[selectedPlan];\n            if (!config) return;\n\n            let price = config.price;\n            if (selectedPlan === 'clarity') {\n                price = (location === 'mainland') ? 2200 : 2400;\n            }\n\n            const totalVal = document.getElementById('elysium1-planTotalVal');\n            if (totalVal) totalVal.textContent = formatToEuro(price);\n\n            const totalPaidLabel = document.getElementById('elysium1-totalPaidLabel');\n            const totalPaid = document.getElementById('elysium1-totalPaid');\n            const choiceText = document.getElementById('elysium1-choice-full-text');\n            const choiceFull = document.getElementById('elysium1-choice-full');\n\n            if (selectedPlan === 'nonresident') {\n                if (totalPaidLabel) totalPaidLabel.textContent = \"Deposit Payable Today\";\n                if (totalPaid) totalPaid.textContent = formatToEuro(price);\n                if (choiceText) choiceText.textContent = \"Pay Deposit Today\";\n                if (choiceFull) choiceFull.textContent = formatToEuro(price);\n                sendDataToGF1(0, 0, 0);\n                saveCalculatorState1();\n                return;\n            }\n\n            if (!config.hasInstallments) {\n                if (totalPaidLabel) totalPaidLabel.textContent = \"Total Price (Single Payment)\";\n                if (totalPaid) totalPaid.textContent = formatToEuro(price);\n                if (choiceText) choiceText.textContent = \"Pay Full Price Payment\";\n                if (choiceFull) choiceFull.textContent = formatToEuro(price);\n                sendDataToGF1(0, 0, 0);\n                saveCalculatorState1();\n                return;\n            }\n\n            if (totalPaidLabel) totalPaidLabel.textContent = \"Total Price (incl. Deposit)\";\n            if (choiceText) choiceText.textContent = \"Pay Total Price\";\n\n            const dep = parseFloat(depositSlider.value);\n            const term = parseInt(termSlider.value);\n\n            const depVal = document.getElementById('elysium1-depositVal');\n            const termVal = document.getElementById('elysium1-termVal');\n            if (depVal) depVal.textContent = formatToEuro(dep);\n            if (termVal) termVal.textContent = term + ' months';\n\n            const financed = Math.max(price - dep, 0);\n            let m1 = 0, m2 = 0;\n            if (term === 1) { m1 = financed; } \n            else {\n                m2 = Math.floor((financed \/ term) * 100) \/ 100;\n                m1 = financed - (m2 * (term - 1));\n            }\n\n            const finVal = document.getElementById('elysium1-amountFinanced');\n            const m1Val = document.getElementById('elysium1-month1Payment');\n            const m2Val = document.getElementById('elysium1-months2PlusPayment');\n            const choiceDep = document.getElementById('elysium1-choice-deposit');\n\n            if (finVal) finVal.textContent = formatToEuro(financed);\n            if (m1Val) m1Val.textContent = formatToEuro(m1);\n            if (m2Val) m2Val.textContent = formatToEuro(m2);\n            if (totalPaid) totalPaid.textContent = formatToEuro(dep + financed);\n\n            if (choiceDep) choiceDep.textContent = formatToEuro(dep);\n            if (choiceFull) choiceFull.textContent = formatToEuro(dep + financed);\n\n            renderSchedule1(financed, term, m1, m2);\n            sendDataToGF1(financed, m1, m2);\n            saveCalculatorState1();\n        }\n\n        function renderSchedule1(financed, term, m1, m2) {\n            let html = '';\n            let out = financed;\n            for (let i = 1; i <= term; i++) {\n                let pay = (i === 1) ? m1 : m2;\n                out = Math.max(out - pay, 0);\n                html += `<tr><td>Month ${i}<\/td><td>${formatToEuro(pay)}<\/td><td>${formatToEuro(out)}<\/td><\/tr>`;\n            }\n            const body = document.getElementById('elysium1-scheduleBody');\n            if (body) body.innerHTML = html;\n        }\n\n        function sendDataToGF1(balance, m1, m2) {\n            const config = plans[selectedPlan];\n            let price = config.price;\n            if (selectedPlan === 'clarity') {\n                price = (location === 'mainland') ? 2200 : 2400;\n            }\n            \n            const dep = config.hasInstallments ? parseFloat(depositSlider.value) : price;\n            const checkedRadio = document.querySelector('input[name=\"elysium1_payment_type\"]:checked');\n            const choice = checkedRadio ? checkedRadio.value : 'deposit';\n            \n            let amt = (selectedPlan === 'assist' || choice === 'full') ? price : dep;\n            \n            let paymentDropdownValue = \"Deposit Only\";\n            if (selectedPlan === 'assist') {\n                paymentDropdownValue = \"Single Payment\";\n            } else if (choice === 'full') {\n                paymentDropdownValue = \"Full Price Payment\";\n            }\n\n            const plainIntegerPrice = Math.round(amt).toString();\n            const plainIntegerTerm = config.hasInstallments ? termSlider.value.toString() : \"0\";\n\n            const isComma = (window.gf_global && window.gf_global.number_format === 'decimal_comma') || true;\n            const formattedBal = isComma ? balance.toFixed(2).replace('.', ',') : balance.toFixed(2);\n            const formattedM1 = isComma ? m1.toFixed(2).replace('.', ',') : m1.toFixed(2);\n            const formattedM2 = isComma ? m2.toFixed(2).replace('.', ',') : m2.toFixed(2);\n\n            if (window.jQuery) {\n                \/\/ Price\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PRICE_FIELD_ID}`).val(plainIntegerPrice).trigger('change');\n                \/\/ Plan Name\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PLAN_FIELD_ID}`).val(config.name).trigger('change');\n                \/\/ Dropdown Payment Selection -> ID 145\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PAYTYPE_FIELD_ID}`).val(paymentDropdownValue).trigger('change');\n                \/\/ Funeral Service Type (Burial \/ Cremation \/ Repatriation) -> ID 103\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_SERVICE_TYPE_FIELD_ID}`).val(serviceType).trigger('change');\n                \/\/ Term & Balance fields\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_TERM_FIELD_ID}`).val(plainIntegerTerm).trigger('change');\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_BAL_FIELD_ID}`).val(formattedBal).trigger('change');\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_M1_FIELD_ID}`).val(formattedM1).trigger('change');\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_M2_FIELD_ID}`).val(formattedM2).trigger('change');\n\n                \/\/ Firefox Fix\n                var el = document.getElementById(`input_${GF_FORM_ID}_${GF_PLAN_FIELD_ID}`);\n                if(el) el.dispatchEvent(new Event('change', { bubbles: true }));\n            }\n        }\n\n        window.toggleElysiumSchedule1 = function() {\n            const container = document.getElementById('elysium1-scheduleContainer');\n            if (container) {\n                const isHidden = window.getComputedStyle(container).display === 'none';\n                container.style.setProperty('display', isHidden ? 'block' : 'none', 'important');\n            }\n        };\n\n        depositSlider.addEventListener('input', runCalculations1);\n        termSlider.addEventListener('input', runCalculations1);\n        \n        function triggerInitialUpdate1() {\n            loadCalculatorState1(); \n            handlePlanChange1();\n            setTimeout(handlePlanChange1, 300);\n            setTimeout(handlePlanChange1, 800);\n        }\n\n        if (document.readyState === 'loading') {\n            document.addEventListener('DOMContentLoaded', triggerInitialUpdate1);\n        } else {\n            triggerInitialUpdate1();\n        }\n\n        window.addEventListener('load', triggerInitialUpdate1);\n\n        if (typeof window.jQuery !== 'undefined') {\n            window.jQuery(document).on('gform_post_render', function(event, formId) {\n                if (formId == GF_FORM_ID) {\n                    loadCalculatorState1();\n                    handlePlanChange1();\n                }\n            });\n            window.jQuery(document).on('gform_confirmation_loaded', function(event, formId) {\n                if (formId == GF_FORM_ID) {\n                    sessionStorage.removeItem('elysium1_calc_state');\n                }\n            });\n        }\n    })();\n<\/script><\/div><div id=\"field_4_190\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_190'><span class='gform-field-label__text'>Select preferred monthly payment date:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_190' id='input_4_190' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1st of the month' >1st of the month<\/option><option value='8th of the month' >8th of the month<\/option><option value='15th of the month' >15th of the month<\/option><option value='22nd of the month' >22nd of the month<\/option><\/select><\/div><\/div><div id=\"field_4_101\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_4_101 gfield_product_4_101 gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_4_101_1'><span class='gform-field-label__text'>Plan Purchased - Applicant 1<\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_101.1' value='Plan Purchased - Applicant 1' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_4_101' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Pris:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_4_101'>0,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_101.2' id='ginput_base_price_4_101' class='gform_hidden ginput_calculated_price' value='0,00 \u20ac'\/>\n\t\t\t\t\t<input type='hidden' name='input_101.3' value='1' class='ginput_quantity_4_101 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_4_110\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_110'><span class='gform-field-label__text'>Selected Plan Name APP 1<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_4_110' class='large gfield_select'     aria-invalid=\"false\" ><option value='The Elysium Assist Plan' >The Elysium Assist Plan<\/option><option value='The Clarity Plan' >The Clarity Plan<\/option><option value='The Tranquility Plan' >The Tranquility Plan<\/option><option value='The Serenity Plan' >The Serenity Plan<\/option><option value='The Unity Repatriation Plan' >The Unity Repatriation Plan<\/option><option value='The Elysium Non-Resident Plan' >The Elysium Non-Resident Plan<\/option><\/select><\/div><\/div><div id=\"field_4_103\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_103'><span class='gform-field-label__text'>Funeral Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_4_103' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_114\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_114'><span class='gform-field-label__text'>Term (Months)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_4_114' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_104\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_104'><span class='gform-field-label__text'>Want to pay  Applicant 1<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_104' id='input_4_104' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_145\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_145'><span class='gform-field-label__text'>Payment Selection<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_145' id='input_4_145' class='large gfield_select'     aria-invalid=\"false\" ><option value='Deposit Only' >Deposit Only<\/option><option value='Full Price Payment' >Full Price Payment<\/option><option value='Single Payment' >Single Payment<\/option><\/select><\/div><\/div><div id=\"field_4_118\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_118'><span class='gform-field-label__text'>Balance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_4_118' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_119\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_119'><span class='gform-field-label__text'>Month 1 Payment<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_4_119' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_120\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_120'><span class='gform-field-label__text'>Months 2+ Payment<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_120' id='input_4_120' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_90\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"margin-top:20px; font-size:12px;\"><em>The specific features of the plan are set out in Clause 8 of this contract.<\/em><\/p>\n\n\n\n<style>\n#field_4_190,\n#field_4_191 {\n    position: relative;\n    margin: 18px 0 24px !important;\n    padding: 18px 18px 20px !important;\n    background: #f7f9fc !important;\n    border: 1px solid #dce3ed !important;\n    border-radius: 10px !important;\n    box-shadow: 0 4px 14px rgba(8, 0, 95, 0.04) !important;\n    transition: all 0.25s ease;\n}\n\n#field_4_190:hover,\n#field_4_191:hover {\n    border-color: #c9d2df !important;\n    box-shadow: 0 6px 18px rgba(8, 0, 95, 0.07) !important;\n}\n\n#field_4_190 .gfield_label,\n#field_4_191 .gfield_label {\n    display: flex !important;\n    align-items: center;\n    gap: 8px;\n    margin: 0 0 10px !important;\n    padding: 0 !important;\n    color: #08005f !important;\n    font-family: inherit !important;\n    font-size: 13px !important;\n    font-weight: 700 !important;\n    line-height: 1.4 !important;\n    letter-spacing: 0.1px !important;\n}\n\n#field_4_190 .gfield_required,\n#field_4_191 .gfield_required {\n    margin-left: 3px !important;\n    color: #ed0b68 !important;\n    font-size: 11px !important;\n    font-weight: 700 !important;\n}\n\n#field_4_190 .ginput_container_select,\n#field_4_191 .ginput_container_select {\n    position: relative;\n}\n\n#field_4_190 select,\n#field_4_191 select {\n    width: 100% !important;\n    height: 48px !important;\n    min-height: 48px !important;\n    padding: 0 16px !important;\n    background-color: #ffffff !important;\n    border: 1px solid #cbd5e1 !important;\n    border-radius: 8px !important;\n    color: #08005f !important;\n    font-family: inherit !important;\n    font-size: 15px !important;\n    font-weight: 500 !important;\n    outline: none !important;\n    cursor: pointer;\n    transition:\n        border-color 0.25s ease,\n        box-shadow 0.25s ease,\n        background-color 0.25s ease;\n}\n\n#field_4_190 select:focus,\n#field_4_191 select:focus {\n    border-color: #08005f !important;\n    box-shadow:\n        0 0 0 3px rgba(8, 0, 95, 0.10),\n        0 4px 10px rgba(8, 0, 95, 0.05) !important;\n    background-color: #ffffff !important;\n}\n\n#field_4_190 select:hover,\n#field_4_191 select:hover {\n    border-color: #08005f !important;\n}\n\n#field_4_190 select option,\n#field_4_191 select option {\n    color: #08005f !important;\n    background: #ffffff !important;\n    font-size: 15px !important;\n}\n\n#field_4_190.gfield_error,\n#field_4_191.gfield_error {\n    background: #fff7fa !important;\n    border-color: #ed0b68 !important;\n}\n\n#field_4_190.gfield_error select,\n#field_4_191.gfield_error select {\n    border-color: #ed0b68 !important;\n}\n\n#field_4_190.gfield_error .gfield_label,\n#field_4_191.gfield_error .gfield_label {\n    color: #08005f !important;\n}\n\n@media (max-width: 767px) {\n    #field_4_190,\n    #field_4_191 {\n        margin: 15px 0 20px !important;\n        padding: 15px !important;\n        border-radius: 9px !important;\n    }\n\n    #field_4_190 .gfield_label,\n    #field_4_191 .gfield_label {\n        font-size: 12px !important;\n        margin-bottom: 9px !important;\n    }\n\n    #field_4_190 select,\n    #field_4_191 select {\n        height: 46px !important;\n        min-height: 46px !important;\n        padding: 0 14px !important;\n        font-size: 14px !important;\n    }\n}\n<\/style><\/div><div id=\"field_4_149\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Beneficiaries - Applicant 1<\/h3><\/div><div id=\"field_4_150\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p> Under the 10-Year & 14-Year Legacy-Refund Commitments, the Plan Fee will be refunded to the Plan Holder\u2019s nominated Beneficiary\/ies, subject to the terms of the Plan. <br>\n\nPayment will be released upon presentation of the original Funeral Plan Certificate and, where a nominated Beneficiary is under 18 years of age, once that Beneficiary has reached the age of 18.\n<\/p><\/div><fieldset id=\"field_4_151\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_151'>\n                            <span id='input_4_151_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_151.2' id='input_4_151_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_151_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_151_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.3' id='input_4_151_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_151_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_151_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.4' id='input_4_151_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_151_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_151_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.6' id='input_4_151_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_151_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_152\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_152' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_152_1_container' >\n                                        <input type='text' name='input_152.1' id='input_4_152_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_152_1' id='input_4_152_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_152_2_container' >\n                                        <input type='text' name='input_152.2' id='input_4_152_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_152_2' id='input_4_152_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_152_3_container' >\n                                    <input type='text' name='input_152.3' id='input_4_152_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_152_3' id='input_4_152_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_152.4' id='input_4_152_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_152_5_container' >\n                                    <input type='text' name='input_152.5' id='input_4_152_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_152_5' id='input_4_152_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_152_6_container' >\n                                        <select name='input_152.6' id='input_4_152_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_152_6' id='input_4_152_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_155\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_155'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_155' id='input_4_155' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_153\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_153'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_153'\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_153'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_153' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_153' 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_4_153' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_156\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_156'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_156' id='input_4_156' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_157\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_157'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_4_157' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_157\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_157'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_4_158\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_158'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_158' id='input_4_158' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_159\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is there a second beneficiary?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_159'>\n\t\t\t<div class='gchoice gchoice_4_159_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_159' type='radio' value='Yes'  id='choice_4_159_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_159_0' id='label_4_159_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_159_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_159' type='radio' value='No'  id='choice_4_159_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_159_1' id='label_4_159_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_160\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">2nd Beneficiary Details  - Applicant 1<\/h3><\/div><fieldset id=\"field_4_161\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_161'>\n                            <span id='input_4_161_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_161.2' id='input_4_161_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_161_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_161_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_161.3' id='input_4_161_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_161_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_161_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_161.4' id='input_4_161_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_161_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_161_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_161.6' id='input_4_161_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_161_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_162\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_162' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_162_1_container' >\n                                        <input type='text' name='input_162.1' id='input_4_162_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_162_1' id='input_4_162_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_162_2_container' >\n                                        <input type='text' name='input_162.2' id='input_4_162_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_162_2' id='input_4_162_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_162_3_container' >\n                                    <input type='text' name='input_162.3' id='input_4_162_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_162_3' id='input_4_162_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_162.4' id='input_4_162_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_162_5_container' >\n                                    <input type='text' name='input_162.5' id='input_4_162_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_162_5' id='input_4_162_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_162_6_container' >\n                                        <select name='input_162.6' id='input_4_162_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_162_6' id='input_4_162_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_163\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_163'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_163' id='input_4_163' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_164\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_164'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_164'\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_164'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_164' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_164' 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_4_164' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_165\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_165'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_165' id='input_4_165' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_166\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_166'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_4_166' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_166\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_166'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_4_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_167'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_4_167' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Plan Purchased - Applicant 2<\/h3><\/div><div id=\"field_4_105\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"elysium-master-container\">\n    \n    <div class=\"elysium-master-header\">\n        <h2 class=\"elysium-master-title\">The Elysium Funeral Plan Payment Calculator (Applicant 2)<\/h2>\n        <p class=\"elysium-master-subtitle\">Select your plan and customise it to suit your budget.<\/p>\n    <\/div>\n\n    <div class=\"elysium-master-grid\">\n        <div class=\"elysium-master-inputs\">\n            <!-- Plan Selector -->\n            <div class=\"elysium-master-group\">\n                <label for=\"elysium2-planSelect\" class=\"elysium-master-label\">Select Funeral Plan<\/label>\n                <div class=\"elysium-dropdown-wrapper\">\n                    <select id=\"elysium2-planSelect\" class=\"elysium-master-select\" onchange=\"handlePlanChange2()\">\n                        <option value=\"\" disabled selected>Please select a plan...<\/option>\n                        <option value=\"assist\">The Elysium Assist Plan (\u20ac1,800.00)<\/option>\n                        <option value=\"clarity\">The Clarity Plan (From \u20ac2,200.00)<\/option>\n                        <option value=\"tranquility\">The Tranquility Plan (\u20ac2,950.00)<\/option>\n                        <option value=\"serenity\">The Serenity Plan (\u20ac3,350.00)<\/option>\n                        <option value=\"unity\">The Unity Repatriation Plan (\u20ac7,800.00)<\/option>\n                        <option value=\"nonresident\">The Elysium Non-Resident Plan (\u20ac500.00 Deposit)<\/option>\n                    <\/select>\n                <\/div>\n            <\/div>\n\n            <!-- Funeral \/ Service Type Selector (Burial \/ Cremation \/ Repatriation) -->\n            <div id=\"elysium2-service-group\" class=\"elysium-master-group\" style=\"display: none;\">\n                <label class=\"elysium-master-label\">Funeral Type<\/label>\n                <div class=\"elysium-location-toggle\">\n                    <button type=\"button\" id=\"elysium2-btn-cremation\" class=\"elysium-toggle-btn active\" onclick=\"setElysiumServiceType2('Cremation')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Cremation<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium2-btn-burial\" class=\"elysium-toggle-btn\" onclick=\"setElysiumServiceType2('Burial')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Burial<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium2-btn-repatriation\" class=\"elysium-toggle-btn hide\" onclick=\"setElysiumServiceType2('Repatriation')\">\n                        <span class=\"elysium-toggle-lbl\">Funeral Service<\/span>\n                        <span class=\"elysium-toggle-price\" style=\"font-size: 14px;\">Repatriation<\/span>\n                    <\/button>\n                <\/div>\n            <\/div>\n\n            <!-- Location Selector -->\n            <div id=\"elysium2-location-group\" class=\"elysium-master-group\" style=\"display: none;\">\n                <label class=\"elysium-master-label\">Select Your Location<\/label>\n                <div class=\"elysium-location-toggle\">\n                    <button type=\"button\" id=\"elysium2-btn-mainland\" class=\"elysium-toggle-btn active\" onclick=\"setElysiumLocation2('mainland')\">\n                        <span class=\"elysium-toggle-lbl\">Mainland Spain<\/span>\n                        <span class=\"elysium-toggle-price\">\u20ac2,200.00<\/span>\n                    <\/button>\n                    <button type=\"button\" id=\"elysium2-btn-islands\" class=\"elysium-toggle-btn\" onclick=\"setElysiumLocation2('islands')\">\n                        <span class=\"elysium-toggle-lbl\">Canary & Balearic Islands<\/span>\n                        <span class=\"elysium-toggle-price\">\u20ac2,400.00<\/span>\n                    <\/button>\n                <\/div>\n            <\/div>\n\n            <div id=\"elysium2-assist-advisory\" class=\"elysium-advisory-card hide\">\n                <div class=\"elysium-advisory-header\">Important Plan Notice<\/div>\n                <p class=\"elysium-advisory-text\">The Elysium Assist Plan is available exclusively to clients <b>over 75 years of age<\/b> and is payable <b>in full<\/b> (Cremation only).<\/p>\n            <\/div>\n\n            <!-- Non-Resident Plan Advisory Alert (Visible only for Non-Resident Plan) -->\n            <div id=\"elysium2-nonresident-advisory\" class=\"elysium-advisory-card hide\">\n                <div class=\"elysium-advisory-header\">Non-Resident Plan Notice<\/div>\n                <p class=\"elysium-advisory-text\">\n                    Secure today\u2019s agreed price with a <b>\u20ac500.00 deposit today<\/b>. The remaining balance of your chosen plan is payable on <b>Enactment of the Plan<\/b>.\n                <\/p>\n                <p class=\"elysium-advisory-alternative\">\n                    This plan is country-specific and provides funeral arrangements exclusively in the country where the plan is held.\n                <\/p>\n            <\/div>\n\n            <div id=\"elysium2-interactive-sliders\" style=\"display: none;\">\n                <!-- Slider: Deposit -->\n                <div class=\"elysium-master-group\">\n                    <div class=\"elysium-master-label-row\">\n                        <label for=\"elysium2-deposit\" class=\"elysium-master-label\">Deposit (\u20ac)<\/label>\n                        <span id=\"elysium2-depositVal\" class=\"elysium-master-value-highlight\">\u20ac500.00<\/span>\n                    <\/div>\n                    <input type=\"range\" id=\"elysium2-deposit\" min=\"500\" max=\"1000\" step=\"50\" value=\"500\" class=\"elysium-master-slider\">\n                <\/div>\n\n                <!-- Slider: Term -->\n                <div class=\"elysium-master-group\">\n                    <div class=\"elysium-master-label-row\">\n                        <label for=\"elysium2-term\" class=\"elysium-master-label\">Term (Months)<\/label>\n                        <span id=\"elysium2-termVal\" class=\"elysium-master-value-highlight\">12 months<\/span>\n                    <\/div>\n                    <input type=\"range\" id=\"elysium2-term\" min=\"12\" max=\"120\" step=\"1\" value=\"12\" class=\"elysium-master-slider\">\n                <\/div>\n            <\/div>\n        <\/div>\n\n        <!-- Summary -->\n        <div class=\"elysium-master-summary\">\n            <div>\n                <h3 class=\"elysium-master-summary-title\">Payment Summary<\/h3>\n                <div class=\"elysium-master-row\">\n                    <span class=\"elysium-master-row-label font-bold\" id=\"elysium2-label-planName\">Please select a plan...<\/span>\n                    <span id=\"elysium2-planTotalVal\" class=\"elysium-master-row-value font-bold\">\u20ac0.00<\/span>\n                <\/div>\n                <div class=\"elysium-master-row\" id=\"elysium2-row-serviceType\" style=\"display: none;\">\n                    <span>Funeral Service<\/span>\n                    <span id=\"elysium2-selectedServiceDisplay\" class=\"font-bold\" style=\"color: #050058;\">Cremation<\/span>\n                <\/div>\n                <div id=\"elysium2-breakdown-rows\" style=\"display: none;\">\n                    <div class=\"elysium-master-row border-top\">\n                        <span>Balance<\/span>\n                        <span id=\"elysium2-amountFinanced\">\u20ac0.00<\/span>\n                    <\/div>\n                    <div class=\"elysium-master-row\">\n                        <span>Month 1 Payment<\/span>\n                        <span id=\"elysium2-month1Payment\" class=\"highlight-pink\">\u20ac0.00<\/span>\n                    <\/div>\n                    <div class=\"elysium-master-row\">\n                        <span>Months 2+ Payment<\/span>\n                        <span id=\"elysium2-months2PlusPayment\">\u20ac0.00<\/span>\n                    <\/div>\n                <\/div>\n\n                <!-- Custom Row for Non-Resident Balance -->\n                <div id=\"elysium2-enactment-row\" class=\"elysium-master-row border-top hide\">\n                    <span>Plan Balance<\/span>\n                    <span class=\"font-bold\" style=\"color: #050058;\">Payable on Enactment<\/span>\n                <\/div>\n\n                <div class=\"elysium-master-row border-top\">\n                    <span class=\"font-bold\" id=\"elysium2-totalPaidLabel\">Total Price (incl. Deposit)<\/span>\n                    <span id=\"elysium2-totalPaid\" class=\"highlight-navy\" style=\"font-size: 14px !important; font-weight: 700;\">\u20ac0.00<\/span>\n                <\/div>\n\n                <div id=\"elysium2-payment-selection-container\" style=\"display: none; margin-top: 20px; border-top: 1px dashed #cbd5e1; padding-top: 15px;\">\n                    <label style=\"font-weight:600; color:#050058; display:block; margin-bottom:8px;\">Select amount to pay today:<\/label>\n                    <div style=\"display: flex; flex-direction: column; gap: 8px;\">\n                        <label id=\"elysium2-option-deposit-label\" style=\"display:flex; align-items:center; gap:10px; background:#f8fafc; padding:10px; border-radius:6px; border:1px solid #e2e8f0; cursor:pointer;\">\n                            <input type=\"radio\" name=\"elysium2_payment_type\" value=\"deposit\" checked onchange=\"handlePaymentSelectionChange2()\">\n                            <span>Pay Deposit Only (<span id=\"elysium2-choice-deposit\">\u20ac0.00<\/span>)<\/span>\n                        <\/label>\n                        <label id=\"elysium2-option-full-label\" style=\"display:flex; align-items:center; gap:10px; background:#f8fafc; padding:10px; border-radius:6px; border:1px solid #e2e8f0; cursor:pointer;\">\n                            <input type=\"radio\" name=\"elysium2_payment_type\" value=\"full\" onchange=\"handlePaymentSelectionChange2()\">\n                            <span><span id=\"elysium2-choice-full-text\">Pay Total Price<\/span> (<span id=\"elysium2-choice-full\">\u20ac0.00<\/span>)<\/span>\n                        <\/label>\n                    <\/div>\n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n\n    <!-- Accordion Schedule -->\n    <div id=\"elysium2-accordion-wrapper\" class=\"elysium-master-accordion\" style=\"display: none;\">\n        <button type=\"button\" onclick=\"toggleElysiumSchedule2()\" class=\"elysium-master-accordion-btn\">\n            <span>View Full Payment Breakdown<\/span>\n        <\/button>\n        <div id=\"elysium2-scheduleContainer\" class=\"elysium-master-schedule-container\">\n            <table class=\"elysium-master-table\">\n                <thead>\n                    <tr><th>Installment<\/th><th>Payment Amount<\/th><th>Remaining Balance<\/th><\/tr>\n                <\/thead>\n                <tbody id=\"elysium2-scheduleBody\"><\/tbody>\n            <\/table>\n        <\/div>\n    <\/div>\n<\/div>\n\n<script>\n    (function() {\n        const planSelect = document.getElementById('elysium2-planSelect');\n        const depositSlider = document.getElementById('elysium2-deposit');\n        const termSlider = document.getElementById('elysium2-term');\n        if (!planSelect || !depositSlider || !termSlider) return;\n\n        const GF_FORM_ID = 4;\n        const GF_PRICE_FIELD_ID = 106; \n        const GF_PLAN_FIELD_ID = 111;  \n        const GF_PAYTYPE_FIELD_ID = 146;        \/\/ DropDown ID 146 (Deposit Only \/ Full Price Payment)\n        const GF_SERVICE_TYPE_FIELD_ID = 109;   \/\/ Field ID 109 (Cremation \/ Burial \/ Repatriation)\n        const GF_TERM_FIELD_ID = 115;   \n        const GF_BAL_FIELD_ID = 121;            \/\/ Balance: Field 121\n        const GF_M1_FIELD_ID = 122;             \/\/ Month 1: Field 122\n        const GF_M2_FIELD_ID = 123;             \/\/ Month 2: Field 123\n\n        const plans = {\n            assist: { name: \"The Elysium Assist Plan\", price: 1800, hasInstallments: false, hasLocations: false, serviceTypeMode: \"cremation_only\" },\n            clarity: { name: \"The Clarity Plan\", price: 2200, hasInstallments: true, hasLocations: true, serviceTypeMode: \"choice\" },\n            tranquility: { name: \"The Tranquility Plan\", price: 2950, hasInstallments: true, hasLocations: false, serviceTypeMode: \"choice\" },\n            serenity: { name: \"The Serenity Plan\", price: 3350, hasInstallments: true, hasLocations: false, serviceTypeMode: \"choice\" },\n            unity: { name: \"The Unity Repatriation Plan\", price: 7800, hasInstallments: true, hasLocations: false, serviceTypeMode: \"repatriation_only\" },\n            nonresident: { name: \"The Elysium Non-Resident Plan\", price: 500, hasInstallments: false, hasLocations: false, serviceTypeMode: \"choice\" }\n        };\n\n        let selectedPlan = '';\n        let location = 'mainland';\n        let serviceType = 'Cremation'; \/\/ Default\n\n        function formatToEuro(n) {\n            return new Intl.NumberFormat('en-IE', { style: 'currency', currency: 'EUR' }).format(n);\n        }\n\n        \/\/ Save state on any change\n        function saveCalculatorState2() {\n            try {\n                const checkedRadio = document.querySelector('input[name=\"elysium2_payment_type\"]:checked');\n                const state = {\n                    plan: planSelect.value,\n                    location: location,\n                    serviceType: serviceType,\n                    deposit: depositSlider.value,\n                    term: termSlider.value,\n                    paymentType: checkedRadio ? checkedRadio.value : 'deposit'\n                };\n                sessionStorage.setItem('elysium2_calc_state', JSON.stringify(state));\n            } catch (e) {\n                \/\/ Silently bypass storage restrictions\n            }\n        }\n\n        \/\/ Load state ONLY if Gravity Forms has an active validation error container on the page\n        function loadCalculatorState2() {\n            try {\n                planSelect.setAttribute('autocomplete', 'off');\n                depositSlider.setAttribute('autocomplete', 'off');\n                termSlider.setAttribute('autocomplete', 'off');\n\n                const hasValidationError = !!document.getElementById('gform_4_validation_container');\n                \n                if (!hasValidationError) {\n                    sessionStorage.removeItem('elysium2_calc_state');\n                    planSelect.value = \"\";\n                    depositSlider.value = \"500\";\n                    termSlider.value = \"12\";\n                    serviceType = 'Cremation';\n                    const depRadio = document.querySelector('input[name=\"elysium2_payment_type\"][value=\"deposit\"]');\n                    if (depRadio) depRadio.checked = true;\n                    selectedPlan = \"\";\n                    return;\n                }\n\n                const saved = sessionStorage.getItem('elysium2_calc_state');\n                if (saved) {\n                    const state = JSON.parse(saved);\n                    if (state.plan !== undefined) {\n                        planSelect.value = state.plan;\n                        selectedPlan = state.plan;\n                    }\n                    if (state.location !== undefined) {\n                        location = state.location;\n                        const btnMainland = document.getElementById('elysium2-btn-mainland');\n                        const btnIslands = document.getElementById('elysium2-btn-islands');\n                        if (btnMainland) btnMainland.classList.toggle('active', location === 'mainland');\n                        if (btnIslands) btnIslands.classList.toggle('active', location === 'islands');\n                    }\n                    if (state.serviceType !== undefined) {\n                        serviceType = state.serviceType;\n                    }\n                    if (state.deposit !== undefined) {\n                        depositSlider.value = state.deposit;\n                    }\n                    if (state.term !== undefined) {\n                        termSlider.value = state.term;\n                    }\n                    if (state.paymentType !== undefined) {\n                        const radio = document.querySelector(`input[name=\"elysium2_payment_type\"][value=\"${state.paymentType}\"]`);\n                        if (radio) radio.checked = true;\n                    }\n                }\n            } catch (e) {\n                \/\/ Silently bypass storage restrictions\n            }\n        }\n\n        window.setElysiumLocation2 = function(loc) {\n            location = loc;\n            const btnMainland = document.getElementById('elysium2-btn-mainland');\n            const btnIslands = document.getElementById('elysium2-btn-islands');\n            if (btnMainland) btnMainland.classList.toggle('active', loc === 'mainland');\n            if (btnIslands) btnIslands.classList.toggle('active', loc === 'islands');\n            runCalculations2();\n        };\n\n        window.setElysiumServiceType2 = function(type) {\n            serviceType = type;\n            updateServiceButtonsUI2();\n            runCalculations2();\n        };\n\n        function updateServiceButtonsUI2() {\n            const btnCremation = document.getElementById('elysium2-btn-cremation');\n            const btnBurial = document.getElementById('elysium2-btn-burial');\n            const btnRepat = document.getElementById('elysium2-btn-repatriation');\n            const serviceDisplay = document.getElementById('elysium2-selectedServiceDisplay');\n\n            if (btnCremation) btnCremation.classList.toggle('active', serviceType === 'Cremation');\n            if (btnBurial) btnBurial.classList.toggle('active', serviceType === 'Burial');\n            if (btnRepat) btnRepat.classList.toggle('active', serviceType === 'Repatriation');\n            if (serviceDisplay) serviceDisplay.textContent = serviceType;\n        }\n\n        window.handlePlanChange2 = function() {\n            selectedPlan = planSelect.value;\n            const config = plans[selectedPlan];\n            const planLabel = document.getElementById('elysium2-label-planName');\n\n            const serviceGroup = document.getElementById('elysium2-service-group');\n            const btnCremation = document.getElementById('elysium2-btn-cremation');\n            const btnBurial = document.getElementById('elysium2-btn-burial');\n            const btnRepat = document.getElementById('elysium2-btn-repatriation');\n            const serviceRow = document.getElementById('elysium2-row-serviceType');\n\n            const locGroup = document.getElementById('elysium2-location-group');\n            const assistAdv = document.getElementById('elysium2-assist-advisory');\n            const nonresidentAdv = document.getElementById('elysium2-nonresident-advisory');\n            const sliders = document.getElementById('elysium2-interactive-sliders');\n            const breakdown = document.getElementById('elysium2-breakdown-rows');\n            const enactmentRow = document.getElementById('elysium2-enactment-row');\n            const accordion = document.getElementById('elysium2-accordion-wrapper');\n            const depLabel = document.getElementById('elysium2-option-deposit-label');\n            const fullLabel = document.getElementById('elysium2-option-full-label');\n            const paySelectionContainer = document.getElementById('elysium2-payment-selection-container');\n\n            if (!config) {\n                if (planLabel) planLabel.textContent = \"Please select a plan...\";\n                if (serviceGroup) serviceGroup.style.setProperty('display', 'none', 'important');\n                if (serviceRow) serviceRow.style.setProperty('display', 'none', 'important');\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'none', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                \n                const planTotalVal = document.getElementById('elysium2-planTotalVal');\n                const totalPaid = document.getElementById('elysium2-totalPaid');\n                if (planTotalVal) planTotalVal.textContent = \"\u20ac0.00\";\n                if (totalPaid) totalPaid.textContent = \"\u20ac0.00\";\n\n                if (window.jQuery) {\n                    \/\/ Reset fields for Applicant 2 using the updated updateGFField2 helper\n                    function resetGFField2(fieldId) {\n                        var $el = window.jQuery(`#input_${GF_FORM_ID}_${fieldId}`);\n                        if ($el.length) {\n                            $el.val(\"0\").trigger('change');\n                            $el[0].dispatchEvent(new Event('change', { bubbles: true }));\n                        }\n                    }\n                    resetGFField2(GF_PRICE_FIELD_ID);\n                    resetGFField2(GF_PLAN_FIELD_ID);\n                    resetGFField2(GF_PAYTYPE_FIELD_ID);\n                    resetGFField2(GF_SERVICE_TYPE_FIELD_ID);\n                    resetGFField2(GF_TERM_FIELD_ID);\n                    resetGFField2(GF_BAL_FIELD_ID);\n                    resetGFField2(GF_M1_FIELD_ID);\n                    resetGFField2(GF_M2_FIELD_ID);\n                    \n                    if(typeof window.gf_apply_rules == 'function') {\n                        window.gf_apply_rules(GF_FORM_ID, [GF_PLAN_FIELD_ID]);\n                    }\n                }\n                saveCalculatorState2();\n                return;\n            }\n\n            if (planLabel) planLabel.textContent = config.name;\n\n            \/\/ Handle Funeral Type (Burial \/ Cremation \/ Repatriation) rules\n            if (serviceGroup) serviceGroup.style.setProperty('display', 'block', 'important');\n            if (serviceRow) serviceRow.style.setProperty('display', 'flex', 'important');\n\n            if (config.serviceTypeMode === 'cremation_only') {\n                serviceType = 'Cremation';\n                if (btnCremation) btnCremation.classList.remove('hide');\n                if (btnBurial) btnBurial.classList.add('hide');\n                if (btnRepat) btnRepat.classList.add('hide');\n            } else if (config.serviceTypeMode === 'repatriation_only') {\n                serviceType = 'Repatriation';\n                if (btnCremation) btnCremation.classList.add('hide');\n                if (btnBurial) btnBurial.classList.add('hide');\n                if (btnRepat) btnRepat.classList.remove('hide');\n            } else {\n                \/\/ Choice of Burial or Cremation\n                if (serviceType === 'Repatriation') serviceType = 'Cremation';\n                if (btnCremation) btnCremation.classList.remove('hide');\n                if (btnBurial) btnBurial.classList.remove('hide');\n                if (btnRepat) btnRepat.classList.add('hide');\n            }\n            updateServiceButtonsUI2();\n\n            if (selectedPlan === 'assist') {\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.remove('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                const fullRadio = document.querySelector('input[name=\"elysium2_payment_type\"][value=\"full\"]');\n                if (fullRadio) fullRadio.checked = true;\n            } else if (selectedPlan === 'nonresident') {\n                if (locGroup) locGroup.style.setProperty('display', 'none', 'important');\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.remove('hide');\n                if (sliders) sliders.style.setProperty('display', 'none', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'none', 'important');\n                if (enactmentRow) enactmentRow.classList.remove('hide');\n                if (accordion) accordion.style.setProperty('display', 'none', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'none', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'none', 'important');\n                const depRadio = document.querySelector('input[name=\"elysium2_payment_type\"][value=\"deposit\"]');\n                if (depRadio) depRadio.checked = true;\n            } else {\n                if (assistAdv) assistAdv.classList.add('hide');\n                if (nonresidentAdv) nonresidentAdv.classList.add('hide');\n                if (sliders) sliders.style.setProperty('display', 'block', 'important');\n                if (breakdown) breakdown.style.setProperty('display', 'block', 'important');\n                if (enactmentRow) enactmentRow.classList.add('hide');\n                if (accordion) accordion.style.setProperty('display', 'block', 'important');\n                if (depLabel) depLabel.style.setProperty('display', 'flex', 'important');\n                if (fullLabel) fullLabel.style.setProperty('display', 'flex', 'important');\n                if (paySelectionContainer) paySelectionContainer.style.setProperty('display', 'block', 'important');\n                if (locGroup) locGroup.style.setProperty('display', config.hasLocations ? 'block' : 'none', 'important');\n            }\n            runCalculations2();\n        };\n\n        window.handlePaymentSelectionChange2 = function() {\n            runCalculations2();\n        };\n\n        function runCalculations2() {\n            const config = plans[selectedPlan];\n            if (!config) return;\n\n            let price = config.price;\n            if (selectedPlan === 'clarity') {\n                price = (location === 'mainland') ? 2200 : 2400;\n            }\n\n            const totalVal = document.getElementById('elysium2-planTotalVal');\n            if (totalVal) totalVal.textContent = formatToEuro(price);\n\n            const totalPaidLabel = document.getElementById('elysium2-totalPaidLabel');\n            const totalPaid = document.getElementById('elysium2-totalPaid');\n            const choiceText = document.getElementById('elysium2-choice-full-text');\n            const choiceFull = document.getElementById('elysium2-choice-full');\n\n            if (selectedPlan === 'nonresident') {\n                if (totalPaidLabel) totalPaidLabel.textContent = \"Deposit Payable Today\";\n                if (totalPaid) totalPaid.textContent = formatToEuro(price);\n                if (choiceText) choiceText.textContent = \"Pay Deposit Today\";\n                if (choiceFull) choiceFull.textContent = formatToEuro(price);\n                sendDataToGF2(0, 0, 0);\n                saveCalculatorState2();\n                return;\n            }\n\n            if (!config.hasInstallments) {\n                if (totalPaidLabel) totalPaidLabel.textContent = \"Total Price (Single Payment)\";\n                if (totalPaid) totalPaid.textContent = formatToEuro(price);\n                if (choiceText) choiceText.textContent = \"Pay Full Price Payment\";\n                if (choiceFull) choiceFull.textContent = formatToEuro(price);\n                sendDataToGF2(0, 0, 0);\n                saveCalculatorState2();\n                return;\n            }\n\n            if (totalPaidLabel) totalPaidLabel.textContent = \"Total Price (incl. Deposit)\";\n            if (choiceText) choiceText.textContent = \"Pay Total Price\";\n\n            const dep = parseFloat(depositSlider.value);\n            const term = parseInt(termSlider.value);\n\n            const depVal = document.getElementById('elysium2-depositVal');\n            const termVal = document.getElementById('elysium2-termVal');\n            if (depVal) depVal.textContent = formatToEuro(dep);\n            if (termVal) termVal.textContent = term + ' months';\n\n            const financed = Math.max(price - dep, 0);\n            let m1 = 0, m2 = 0;\n            if (term === 1) { m1 = financed; } \n            else {\n                m2 = Math.floor((financed \/ term) * 100) \/ 100;\n                m1 = financed - (m2 * (term - 1));\n            }\n\n            const finVal = document.getElementById('elysium2-amountFinanced');\n            const m1Val = document.getElementById('elysium2-month1Payment');\n            const m2Val = document.getElementById('elysium2-months2PlusPayment');\n            const choiceDep = document.getElementById('elysium2-choice-deposit');\n\n            if (finVal) finVal.textContent = formatToEuro(financed);\n            if (m1Val) m1Val.textContent = formatToEuro(m1);\n            if (m2Val) m2Val.textContent = formatToEuro(m2);\n            if (totalPaid) totalPaid.textContent = formatToEuro(dep + financed);\n\n            if (choiceDep) choiceDep.textContent = formatToEuro(dep);\n            if (choiceFull) choiceFull.textContent = formatToEuro(dep + financed);\n\n            renderSchedule2(financed, term, m1, m2);\n            sendDataToGF2(financed, m1, m2);\n            saveCalculatorState2();\n        }\n\n        function renderSchedule2(financed, term, m1, m2) {\n            let html = '';\n            let out = financed;\n            for (let i = 1; i <= term; i++) {\n                let pay = (i === 1) ? m1 : m2;\n                out = Math.max(out - pay, 0);\n                html += `<tr><td>Month ${i}<\/td><td>${formatToEuro(pay)}<\/td><td>${formatToEuro(out)}<\/td><\/tr>`;\n            }\n            const body = document.getElementById('elysium2-scheduleBody');\n            if (body) body.innerHTML = html;\n        }\n\n        \/\/ Send parameters to Gravity Forms inputs\n        function sendDataToGF2(balance, m1, m2) {\n            const config = plans[selectedPlan];\n            let price = config.price;\n            if (selectedPlan === 'clarity') {\n                price = (location === 'mainland') ? 2200 : 2400;\n            }\n            const dep = config.hasInstallments ? parseFloat(depositSlider.value) : price;\n            const checkedRadio = document.querySelector('input[name=\"elysium2_payment_type\"]:checked');\n            const choice = checkedRadio ? checkedRadio.value : 'deposit';\n            \n            let amt = (selectedPlan === 'assist' || choice === 'full') ? price : dep;\n            \n            \/\/ Payment selection Dropdown values matching Field ID 146\n            let paymentDropdownValue = \"Deposit Only\";\n            if (selectedPlan === 'assist') {\n                paymentDropdownValue = \"Single Payment\";\n            } else if (choice === 'full') {\n                paymentDropdownValue = \"Full Price Payment\";\n            }\n\n            const plainIntegerPrice = Math.round(amt).toString();\n            const plainIntegerTerm = config.hasInstallments ? termSlider.value.toString() : \"0\";\n\n            const isComma = (window.gf_global && window.gf_global.number_format === 'decimal_comma') || true;\n            const formattedBal = isComma ? balance.toFixed(2).replace('.', ',') : balance.toFixed(2);\n            const formattedM1 = isComma ? m1.toFixed(2).replace('.', ',') : m1.toFixed(2);\n            const formattedM2 = isComma ? m2.toFixed(2).replace('.', ',') : m2.toFixed(2);\n\n            if (window.jQuery) {\n                \/\/ FIXED FOR FIREFOX: Using native dispatchEvent to ensure Gravity Forms Conditional Logic triggers\n                function updateGFField2(fieldId, val) {\n                    var $el = window.jQuery(`#input_${GF_FORM_ID}_${fieldId}`);\n                    if ($el.length) {\n                        $el.val(val).trigger('change');\n                        $el[0].dispatchEvent(new Event('change', { bubbles: true }));\n                    }\n                }\n\n                updateGFField2(GF_PRICE_FIELD_ID, plainIntegerPrice);\n                updateGFField2(GF_PLAN_FIELD_ID, config.name);\n                updateGFField2(GF_PAYTYPE_FIELD_ID, paymentDropdownValue);\n                updateGFField2(GF_SERVICE_TYPE_FIELD_ID, serviceType);\n                updateGFField2(GF_TERM_FIELD_ID, plainIntegerTerm);\n                updateGFField2(GF_BAL_FIELD_ID, formattedBal);\n                updateGFField2(GF_M1_FIELD_ID, formattedM1);\n                updateGFField2(GF_M2_FIELD_ID, formattedM2);\n                \n                \/\/ Force Gravity Forms to re-evaluate rules\n                if(typeof window.gf_apply_rules == 'function') {\n                    window.gf_apply_rules(GF_FORM_ID, [GF_PLAN_FIELD_ID]);\n                }\n            }\n        }\n\n        window.toggleElysiumSchedule2 = function() {\n            const container = document.getElementById('elysium2-scheduleContainer');\n            if (container) {\n                const isHidden = window.getComputedStyle(container).display === 'none';\n                container.style.setProperty('display', isHidden ? 'block' : 'none', 'important');\n            }\n        };\n\n        depositSlider.addEventListener('input', runCalculations2);\n        termSlider.addEventListener('input', runCalculations2);\n\n        function triggerInitialUpdate2() {\n            loadCalculatorState2(); \n            handlePlanChange2();\n        }\n\n        \/\/ Cleaned up race condition initialization\n        if (document.readyState === 'loading') {\n            document.addEventListener('DOMContentLoaded', function() {\n                setTimeout(triggerInitialUpdate2, 100);\n            });\n        } else {\n            setTimeout(triggerInitialUpdate2, 100);\n        }\n\n        if (typeof window.jQuery !== 'undefined') {\n            window.jQuery(document).on('gform_post_render', function(event, formId) {\n                if (formId == GF_FORM_ID) {\n                    setTimeout(triggerInitialUpdate2, 100);\n                }\n            });\n            window.jQuery(document).on('gform_confirmation_loaded', function(event, formId) {\n                if (formId == GF_FORM_ID) {\n                    sessionStorage.removeItem('elysium2_calc_state');\n                }\n            });\n        }\n    })();\n<\/script><\/div><div id=\"field_4_191\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_191'><span class='gform-field-label__text'>Select preferred monthly payment date:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_191' id='input_4_191' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1st of the month' >1st of the month<\/option><option value='8th of the month' >8th of the month<\/option><option value='15th of the month' >15th of the month<\/option><option value='22nd of the month' >22nd of the month<\/option><\/select><\/div><\/div><div id=\"field_4_107\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_4_107 gfield_product_4_107 gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_4_107_1'><span class='gform-field-label__text'>Plan Purchased - Applicant 2<\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_107.1' value='Plan Purchased - Applicant 2' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_4_107' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Pris:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_4_107'>0,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_107.2' id='ginput_base_price_4_107' class='gform_hidden ginput_calculated_price' value='0,00 \u20ac'\/>\n\t\t\t\t\t<input type='hidden' name='input_107.3' value='1' class='ginput_quantity_4_107 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_4_111\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_111'><span class='gform-field-label__text'>Selected Plan Name (App 2)<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_111' id='input_4_111' class='large gfield_select'     aria-invalid=\"false\" ><option value='Select one' >Select one<\/option><option value='The Elysium Assist Plan' >The Elysium Assist Plan<\/option><option value='The Clarity Plan' >The Clarity Plan<\/option><option value='The Tranquility Plan' >The Tranquility Plan<\/option><option value='The Serenity Plan' >The Serenity Plan<\/option><option value='The Unity Repatriation Plan' >The Unity Repatriation Plan<\/option><option value='The Elysium Non-Resident Plan' >The Elysium Non-Resident Plan<\/option><\/select><\/div><\/div><div id=\"field_4_109\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_109'><span class='gform-field-label__text'>Funeral Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_4_109' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_115\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_115'><span class='gform-field-label__text'>Term (Months)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_4_115' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_106\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_106'><span class='gform-field-label__text'>Want to pay  Applicant 2<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_106' id='input_4_106' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_146\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_146'><span class='gform-field-label__text'>Payment Selection<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_146' id='input_4_146' class='large gfield_select'     aria-invalid=\"false\" ><option value='Deposit Only' >Deposit Only<\/option><option value='Full Price Payment' >Full Price Payment<\/option><option value='Single Payment' >Single Payment<\/option><\/select><\/div><\/div><div id=\"field_4_121\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_121'><span class='gform-field-label__text'>Balance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_4_121' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_122\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_122'><span class='gform-field-label__text'>Month 1 Payment<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_122' id='input_4_122' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_123\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_123'><span class='gform-field-label__text'>Months 2+ Payment<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_123' id='input_4_123' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_112\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"margin-top:20px; font-size:12px;\"><em>The specific features of the plan are set out in Clause 8 of this contract.<\/em><\/p><\/div><div id=\"field_4_168\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Beneficiaries - Applicant 2<\/h3><\/div><div id=\"field_4_185\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p> Under the 10-Year & 14-Year Legacy-Refund Commitments, the Plan Fee will be refunded to the Plan Holder\u2019s nominated Beneficiary\/ies, subject to the terms of the Plan. <br>\n\nPayment will be released upon presentation of the original Funeral Plan Certificate and, where a nominated Beneficiary is under 18 years of age, once that Beneficiary has reached the age of 18.\n<\/p><\/div><fieldset id=\"field_4_169\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_169'>\n                            <span id='input_4_169_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_169.2' id='input_4_169_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_169_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_169_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_169.3' id='input_4_169_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_169_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_169_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_169.4' id='input_4_169_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_169_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_169_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_169.6' id='input_4_169_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_169_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_170\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_170' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_170_1_container' >\n                                        <input type='text' name='input_170.1' id='input_4_170_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_170_1' id='input_4_170_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_170_2_container' >\n                                        <input type='text' name='input_170.2' id='input_4_170_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_170_2' id='input_4_170_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_170_3_container' >\n                                    <input type='text' name='input_170.3' id='input_4_170_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_170_3' id='input_4_170_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_170.4' id='input_4_170_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_170_5_container' >\n                                    <input type='text' name='input_170.5' id='input_4_170_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_170_5' id='input_4_170_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_170_6_container' >\n                                        <select name='input_170.6' id='input_4_170_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_170_6' id='input_4_170_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_171\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_171'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_171' id='input_4_171' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_172\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_172'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_172'\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_172'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_172' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_172' 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_4_172' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_173\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_173'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_173' id='input_4_173' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_174\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_174'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_174' id='input_4_174' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_174\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_174'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_4_175\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_175'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_175' id='input_4_175' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_176\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is there a second beneficiary?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_176'>\n\t\t\t<div class='gchoice gchoice_4_176_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Yes'  id='choice_4_176_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_176_0' id='label_4_176_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_176_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='No'  id='choice_4_176_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_176_1' id='label_4_176_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_177\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">2nd Beneficiary Details  - Applicant 2<\/h3><\/div><fieldset id=\"field_4_178\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_4_178'>\n                            <span id='input_4_178_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_178.2' id='input_4_178_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_178_2' class='gform-field-label gform-field-label--type-sub '>Prefiks<\/label>\n                                                  <\/span>\n                            <span id='input_4_178_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_178.3' id='input_4_178_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_178_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_4_178_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_178.4' id='input_4_178_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_178_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_4_178_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_178.6' id='input_4_178_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_178_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_179\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_4_179' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_179_1_container' >\n                                        <input type='text' name='input_179.1' id='input_4_179_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_179_1' id='input_4_179_1_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 1<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_179_2_container' >\n                                        <input type='text' name='input_179.2' id='input_4_179_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_179_2' id='input_4_179_2_label' class='gform-field-label gform-field-label--type-sub '>Adresselinje 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_179_3_container' >\n                                    <input type='text' name='input_179.3' id='input_4_179_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_179_3' id='input_4_179_3_label' class='gform-field-label gform-field-label--type-sub '>Poststed<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_179.4' id='input_4_179_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_179_5_container' >\n                                    <input type='text' name='input_179.5' id='input_4_179_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_179_5' id='input_4_179_5_label' class='gform-field-label gform-field-label--type-sub '>Postnummer<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_4_179_6_container' >\n                                        <select name='input_179.6' id='input_4_179_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algerie<\/option><option value='US' >Amerika<\/option><option value='AS' >Amerikansk Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antartikis<\/option><option value='AG' >Antigua og Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbajdsjan<\/option><option value='AU' >Australia<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia og Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brasil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KY' >Cayman\u00f8yene<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='CG' >Congo<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danmark<\/option><option value='VI' >De amerikanske jomfru\u00f8yene<\/option><option value='VG' >De britiske jomfru\u00f8yene<\/option><option value='AE' >De forente arabiske emirater<\/option><option value='DO' >Den dominikanske republikk<\/option><option value='CF' >Den sentralafrikanske republikk<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='GQ' >Ekvatorial-Guinea<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbenskysten<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filippinene<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrike<\/option><option value='PF' >Fransk Polynesia<\/option><option value='GF' >French Guiana<\/option><option value='TF' >French Southern Territories<\/option><option value='FO' >F\u00e6r\u00f8yene<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GL' >Gr\u00f8nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='GR' >Hellas<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='BY' >Hviterussland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KH' >Kambodsja<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='CV' >Kapp Verde<\/option><option value='KZ' >Kasakhstan<\/option><option value='KE' >Kenya<\/option><option value='CN' >Kina<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='KM' >Komorene<\/option><option value='CD' >Kongo, Den demokratiske republikken<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='HR' >Kroatia<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='CY' >Kypros<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LS' >Lesotho<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldivene<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall\u00f8yene<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Mikronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MP' >Nord-Marianene<\/option><option value='NF' >Norfolk Island<\/option><option value='NO' >Norge<\/option><option value='MK' >North Macedonia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Ny-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts og Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent og Grenadinene<\/option><option value='SB' >Salomon\u00f8yene<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome og Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychellene<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' selected='selected'>Spania<\/option><option value='LK' >Sri Lanka<\/option><option value='GB' >Storbritannia<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='CH' >Sveits<\/option><option value='SE' >Sverige<\/option><option value='SY' >Syria Arab Republic<\/option><option value='ZA' >S\u00f8r-Afrika<\/option><option value='TJ' >Tadsjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad og Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='DE' >Tyskland<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukrania<\/option><option value='HU' >Ungarn<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AT' >\u00d8sterike<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_4_179_6' id='input_4_179_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_180\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_180'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_180' id='input_4_180' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_4_181\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_181'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_181'\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_181'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_181' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_181' 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_4_181' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_182\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_182'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_182' id='input_4_182' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_183\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_183'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_183' id='input_4_183' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_183\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_183'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_4_184\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_184'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_184' id='input_4_184' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_130\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Special Instructions<\/h3><\/div><div id=\"field_4_131\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"funeral-plan-instructions\">\n\n    <p>\n        Please enter any special requests or instructions you would like to record in relation to your funeral plan.\n    <\/p>\n\n    <p>\n        You can also use this section to advise us if your plan:\n    <\/p>\n\n    <ul>\n        <li>Forms part of a <strong>Family Plan;<\/strong><\/li>\n        <li>Is a <strong>Living Funeral Plan;<\/strong><\/li>\n        <li>Relates to a pre-arrangement to <strong>donate your body to medical research;<\/strong> or<\/li>\n        <li>Has been created under our <strong>Transfer-In Scheme.<\/strong><\/li>\n    <\/ul>\n\n    <p>\n        Enter any special requests or instructions, such as a favourite reading, hymn, poem, music or other personal wishes.\n    <\/p>\n\n    <p>\n        You will also receive a separate Funeral Wishes Sheet with your Elysium Funeral Plan Guide for further details.\n    <\/p>\n\n<\/div><\/div><div id=\"field_4_132\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_132'><span class='gform-field-label__text'>Enter any special requests or instructions<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_132' id='input_4_132' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_77\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Payment Terms<\/h3><\/div><div id=\"field_4_54\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>3. EFFECTS OF PAYMENT:<\/h4>\n\n<p><strong>3.1 FULL PAYMENT:<\/strong><br>\nThe service is fully guaranteed at no additional cost, except for services not included or exceptional circumstances (public charges, regulatory changes etc).<\/p>\n\n<p><strong>3.2 MONTHLY PAYMENT:<\/strong><br>\nUntil payments have completed:<\/p>\n\n<ul>\n    <li>The Next of Kin will be responsible for paying the outstanding balance before the contract can be fulfilled.<\/li>\n    <li>If the Next of Kin cannot or refuses to pay the outstanding balance immediately, the balance will be transferred to them less our cancellation fee of \u20ac495 (four hundred & ninety-five Euros)  and we will not be obliged to fulfil  our obligations under this contract.<\/li>\n<\/ul>\n\n\n<h4>4. NON-PAYMENT:<\/h4>\n\n<p><strong>In the event of non-payment<\/strong><\/p>\n\n<ul>\n    <li>1 missed payment: <strong>THE COMPANY<\/strong> will notify <strong>THE PLAN HOLDER<\/strong>.<\/li>\n    <li>2 missed payments: <strong>THE COMPANY<\/strong> will notify <strong>THE PLAN HOLDER<\/strong> and place a temporary suspension on the plan.<\/li>\n    <li>3 missed payments: <strong>THE COMPANY<\/strong> will notify <strong>THE PLAN HOLDER<\/strong> and give 7 (seven)   days notice to bring the account back up to date or the plan will be cancelled.<\/li>\n<\/ul>\n\n<p><strong>If the plan is called upon whilst payments are outstanding:<\/strong><\/p>\n\n<ul>\n    <li><strong>THE COMPANY<\/strong> will not be obliged to provide the contract service.<\/li>\n    <li>The plan will be cancelled and the balance outstanding, less our cancellation fee of \u20ac495 (four hundred & ninety-five Euros), will be refunded to the Next of Kin.<\/li>\n<\/ul>\n\n\n<h4>5. CANCELLATION:<\/h4>\n\n<p><strong>5.1 WITHIN 21 DAYS OF SIGNING THIS CONTRACT:<\/strong><br>\n<strong>THE PLAN HOLDER<\/strong> may cancel without penalty within 21 (twenty-one)  calendar days of signing this contract and will receive a full refund of monies paid within 72 (seventy-two)  hours.<\/p>\n\n<p><strong>5.2 AFTER 21 DAYS OF SIGNING THIS CONTRACT:<\/strong><br>\n<strong>THE PLAN HOLDER<\/strong> may cancel after the 21 (twenty-one) day Consideration Period and will receive monies less our standard cancelation fee of \u20ac495 (four hundred & ninety-five Euros). The balance will be transferred back to <strong>THE PLAN HOLDER<\/strong> within 5 (five)  working days. Full details of our cancellation policy can be found in our Terms and Conditions on our website www.elysiumfuneralplans.com.<br>\nEU Consumer Rights Directive: Gives consumers various rights, including the right to withdraw from a sales contract without explanation within  14 (fourteen)  days (a \u201ccooling off period\u201d). THE COMPANY offers a 21 (twenty-one)  day Consideration Period.<br>\n<em>Please Note: Day 1 (one)  of this 21 (twenty-one)  day period is taken as the day this Contract is signed.<\/em><\/p>\n\n\n<h4>6. LIABILITY:<\/h4>\n\n<p><strong>THE COMPANY<\/strong> assumes full responsibility for the proper provision of the service. It may rely on external suppliers in providing the service,however:<\/p>\n\n<ul>\n    <li>It will remain fully liable to <strong>THE PLAN HOLDER<\/strong> for the proper provision of the service.<\/li>\n    <li>It will be responsible for any legal or administrative charges arising from the provision of the contracted service.<\/li>\n    <li>It will not be responsible for decisions, actions, or delays attributable to public authorities.<\/li>\n<\/ul>\n\n\n<h4>7. FINANCIAL PROTECTION:<\/h4>\n\n<p>Funds paid by <strong>THE PLAN HOLDER<\/strong> to <strong>THE COMPANY<\/strong>:<\/p>\n\n<ul>\n    <li>Are used exclusively for the provision of the contracted plan.<\/li>\n    <li>Are managed in a secure ringed fenced account by Amundi Group.<\/li>\n<\/ul>\n\n<p>This guarantees the long-term strength and stability of <strong>THE COMPANY<\/strong>.<\/p><\/div><div id=\"field_4_91\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Details of the Plan<\/h3><\/div><div id=\"field_4_186\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8. DETAILS OF THE PLAN: <\/h4>\n\n<h5>THE ELYSIUM ASSIST PLAN - WHAT IS INCLUDED:<\/h5>\n<ul>\n    <li>The unattended cremation at an appointed crematorium.<\/li>\n    <li>The cremation fee.<\/li>\n    <li>The appointed Funeral Director attending to all the necessary arrangements for the unattended cremation.<\/li>\n    <li>The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in mainland Spain to a mortuary within mainland Spain.<\/li>\n    <li>The preparation and care of the deceased at the allocated mortuary (including full hygienic treatment and removal of pacemaker, where required).<\/li>\n    <li>The supply of a simple coffin suitable  for cremation.<\/li>\n    <li>The supply of a simple urn.<\/li>\n    <li>The return of ashes directly to the family in Spain.<\/li>\n    <li>24-hour bereavement line with English speaking operators.<\/li>\n    <li>International Death Certif\u00edcate.<\/li>\n    <li>The Cremation Certif\u00edcate  to allow ashes to be taken on board an aircraft, where appropriate.<\/li>\n<\/ul>\n\n<h5>THE ELYSIUM ASSIST PLAN - WHAT IS NOT INCLUDED:<\/h5>\n<ul>\n    <li>Privilege Collections.<\/li>\n    <li>Any services provided by a Funeral Director not appointed by <strong>THE COMPANY<\/strong>.<\/li>\n    <li>Face to face appointments with the Funeral Director.<\/li>\n    <li>Viewing of the deceased.<\/li>\n    <li>Dressing of the deceased in personal clothes or inclusion of items within the coffin.<\/li>\n    <li>Family attendance at the crematorium.<\/li>\n    <li>A service at the crematorium or any costs to host the event of a service including a church service.<\/li>\n    <li>Costs for any mortuary storage.<\/li>\n    <li>Choice of date, time or location of the cremation.<\/li>\n    <li>A Wake, following the cremation, including the costs associated with catering for the funeral guests.<\/li>\n    <li>Obituary  notices.<\/li>\n    <li>Flowers, floral tributes, or any items requested.<\/li>\n    <li>Interment of ashes.<\/li>\n    <li>Headstone, memorials, plaques or associated costs for erection or maintenance thereof.<\/li>\n    <li>Repatriation from outside Spain.<\/li>\n    <li>Transfer to or from mainland Spain, the Canary Islands or Balearic Islands.<\/li>\n    <li>Audio or visual equipment.<\/li>\n    <li>Travel or transport costs.<\/li>\n    <li>Any other items or services not listed in the inclusions section.<\/li>\n<\/ul><\/div><div id=\"field_4_96\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8. DETAILS OF THE PLAN:<\/h4>\n<h5>THE CLARITY PLAN - WHAT IS INCLUDED:<\/h5>\n<ul>\n    <li>The unattended cremation at an appointed crematorium or burial at an appointed cemetery.<\/li>\n    <li>The cremation fee.<\/li>\n    <li>The appointed Funeral Director attending to all the necessary arrangements for the unattended cremation.<\/li>\n    <li>The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in mainland Spain to a mortuary within mainland Spain.<\/li>\n    <li>The preparation and care of the deceased at the allocated mortuary (including full hygienic treatment and removal of pacemaker, where required).<\/li>\n    <li>The supply of a standard coffin \u2013 suitable for a burial or a cremation.<\/li>\n    <li>The supply of a standard urn if a cremation service chosen.<\/li>\n    <li>The return of ashes directly to the family in Spain.<\/li>\n    <li>24-hour bereavement line with English speaking operators.<\/li>\n    <li>International Death Certif\u00edcate.<\/li>\n    <li>The Cremation Certificate  to allow ashes to be taken on board an aircraft, where appropriate.<\/li>\n    <li>Choice of Privilege Collections.<\/li>\n<\/ul>\n<h5>THE CLARITY PLAN \u2013 WHAT IS NOT INCLUDED:<\/h5>\n<ul>\n    <li>Any services provided by a Funeral Director not appointed by <strong>THE COMPANY<\/strong>.<\/li>\n    <li>Face to face appointments with the Funeral Director.<\/li>\n    <li>Viewing of the deceased.<\/li>\n    <li>Dressing of the deceased in personal clothes or inclusion of items within the coffin.<\/li>\n    <li>Family attendance at the crematorium.<\/li>\n    <li>A service at the crematorium or any costs to host the event of a service including a church service.<\/li>\n    <li>Costs for any mortuary storage.<\/li>\n    <li>Choice of date, time or location of the cremation.<\/li>\n    <li>Niche and grave fees.<\/li>\n    <li>Burial taxes.<\/li>\n    <li>A Wake, following the cremation, including the costs associated with catering for the funeral guests.<\/li>\n    <li>Obituary notices.<\/li>\n    <li>Flowers, floral tributes, or any items requested in celebration of the deceased.<\/li>\n    <li>Interment of ashes.<\/li>\n    <li>Headstone, memorials, plaques or associated costs for erection or maintenance thereof.<\/li>\n    <li>Gifts including charitable donations, unless included in the Privilege selection.<\/li>\n    <li>Repatriation from outside Spain.<\/li>\n    <li>Transfer to or from mainland Spain, the Canary Islands or Balearic Islands.<\/li>\n    <li>Audio or visual equipment.<\/li>\n    <li>Travel or transport costs.<\/li>\n    <li>Any other items or services not listed in the inclusions section.<\/li>\n<\/ul><\/div><div id=\"field_4_97\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8. DETAILS OF THE PLAN:<\/h4>\n\n<h5>THE TRANQUILITY PLAN \u2013 WHAT IS INCLUDED:<\/h5>\n<ul>\n    <li>The appointed Funeral Director attending to all the necessary funeral arrangements prior to and on the day of the funeral.<\/li>\n    <li>The appointed Funeral Director providing confidential advice on the certification and registration of the death.<\/li>\n    <li>The cremation fee if a cremation has been chosen.<\/li>\n    <li>The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in Spain to the mortuary.<\/li>\n    <li>The care and preparation of the deceased at the funeral home (to include full hygienic treatment and removal of pacemaker, where required).<\/li>\n    <li>The supply of a standard coffin \u2013 suitable for a burial or a cremation.<\/li>\n    <li>Up to 4 (four) days in the Chapel of Rest at the Funeral Home\/Tanatorio allowing family and friends to travel and attend the funeral. Included in this 4 (four) day period is a 1(one) day Wake (viewing)  for family and friends to view the deceased and pay their final respects.<\/li>\n    <li>The transportation of the deceased to the Funeral Director\u2019s appointed crematorium or chosen cemetery.<\/li>\n    <li>International Death Certif\u00edcate.<\/li>\n    <li>24-hour bereavement line with English speaking operators.<\/li>\n    <li>The supply of a standard urn if a cremation was chosen.<\/li>\n    <li>The Cremation Certif\u00edcate to allow ashes to be taken on board an aircraft, where appropriate.<\/li>\n    <li>Choice of Privilege Collections.<\/li>\n<\/ul>\n\n<h5>THE TRANQUILITY PLAN \u2013 WHAT IS NOT INCLUDED:<\/h5>\n<ul>\n    <li>Any services provided by a Funeral Director not appointed by <strong>THE COMPANY<\/strong>.<\/li>\n    <li>Any costs to host the event of a service including a church service.<\/li>\n    <li>A Wake, following the cremation, including the costs associated with catering for the funeral guests.<\/li>\n    <li>Obituary notices.<\/li>\n    <li>Flowers, floral tributes, or any items requested.<\/li>\n    <li>Niche and grave fees.<\/li>\n    <li>Burial taxes.<\/li>\n    <li>Headstone, memorials, or associated costs for stonework and erection thereof.<\/li>\n    <li>Gifts, including charitable donations unless included in the Privilege selection.<\/li>\n    <li>Cost incurred for the upkeep and maintenance of a memorial.<\/li>\n    \n    <li>Hymn cards and order of service.<\/li>\n    <li>Audio or visual equipment.<\/li>\n    <li>Interment or distribution of ashes.<\/li>\n    <li>Repatriation from outside Spain.<\/li>\n    <li>Transfer to or from Mainland Spain, the Canary Islands or Balearic Islands.<\/li>\n    <li>Viewing of the deceased in the Chapel of Rest on all 4 (four) days.<\/li>\n    <li>Any other items or services not listed in the inclusions section.<\/li>\n<\/ul><\/div><div id=\"field_4_98\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8. DETAILS OF THE PLAN:<\/h4>\n<h5>THE SERENITY PLAN -  WHAT IS INCLUDED:<\/h5>\n                        <ul>\n                            <li>The appointed Funeral Director attending to all the necessary funeral arrangements prior to and on the day of the funeral.<\/li>\n                            <li>The appointed Funeral Director providing confidential advice on the certification and registration of the death.<\/li>\n                            <li>The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in Spain to the mortuary.<\/li>\n                            <li>The care and preparation of the deceased at the funeral home (to include full hygienic treatment and removal of pacemaker, where required).<\/li>\n                            <li>The supply of a quality veneered coffin \u2013 suitable for a burial or a cremation.<\/li>\n                            <li>A member of the clergy or celebrant for the funeral service.<\/li>\n                            <li>Relevant funeral staff required to conduct the funeral service.<\/li>\n                            <li>The cremation fee.<\/li>\n                            <li>Up to 5 (five) days in the Chapel of Rest at the Funeral Home\/Tanatorio allowing family and friends to travel and attend the funeral. Included in this 5 (five) day period is a 1(one) day Wake (viewing) for family and friends to view the deceased and pay their final respects.<\/li>\n                            <li>The transportation of the deceased to the Funeral Director\u2019s appointed cemetery\/crematorium.<\/li>\n                            <li>International Death Certif\u00edcate.<\/li>\n                            <li>24-hour bereavement line with English speaking operators.<\/li>\n                            <li>The supply of a small spray of flowers.<\/li>\n                            <li>The supply of a simple urn.<\/li>\n                            <li>The Cremation Certif\u00edcate  to allow ashes to be taken on board an aircraft, where appropriate.<\/li>\n                            <li>Choice of Privilege Collections.<\/li>\n                        <\/ul>\n\n                        <h5>THE SERENITY PLAN -  WHAT IS NOT INCLUDED:<\/h5>\n                        <ul>\n                            <li>Any services provided by a Funeral Director not appointed by <strong>THE COMPANY<\/strong>.<\/li>\n                            <li>Additional venue costs to host the funeral service,  including a church service.<\/li>\n                            <li>A Wake, following the cremation, including the costs associated with catering for the funeral guests.<\/li>\n                            <li>Obituary notices posted in the media.<\/li>\n                            <li>Extra flowers, floral tributes, or any items requested for the funeral service. <\/li>\n                            <li>Niche and grave fees.<\/li>\n                            <li>Burial taxes.<\/li>\n                            <li>Headstone, memorials, or associated costs for stonework and erection thereof.<\/li>\n                            <li>Gifts, including charitable donations unless included in the Privilege Selection.<\/li>\n                            <li>Cost incurred for the upkeep and maintenance of a memorial.<\/li>\n                            <li>Any transportation of funeral guests on the day of the funeral.<\/li>\n                            <li>List of funeral guests who sent flowers and charitable donations.<\/li>\n                            <li>Viewing of the deceased in the Chapel of Rest on all five days.<\/li>\n                            <li>Hymn cards and order of service.<\/li>\n                            <li>Audio or visual equipment.<\/li>\n                            <li>Interment or distribution of ashes.<\/li>\n                            <li>Repatriation to or from Spain.<\/li>\n                            <li>Transfer to or from mainland Spain, Canary Islands and Balearic Islands.<\/li>\n                            <li>Any other items or services not listed in the inclusions section.<\/li>\n                        <\/ul><\/div><div id=\"field_4_99\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8. DETAILS OF THE PLAN:<\/h4>\n\n<h5>THE UNITY REPATRIATION PLAN \u2013 WHAT IS INCLUDED:<\/h5>\n<ul>\n    <li>Attending to all legal and administrative formalities required for repatriation from mainland Spain to the UK or any EU member state.<\/li>\n    <li>The appointed Funeral Director in Spain attending to all the necessary funeral arrangements prior to and up to delivery of the coffin to the airport.<\/li>\n    <li>The Appointed Funeral Directors in Spain providing confidential advice on the certification and registration of the death.<\/li>\n    <li>The collection and transportation of the deceased from a place of residence, a care home, hospital, or resting place in mainland Spain to the mortuary in mainland Spain.<\/li>\n    <li>The care and preparation of the deceased for transportation (to include full hygienic treatment and removal of pacemaker, where required).<\/li>\n    <li>4 (four) days mortuary expenses in Spain.<\/li>\n    <li>The supply of a coffin suitable for transportation, including the legally required body bag.<\/li>\n    <li>The transportation of the deceased to the airport in Spain.<\/li>\n    <li>The flight for the deceased to the Receiving Country.<\/li>\n    <li>International Death Certif\u00edcate.<\/li>\n    <li>24-hour bereavement line with English speaking operators.<\/li>\n<\/ul>\n\n<h5>THE UNITY REPATRIATION PLAN \u2013 WHAT IS NOT INCLUDED:<\/h5>\n<ul>\n    <li>Any services provided by a Funeral Director not appointed by <strong>THE COMPANY<\/strong>.<\/li>\n    <li>Wake\/s following the repatriation including the costs associated with venue and catering for family\/guests.<\/li>\n    <li>Obituary notices.<\/li>\n    <li>Flowers.<\/li>\n    <li>Burial fees.<\/li>\n    <li>Headstones or memorials.<\/li>\n    <li>Family transportation \/ flights.<\/li>\n    <li>Printed materials.<\/li>\n    <li>Audio-visual equipment.<\/li>\n    <li>Additional airport or handling charges.<\/li>\n    <li>Exceptional airline, governmental or authority charges.<\/li>\n    <li>Any other goods or services not expressly included.<\/li>\n<\/ul><\/div><div id=\"field_4_137\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>8.  THE NON-RESIDENT PLAN<\/h4>\n\n<h4> PLAN INCLUSIONS\/EXCLUSIONS <\/h4>\n<p>\nThe inclusions and exclusions applicable to this plan are those associated with the plan selected <\/p><\/div><div id=\"field_4_92\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Donations<\/h3><\/div><div id=\"field_4_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>9. SOCIAL CONTRIBUTIONS - (NON-CONTRACTUAL):<\/h4>\n<p><strong>THE COMPANY<\/strong> may make donations to charitable causes and\/or plant trees.<br>These actions are voluntary and do not form part of the contracted service.<\/p><\/div><div id=\"field_4_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_55'><span class='gform-field-label__text'>NOMINATED CHARITY IF APPLICABLE<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_4_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_95\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Policies<\/h3><\/div><div id=\"field_4_56\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>10. DATA PROTECTION:<\/h4>\n<p>Data held by <strong>THE COMPANY<\/strong> regarding <strong>THE PLAN HOLDER<\/strong> will be processed in accordance with: General Data Protection Regulation (GDPR) \/ Organic Law 3\/2018 \/ The Rules of LOPD which <strong>THE COMPANY<\/strong> voluntarily subscribes to.<\/p>\n\n<h4>11. APPLICABLE LAW:<\/h4>\n<p>This Agreement and the services provided under it shall be governed by and comply with applicable Spanish law and regulations, including those relating to funeral services, consumer protection and data protection.\n\nAny mandatory legal requirement shall prevail over any conflicting provision of this Agreement.\n<\/p>\n\n<h4>12. ACCEPTANCE:<\/h4>\n<p><strong>THE PLAN HOLDER<\/strong> declares:<\/p>\n<ul>\n<li>That I have read and understood this contract in conjunction with the Terms and Conditions found at www.elysiumfuneralplans.com.<\/li>\n<li>That I accept all its Terms and Conditions.<\/li>\n<li>That I freely enter into this contract for the plan nominated with the plan payment as declared.<\/li>\n<\/ul><\/div><div id=\"field_4_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">13. SIGNATURES<\/h3><\/div><fieldset id=\"field_4_58\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>PLAN HOLDER 1: SIGNATURE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_58' id='input_4_58_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_4_58_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_4_58_data' name='input_4_58_data' class='gfield_signature_data' \/><canvas id=\"input_4_58\" width=\"300\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/elysiumfuneralplans.com\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_4_58_textinput' name='input_4_58_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:300px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_4_58_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_4_58_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:300px;max-width:100%;display:flex;align-items:center;'><div id='input_4_58_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_4_58_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_4_58_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_4_58_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_4_58_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_4_58_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_4_58_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_4_58_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_4_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_59'><span class='gform-field-label__text'>PLAN HOLDER 1: NAME<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_4_59' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_60\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_60'><span class='gform-field-label__text'>PLAN HOLDER 1: DATE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_60'\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_60'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_60' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_60' 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_4_60' aria-label='PLAN HOLDER 1: DATE: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_4_61\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>PLAN HOLDER 2: SIGNATURE (if applicable)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_61' id='input_4_61_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_4_61_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_4_61_data' name='input_4_61_data' class='gfield_signature_data' \/><canvas id=\"input_4_61\" width=\"300\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/elysiumfuneralplans.com\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_4_61_textinput' name='input_4_61_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:300px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_4_61_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_4_61_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:300px;max-width:100%;display:flex;align-items:center;'><div id='input_4_61_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_4_61_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_4_61_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_4_61_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_4_61_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_4_61_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_4_61_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_4_61_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_4_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_62'><span class='gform-field-label__text'>PLAN HOLDER 2: NAME<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_4_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_63\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_63'><span class='gform-field-label__text'>PLAN HOLDER 2: DATE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_4_63'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_63'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_4_63' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_4_63' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_4_63' aria-label='PLAN HOLDER 2: DATE: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_4_140\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Associate Details<\/h3><\/div><div id=\"field_4_138\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_138'><span class='gform-field-label__text'>Associate Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_4_138' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_138\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_138'>Please leave blank if not known:<\/div><\/div><div id=\"field_4_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">THE COMPANY \/ OFFICE ONLY<\/h3><\/div><fieldset id=\"field_4_65\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>COMPANY SIGNATURE<\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_65' id='input_4_65_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_4_65_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_4_65_data' name='input_4_65_data' class='gfield_signature_data' \/><canvas id=\"input_4_65\" width=\"300\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/elysiumfuneralplans.com\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_4_65_textinput' name='input_4_65_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:300px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_4_65_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_4_65_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:300px;max-width:100%;display:flex;align-items:center;'><div id='input_4_65_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_4_65_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_4_65_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_4_65_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_4_65_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_4_65_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_4_65_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_4_65_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_4_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_66'><span class='gform-field-label__text'>NAME<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_4_66' type='text' value='Elisa Belinda Summers' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_67'><span class='gform-field-label__text'>POSITION<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_4_67' type='text' value='Director' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_68'><span class='gform-field-label__text'>A\/AP No.<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_4_68' type='text' value='7023S' class='large'  aria-describedby=\"gfield_description_4_68\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_68'>Office Only<\/div><\/div><div id=\"field_4_116\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Payment<\/h3><\/div><div id=\"field_4_127\" class=\"gfield gfield--type-coupon gfield--input-type-coupon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gf_coupon_code_4'><span class='gform-field-label__text'>Coupon<\/span><\/label><div class='ginput_container' id='gf_coupons_container_4'><div class='ginput_container_coupon'><input id='gf_coupon_code_4' class='gf_coupon_code' onkeyup='DisableApplyButton(4);' onchange='DisableApplyButton(4);' onpaste='setTimeout(function(){DisableApplyButton(4);}, 50);' type='text'    \/><input type='button' disabled='disabled' onclick='ApplyCouponCode(4);' value='Utf\u00f8r' id='gf_coupon_button' class='button'  \/> <img style='display:none;' id='gf_coupon_spinner' src='https:\/\/elysiumfuneralplans.com\/wp-content\/plugins\/gravityformscoupons\/images\/spinner.gif' alt='please wait'\/><\/div><div id='gf_coupon_info'><\/div><input type='hidden' id='gf_coupon_codes_4' name='input_127' value=''  \/><input type='hidden' id='gf_total_no_discount_4'\/><input type='hidden' id='gf_coupons_4' name='gf_coupons_4' value='' \/><\/div><\/div><div id=\"field_4_126\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_4_ gfield_total gfield_total_4_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_4_126'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_126' id='input_4_126' value='0,00 &#8364;' class='gform-text-input-reset ginput_total ginput_total_4' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_4_144\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Payment Method<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(P\u00e5krevd)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_144'>\n\t\t\t<div class='gchoice gchoice_4_144_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_144' type='radio' value='I would prefer to pay offline'  id='choice_4_144_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_144_0' id='label_4_144_0' class='gform-field-label gform-field-label--type-inline'>I would prefer to pay offline<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_144_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_144' type='radio' value='Pay using Card'  id='choice_4_144_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_144_1' id='label_4_144_1' class='gform-field-label gform-field-label--type-inline'>Pay using Card<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_125\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Thank you for advising us that you would prefer to pay offline. We will contact you to arrange an alternative payment method.<\/div><div id=\"field_4_117\" class=\"gfield gfield--type-stripe_creditcard gfield--input-type-stripe_creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--type-stripe_creditcard-payment-element\"  ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_4_117_1'><span class='gform-field-label__text'>Credit Card<\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard ginput_stripe_creditcard gform-grid-row' id='input_4_117'><div class='ginput_full gform-grid-col' id='input_4_117_1_container' data-payment-element='true'><div id='input_4_117_1' class='StripeElement--payment-element'><\/div><\/div><!-- .ginput_full --><\/div><!-- .ginput_container --><div class=\"gfield_description validation_message gfield_validation_message\">Configuration Required: To use the Stripe field, please configure your <a href=\"\" target=\"_blank\">Stripe Settings<\/a>.<\/div>\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\t:root {\r\n  \t\t\t\t\t--link-login-string: \"Link login\"\r\n\t\t\t\t}\r\n\t\t\t<\/style><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit Contract<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='T15Jwh8i48MthMgAeqM5Lyrb6zDxY5RL\/VP+5rU66b61ZIgl1i8qA2x3Ii\/q6aJiRSMSGnwZKVEywK+k\/Sz9\/ISqXUU2ifR2UPaMtq6QFAhPEPc=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' value='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