{"id":2020,"date":"2026-08-28T20:09:20","date_gmt":"2026-08-28T20:09:20","guid":{"rendered":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/?page_id=2020"},"modified":"2026-09-18T18:11:55","modified_gmt":"2026-09-18T18:11:55","slug":"application-form-cyprus","status":"publish","type":"page","link":"https:\/\/elysiumfuneralplans.com\/nl\/application-form-cyprus\/","title":{"rendered":"Application Form &#8211; Cyprus"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2020\" class=\"elementor elementor-2020\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-939ffcd e-flex e-con-boxed e-con e-parent\" data-id=\"939ffcd\" 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-8c420ac elementor-widget-mobile__width-inherit elementor-widget elementor-widget-heading\" data-id=\"8c420ac\" 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-d7bf4ad gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"d7bf4ad\" 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\/\">\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-a4deea7 gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"a4deea7\" 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-0e15982 gsap-custom-btn elementor-widget elementor-widget-button\" data-id=\"0e15982\" 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\">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 - Cyprus<\/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 gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_7' style='display:none'><style>#gform_wrapper_7[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/nl\/wp-json\/wp\/v2\/pages\/2020' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_189\" 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_7_189'><span class='gform-field-label__text'>Instagram<\/span><\/label><div class='ginput_container'><input name='input_189' id='input_7_189' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_7_189'>Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.<\/div><\/div><div id=\"field_7_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 = $(this);\n            if($section.hasClass('wrapped-already')) return;\n            $section.addClass('wrapped-already');\n            \n            var titleText = $section.find('.gsection_title').text();\n            if(!titleText) titleText = $section.text(); \n            \n            var fieldIdAttr = $section.attr('id') || '';\n            var fieldIdClass = fieldIdAttr ? 'custom-gf-box-' + fieldIdAttr.replace('field_', '') : '';\n\n            var sectionClasses = $section.attr('class') || '';\n            var customClasses = sectionClasses.split(' ').filter(function(c) {\n                return c && \n                       !c.startsWith('gfield') && \n                       !c.startsWith('gsection') && \n                       !c.startsWith('field_') && \n                       c !== 'wrapped-already';\n            }).join(' ');\n\n            var finalClasses = ['custom-gf-box', fieldIdClass, customClasses].filter(Boolean).join(' ');\n\n            var $fields = $section.nextUntil('.gfield--type-section, .gform_footer, .gform_page_footer');\n            var $wrapper = $('<fieldset class=\"' + finalClasses + '\"><\/fieldset>');\n            var $legend = $('<legend class=\"custom-gf-badge\"><\/legend>').text(titleText);\n            \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_7_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_7_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_7_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_7_2' type='text' value='7023C' class='medium'  aria-describedby=\"gfield_description_7_2\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_2'>(Auto fills)<\/div><\/div><div id=\"field_7_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_7_4'><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_4'\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_4'\n\t\t\t\t\tvalue='30\/09\/2026'\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_7_4' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_4' 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_7_4' aria-label='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_7_185\" 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 the Contract: The Company<\/h3><\/div><div id=\"field_7_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\"  ><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        font-style: italic !important;\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_7_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_7_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\">(Vereist)<\/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_7_134'>\n                            <span id='input_7_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_7_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_7_134_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_134_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.3' id='input_7_134_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_134_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_134_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.4' id='input_7_134_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_134_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_134_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_134.6' id='input_7_134_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_134_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_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 in Cyprus<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/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_7_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_7_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_7_1' id='input_7_7_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_7_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_7_2' id='input_7_7_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_7_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_7_3' id='input_7_7_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_7.4' id='input_7_7_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_7_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_7_5' id='input_7_7_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_7_6_container' >\n                                        <select name='input_7.6' id='input_7_7_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' selected='selected'>Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_7_6' id='input_7_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_7_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_7_8'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_8' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_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_7_9'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_7_9' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_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_7_10'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_7_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_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_7_11'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_7_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_12'><span class='gform-field-label__text'>ID (Cyprus Identity Card \/ Other)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_7_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_141'><span class='gform-field-label__text'>PASSPORT ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_7_141' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_13'><span class='gform-field-label__text'>Upload your ID<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_13' id='input_7_13' type='file' class='large' aria-describedby=\"gfield_upload_rules_7_13 gfield_description_7_13\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_7_13'>Toegestane bestandstypen: jpg, jpeg, png, pdf, Max. bestandsgrootte: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_7_13'><\/div> <\/div><div class='gfield_description' id='gfield_description_7_13'>Passport \/ Cyprus Identity Card \/ Other<\/div><\/div><div id=\"field_7_130\" 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_7_130'><span class='gform-field-label__text'>Religion<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_7_130' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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\"  ><p style=\"margin-top:10px\"><strong>Hereinafter referred to as \u201cThe Plan Holder\u201d.<\/strong><\/p><\/div><fieldset id=\"field_7_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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_14'>\n\t\t\t<div class='gchoice gchoice_7_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_7_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_14_0' id='label_7_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_7_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_7_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_14_1' id='label_7_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_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_7_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\">(Vereist)<\/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_7_135'>\n                            <span id='input_7_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_7_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_7_135_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_135_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.3' id='input_7_135_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_135_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_135_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.4' id='input_7_135_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_135_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_135_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_135.6' id='input_7_135_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_135_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_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\">(Vereist)<\/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_7_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_7_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_17_1' id='input_7_17_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_7_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_17_2' id='input_7_17_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_7_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_17_3' id='input_7_17_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_7_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_7_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_17_5' id='input_7_17_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_17_6_container' >\n                                        <select name='input_17.6' id='input_7_17_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' selected='selected'>Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_17_6' id='input_7_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_7_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_7_18'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_18' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_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_7_19'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_19' id='input_7_19' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_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_7_20'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_7_20' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_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_7_21'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_7_21' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_22'><span class='gform-field-label__text'>ID (Passport \/ Cyprus Identity Card \/ Other)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_7_22' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_142'><span class='gform-field-label__text'>PASSPORT ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_7_142' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_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_7_72' type='file' class='large' aria-describedby=\"gfield_upload_rules_7_72 gfield_description_7_72\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_7_72'>Toegestane bestandstypen: jpg, jpeg, png, pdf, Max. bestandsgrootte: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_7_72'><\/div> <\/div><div class='gfield_description' id='gfield_description_7_72'>Passport \/ Cyprus Identity Card \/ Other<\/div><\/div><div id=\"field_7_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_7_143'><span class='gform-field-label__text'>Religion<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_7_143' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_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\">(Vereist)<\/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_7_136'>\n                            <span id='input_7_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_7_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_7_136_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_136_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.3' id='input_7_136_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_136_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_136_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.4' id='input_7_136_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_136_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_136_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_136.6' id='input_7_136_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_136_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_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\">(Vereist)<\/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_7_26' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_26_1_container' >\n                                        <input type='text' name='input_26.1' id='input_7_26_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_26_1' id='input_7_26_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_26_2_container' >\n                                        <input type='text' name='input_26.2' id='input_7_26_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_26_2' id='input_7_26_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_26_3_container' >\n                                    <input type='text' name='input_26.3' id='input_7_26_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_26_3' id='input_7_26_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_26.4' id='input_7_26_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_26_5_container' >\n                                    <input type='text' name='input_26.5' id='input_7_26_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_26_5' id='input_7_26_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_26_6_container' >\n                                        <select name='input_26.6' id='input_7_26_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' selected='selected'>Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_26_6' id='input_7_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_7_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_7_27'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_27' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_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_7_28'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_28' id='input_7_28' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_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_7_29'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_7_29' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_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_7_30'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_7_30' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_31'>\n\t\t\t<div class='gchoice gchoice_7_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_7_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_31_0' id='label_7_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_7_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_7_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_31_1' id='label_7_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_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_7_148\" 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_7_148'><div class='gchoice gchoice_7_148_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.1' type='checkbox'  value='Yes'  id='choice_7_148_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_148_1' id='label_7_148_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_7_149\" 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 7\n    if (form_id == 7) {\n        \n        \/\/ Targets your new Checkbox Field (Field ID 147, Choice 1)\n        var checkboxSelector = '#choice_7_148_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_7_136_2', target: '#input_7_137_2' }, \/\/ Prefix (Dropdown)\n                    { src: '#input_7_136_3', target: '#input_7_137_3' }, \/\/ First Name\n                    { src: '#input_7_136_4', target: '#input_7_137_4' }, \/\/ Middle Name\n                    { src: '#input_7_136_6', target: '#input_7_137_6' }, \/\/ Last Name\n                    { src: '#input_7_26_1',  target: '#input_7_34_1'  }, \/\/ Address Line 1\n                    { src: '#input_7_26_2',  target: '#input_7_34_2'  }, \/\/ Address Line 2\n                    { src: '#input_7_26_3',  target: '#input_7_34_3'  }, \/\/ City\n                    { src: '#input_7_26_5',  target: '#input_7_34_5'  }, \/\/ Zip Code\n                    { src: '#input_7_26_6',  target: '#input_7_34_6'  }, \/\/ Country Dropdown\n                    { src: '#input_7_27',    target: '#input_7_35'    }, \/\/ Date of Birth\n                    { src: '#input_7_28',    target: '#input_7_36'    }, \/\/ Email\n                    { src: '#input_7_29',    target: '#input_7_37'    }, \/\/ Phone\n                    { src: '#input_7_30',    target: '#input_7_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_136.2\"]:checked').val();\n                if(prefixRadioVal) {\n                    jQuery('input[name=\"input_137.2\"][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_7_31 input[type=\"radio\"]:checked').val();\n                if(confirmVal) {\n                    jQuery('#field_7_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_7_137_2', '#input_7_137_3', '#input_7_137_4', '#input_7_137_6',\n                    '#input_7_34_1', '#input_7_34_2', '#input_7_34_3',\n                    '#input_7_34_5', '#input_7_34_6', '#input_7_35',\n                    '#input_7_36', '#input_7_37', '#input_7_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_137.2\"]').prop('checked', false).trigger('change');\n                jQuery('#field_7_39 input[type=\"radio\"]').prop('checked', false).trigger('change');\n            }\n        });\n    }\n});\n<\/script><\/div><fieldset id=\"field_7_137\" 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\">(Vereist)<\/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_7_137'>\n                            <span id='input_7_137_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_137.2' id='input_7_137_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_7_137_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_137_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_137.3' id='input_7_137_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_137_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_137_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_137.4' id='input_7_137_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_137_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_137_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_137.6' id='input_7_137_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_137_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_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\">(Vereist)<\/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_7_34' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_34_1_container' >\n                                        <input type='text' name='input_34.1' id='input_7_34_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_34_1' id='input_7_34_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_34_2_container' >\n                                        <input type='text' name='input_34.2' id='input_7_34_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_34_2' id='input_7_34_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_34_3_container' >\n                                    <input type='text' name='input_34.3' id='input_7_34_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_34_3' id='input_7_34_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_34.4' id='input_7_34_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_34_5_container' >\n                                    <input type='text' name='input_34.5' id='input_7_34_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_34_5' id='input_7_34_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_34_6_container' >\n                                        <select name='input_34.6' id='input_7_34_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' selected='selected'>Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_34_6' id='input_7_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_7_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_7_35'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_35' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_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_7_36'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_36' id='input_7_36' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_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_7_37'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_37' id='input_7_37' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_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_7_38'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_7_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_39'>\n\t\t\t<div class='gchoice gchoice_7_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Yes'  id='choice_7_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_39_0' id='label_7_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_7_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='No'  id='choice_7_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_39_1' id='label_7_39_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_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_7_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 to provide and coordinate the funeral services selected by the Plan Holder, subject to the terms, conditions, inclusions and exclusions contained within this Contract and the applicable Elysium Funeral Plan.<\/p>\n<p>Elysium Funeral Plans SL, hereinafter referred to as \u201cElysium\u201d or \u201cthe Company\u201d, undertakes to:<\/p>\n<ul>\n<li>Organise and coordinate the contracted funeral arrangements.<\/li>\n<li>Coordinate the appointed Cyprus Funeral Director and other necessary service providers.<\/li>\n<li>Coordinate the administrative arrangements necessary for the contracted funeral services.<\/li>\n<li>Arrange the contracted services in accordance with the Plan selected by the Plan Holder.<\/li>\n<li>Use reasonable endeavours to ensure the proper provision of the contracted services when the Plan is called upon.<\/li>\n<\/ul>\n<p>Where the funeral services are to be provided in Cyprus, Elysium will work with an appropriately authorised and\/or licensed local Funeral Director or other appropriate service provider.<\/p>\n<p>The regulated funeral services themselves will be undertaken by the relevant local provider in accordance with the laws and requirements applicable in Cyprus.<\/p><\/div><div id=\"field_7_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 provided by Elysium is limited to the goods and services expressly included within the selected Plan.<\/p>\n<p><strong>2.1 INCLUDED<\/strong><\/p>\n<p>Unless otherwise stated within the selected Plan, the contracted service includes:<\/p>\n<ul>\n<li>Organisation and coordination of the funeral.<\/li>\n<li>Basic funeral services applicable to the Plan selected.<\/li>\n<li>Coordination with the appointed Cyprus Funeral Director.<\/li>\n<li>Administrative coordination relating to the funeral.<\/li>\n<li>Coordination with relevant Cyprus authorities and service providers where required.<\/li>\n<li>Payment of contracted services to the nominated service provider in accordance with the Plan.<\/li>\n<\/ul>\n<p><strong>2.2 EXCLUDED<\/strong><\/p>\n<p>Unless expressly included in the selected Plan, the following are excluded:<\/p>\n<ul>\n<li>Additional flowers or floral tributes.<\/li>\n<li>Obituaries or media notices.<\/li>\n<li>Catering and wakes.<\/li>\n<li>Burial plots or cemetery charges.<\/li>\n<li>Headstones, plaques or memorials.<\/li>\n<li>Cemetery maintenance charges.<\/li>\n<li>Additional municipal, cemetery or crematorium charges not included in the selected Plan.<\/li>\n<li>Additional venue costs.<\/li>\n<li>Additional transportation.<\/li>\n<li>Services provided by a Funeral Director not appointed or authorised by Elysium.<\/li>\n<li>International repatriation unless specifically included in the Unity Plan.<\/li>\n<li>Services, goods or expenses not expressly stated within this Contract.<\/li>\n<\/ul>\n<p>Any additional service requested by the Plan Holder or Next of Kin will be quoted separately and must be paid for before the additional service is provided.<\/p><\/div><div id=\"field_7_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_7_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    .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    .elysium-master-header {\n        background-color: #050058 !important;\n        color: #FFFFFF !important;\n        padding: 30px 24px !important;\n        text-align: center !important;\n        border-bottom: 4px solid #E40B5C !important;\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    .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    .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    .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    .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;\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;\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    .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    .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    .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    .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<\/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 (\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            <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 = 7;\n        const GF_PRICE_FIELD_ID = 104; \n        const GF_PLAN_FIELD_ID = 110;  \n        const GF_PAYTYPE_FIELD_ID = 146;        \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, serviceTypeMode: \"cremation_only\" },\n            clarity: { name: \"The Clarity Plan\", price: 2200, hasInstallments: true, serviceTypeMode: \"choice\" },\n            tranquility: { name: \"The Tranquility Plan\", price: 2950, hasInstallments: true, serviceTypeMode: \"choice\" },\n            serenity: { name: \"The Serenity Plan\", price: 3350, hasInstallments: true, serviceTypeMode: \"choice\" },\n            unity: { name: \"The Unity Repatriation Plan\", price: 7800, hasInstallments: true, serviceTypeMode: \"repatriation_only\" },\n            nonresident: { name: \"The Elysium Non-Resident Plan\", price: 500, hasInstallments: false, serviceTypeMode: \"choice\" }\n        };\n\n        let selectedPlan = '';\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        function saveCalculatorState1() {\n            try {\n                const checkedRadio = document.querySelector('input[name=\"elysium1_payment_type\"]:checked');\n                const state = {\n                    plan: planSelect.value,\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                const hasValidationError = !!document.getElementById('gform_' + GF_FORM_ID + '_validation_container');\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) {\n                        planSelect.value = state.plan;\n                        selectedPlan = state.plan;\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.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 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 (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                    \/\/ 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                saveCalculatorState1();\n                return;\n            }\n\n            if (planLabel) planLabel.textContent = config.name;\n\n            \/\/ Handle Funeral Type (Burial \/ Cremation \/ Repatriation) rules per client specifications\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            updateServiceButtonsUI();\n\n            if (selectedPlan === 'assist') {\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 (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            }\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\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>${formatToEuro(out)}<\/td><\/tr>`;\n            }\n            const body = document.getElementById('elysium1-scheduleBody');\n            if (body) body.innerHTML = html;\n        }\n\n        function sendDataToGF1(balance, m1, m2) {\n            const config = plans[selectedPlan];\n            let price = config.price;\n            \n            const dep = config.hasInstallments ? parseFloat(depositSlider.value) : price;\n            const checkedRadio = document.querySelector('input[name=\"elysium1_payment_type\"]:checked');\n            const choice = checkedRadio ? checkedRadio.value : 'deposit';\n            \n            let amt = (selectedPlan === 'assist' || choice === 'full') ? price : dep;\n            \n            \/\/ Payment selection Dropdown values matching Field ID 145\n            let paymentDropdownValue = \"Deposit Only\";\n            if (selectedPlan === 'assist') {\n                paymentDropdownValue = \"Single Payment\";\n            } else if (choice === 'full') {\n                paymentDropdownValue = \"Full Price Payment\";\n            }\n\n            const plainIntegerPrice = Math.round(amt).toString();\n            const plainIntegerTerm = config.hasInstallments ? termSlider.value.toString() : \"0\";\n\n            const isComma = (window.gf_global && window.gf_global.number_format === 'decimal_comma') || true;\n            const formattedBal = isComma ? balance.toFixed(2).replace('.', ',') : balance.toFixed(2);\n            const formattedM1 = isComma ? m1.toFixed(2).replace('.', ',') : m1.toFixed(2);\n            const formattedM2 = isComma ? m2.toFixed(2).replace('.', ',') : m2.toFixed(2);\n\n            if (window.jQuery) {\n                \/\/ Price\n                window.jQuery(`#input_${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_7_187\" 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_7_187'><span class='gform-field-label__text'>Select preferred monthly payment date:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_187' id='input_7_187' 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_7_101\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_7_101 gfield_product_7_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_7_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_7_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'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_7_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_7_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_7_101 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_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_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_103'><span class='gform-field-label__text'>Funeral Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_7_103' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_114'><span class='gform-field-label__text'>Term (Months)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_7_114' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_104' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_146'><span class='gform-field-label__text'>Payment Selection<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_146' id='input_7_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_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_118'><span class='gform-field-label__text'>Balance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_7_118' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_119' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_120' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_187,\n#field_7_188 {\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_7_187:hover,\n#field_7_188:hover {\n    border-color: #c9d2df !important;\n    box-shadow: 0 6px 18px rgba(8, 0, 95, 0.07) !important;\n}\n\n#field_7_187 .gfield_label,\n#field_7_188 .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_7_187 .gfield_required,\n#field_7_188 .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_7_187 .ginput_container_select,\n#field_7_188 .ginput_container_select {\n    position: relative;\n}\n\n#field_7_187 select,\n#field_7_188 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_7_187 select:focus,\n#field_7_188 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_7_187 select:hover,\n#field_7_188 select:hover {\n    border-color: #08005f !important;\n}\n\n#field_7_187 select option,\n#field_7_188 select option {\n    color: #08005f !important;\n    background: #ffffff !important;\n    font-size: 15px !important;\n}\n\n#field_7_187.gfield_error,\n#field_7_188.gfield_error {\n    background: #fff7fa !important;\n    border-color: #ed0b68 !important;\n}\n\n#field_7_187.gfield_error select,\n#field_7_188.gfield_error select {\n    border-color: #ed0b68 !important;\n}\n\n#field_7_187.gfield_error .gfield_label,\n#field_7_188.gfield_error .gfield_label {\n    color: #08005f !important;\n}\n\n@media (max-width: 767px) {\n    #field_7_187,\n    #field_7_188 {\n        margin: 15px 0 20px !important;\n        padding: 15px !important;\n        border-radius: 9px !important;\n    }\n\n    #field_7_187 .gfield_label,\n    #field_7_188 .gfield_label {\n        font-size: 12px !important;\n        margin-bottom: 9px !important;\n    }\n\n    #field_7_187 select,\n    #field_7_188 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_7_150\" 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_7_184\" 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_7_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\">(Vereist)<\/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_7_151'>\n                            <span id='input_7_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_7_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_7_151_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_151_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.3' id='input_7_151_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_151_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_151_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.4' id='input_7_151_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_151_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_151_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_151.6' id='input_7_151_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_151_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_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\">(Vereist)<\/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_7_152' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_152_1_container' >\n                                        <input type='text' name='input_152.1' id='input_7_152_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_152_1' id='input_7_152_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_152_2_container' >\n                                        <input type='text' name='input_152.2' id='input_7_152_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_152_2' id='input_7_152_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_152_3_container' >\n                                    <input type='text' name='input_152.3' id='input_7_152_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_152_3' id='input_7_152_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_152.4' id='input_7_152_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_152_5_container' >\n                                    <input type='text' name='input_152.5' id='input_7_152_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_152_5' id='input_7_152_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_152_6_container' >\n                                        <select name='input_152.6' id='input_7_152_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_152_6' id='input_7_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_7_153\" 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_7_153'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_153' id='input_7_153' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_154\" 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_7_154'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/jjjj'\n\t\t\t\t\tid='input_7_154'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_154'\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_7_154' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_154' 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_7_154' 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_7_155\" 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_7_155'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_7_155' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_156\" 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_7_156'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_156' id='input_7_156' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_156\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_156'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_7_157\" 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_7_157'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_7_157' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_158\" 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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_158'>\n\t\t\t<div class='gchoice gchoice_7_158_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='Yes'  id='choice_7_158_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_158_0' id='label_7_158_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_7_158_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='No'  id='choice_7_158_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_158_1' id='label_7_158_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_159\" 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_7_160\" 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\">(Vereist)<\/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_7_160'>\n                            <span id='input_7_160_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_160.2' id='input_7_160_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_7_160_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_160_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_160.3' id='input_7_160_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_160_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_160_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_160.4' id='input_7_160_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_160_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_160_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_160.6' id='input_7_160_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_160_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_161\" 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\">(Vereist)<\/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_7_161' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_161_1_container' >\n                                        <input type='text' name='input_161.1' id='input_7_161_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_161_1' id='input_7_161_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_161_2_container' >\n                                        <input type='text' name='input_161.2' id='input_7_161_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_161_2' id='input_7_161_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_161_3_container' >\n                                    <input type='text' name='input_161.3' id='input_7_161_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_161_3' id='input_7_161_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_161.4' id='input_7_161_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_161_5_container' >\n                                    <input type='text' name='input_161.5' id='input_7_161_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_161_5' id='input_7_161_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_161_6_container' >\n                                        <select name='input_161.6' id='input_7_161_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_161_6' id='input_7_161_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_7_162\" 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_7_162'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_162' id='input_7_162' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_163\" 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_7_163'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/jjjj'\n\t\t\t\t\tid='input_7_163'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_163'\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_7_163' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_163' 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_7_163' 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_7_164\" 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_7_164'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_164' id='input_7_164' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_165\" 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_7_165'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_165' id='input_7_165' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_165\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_165'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_7_166\" 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_7_166'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_7_166' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_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 (\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            <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 = 7;\n        const GF_PRICE_FIELD_ID = 106; \n        const GF_PLAN_FIELD_ID = 111;  \n        const GF_PAYTYPE_FIELD_ID = 147;        \/\/ DropDown ID 147 (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, serviceTypeMode: \"cremation_only\" },\n            clarity: { name: \"The Clarity Plan\", price: 2200, hasInstallments: true, serviceTypeMode: \"choice\" },\n            tranquility: { name: \"The Tranquility Plan\", price: 2950, hasInstallments: true, serviceTypeMode: \"choice\" },\n            serenity: { name: \"The Serenity Plan\", price: 3350, hasInstallments: true, serviceTypeMode: \"choice\" },\n            unity: { name: \"The Unity Repatriation Plan\", price: 7800, hasInstallments: true, serviceTypeMode: \"repatriation_only\" },\n            nonresident: { name: \"The Elysium Non-Resident Plan\", price: 500, hasInstallments: 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_' + GF_FORM_ID + '_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.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.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 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 (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                    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                    \/\/ 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                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 (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 (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            }\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\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>${formatToEuro(out)}<\/td><\/tr>`;\n            }\n            const body = document.getElementById('elysium2-scheduleBody');\n            if (body) body.innerHTML = html;\n        }\n\n        \/\/ Send parameters to Gravity Forms inputs\n        function sendDataToGF2(balance, m1, m2) {\n            const config = plans[selectedPlan];\n            let price = config.price;\n            \n            const dep = config.hasInstallments ? parseFloat(depositSlider.value) : price;\n            const checkedRadio = document.querySelector('input[name=\"elysium2_payment_type\"]:checked');\n            const choice = checkedRadio ? checkedRadio.value : 'deposit';\n            \n            let amt = (selectedPlan === 'assist' || choice === 'full') ? price : dep;\n            \n            \/\/ Payment selection Dropdown values matching Field ID 147\n            let paymentDropdownValue = \"Deposit Only\";\n            if (selectedPlan === 'assist') {\n                paymentDropdownValue = \"Single Payment\";\n            } else if (choice === 'full') {\n                paymentDropdownValue = \"Full Price Payment\";\n            }\n\n            const plainIntegerPrice = Math.round(amt).toString();\n            const plainIntegerTerm = config.hasInstallments ? termSlider.value.toString() : \"0\";\n\n            const isComma = (window.gf_global && window.gf_global.number_format === 'decimal_comma') || true;\n            const formattedBal = isComma ? balance.toFixed(2).replace('.', ',') : balance.toFixed(2);\n            const formattedM1 = isComma ? m1.toFixed(2).replace('.', ',') : m1.toFixed(2);\n            const formattedM2 = isComma ? m2.toFixed(2).replace('.', ',') : m2.toFixed(2);\n\n            if (window.jQuery) {\n                \/\/ Price -> Field 106\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PRICE_FIELD_ID}`).val(plainIntegerPrice).trigger('change');\n                \/\/ Plan Name -> Field 111\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PLAN_FIELD_ID}`).val(config.name).trigger('change');\n                \/\/ Dropdown Payment Selection -> Field 147\n                window.jQuery(`#input_${GF_FORM_ID}_${GF_PAYTYPE_FIELD_ID}`).val(paymentDropdownValue).trigger('change');\n                \/\/ Funeral Service Type (Burial \/ Cremation \/ Repatriation) -> Field 109\n                window.jQuery(`#input_${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.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            setTimeout(handlePlanChange2, 300);\n            setTimeout(handlePlanChange2, 800);\n        }\n\n        if (document.readyState === 'loading') {\n            document.addEventListener('DOMContentLoaded', triggerInitialUpdate2);\n        } else {\n            triggerInitialUpdate2();\n        }\n\n        window.addEventListener('load', triggerInitialUpdate2);\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                    loadCalculatorState2();\n                    handlePlanChange2();\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_7_188\" 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_7_188'><span class='gform-field-label__text'>Select preferred monthly payment date:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_188' id='input_7_188' 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_7_107\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_7_107 gfield_product_7_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_7_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_7_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'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_7_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_7_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_7_107 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_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_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_109'><span class='gform-field-label__text'>Funeral Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_7_109' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_115'><span class='gform-field-label__text'>Term (Months)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_7_115' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_106' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_7_147\" 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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_147'><span class='gform-field-label__text'>Payment Selection<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_147' id='input_7_147' 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_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_121'><span class='gform-field-label__text'>Balance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_7_121' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_122' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_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_7_123' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_169\" 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><fieldset id=\"field_7_167\" 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\">(Vereist)<\/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_7_167'>\n                            <span id='input_7_167_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_167.2' id='input_7_167_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_7_167_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_167_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_167.3' id='input_7_167_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_167_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_167_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_167.4' id='input_7_167_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_167_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_167_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_167.6' id='input_7_167_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_167_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_168\" 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\">(Vereist)<\/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_7_168' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_168_1_container' >\n                                        <input type='text' name='input_168.1' id='input_7_168_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_168_1' id='input_7_168_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_168_2_container' >\n                                        <input type='text' name='input_168.2' id='input_7_168_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_168_2' id='input_7_168_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_168_3_container' >\n                                    <input type='text' name='input_168.3' id='input_7_168_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_168_3' id='input_7_168_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_168.4' id='input_7_168_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_168_5_container' >\n                                    <input type='text' name='input_168.5' id='input_7_168_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_168_5' id='input_7_168_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_168_6_container' >\n                                        <select name='input_168.6' id='input_7_168_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_168_6' id='input_7_168_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_7_170\" 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_7_170'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_170' id='input_7_170' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_171\" 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_7_171'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/jjjj'\n\t\t\t\t\tid='input_7_171'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_171'\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_7_171' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_171' 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_7_171' 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_7_172\" 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_7_172'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_172' id='input_7_172' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_173\" 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_7_173'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_173' id='input_7_173' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_173\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_173'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_7_174\" 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_7_174'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_174' id='input_7_174' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_175\" 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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_175'>\n\t\t\t<div class='gchoice gchoice_7_175_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='Yes'  id='choice_7_175_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_175_0' id='label_7_175_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_7_175_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='No'  id='choice_7_175_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_175_1' id='label_7_175_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_176\" 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_7_177\" 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\">(Vereist)<\/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_7_177'>\n                            <span id='input_7_177_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_177.2' id='input_7_177_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_7_177_2' class='gform-field-label gform-field-label--type-sub '>Voorvoegsel<\/label>\n                                                  <\/span>\n                            <span id='input_7_177_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_177.3' id='input_7_177_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_177_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            <span id='input_7_177_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_177.4' id='input_7_177_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_177_4' class='gform-field-label gform-field-label--type-sub '>Middle Name<\/label>\n                                                <\/span>\n                            <span id='input_7_177_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_177.6' id='input_7_177_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_177_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_178\" 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\">(Vereist)<\/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_7_178' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_178_1_container' >\n                                        <input type='text' name='input_178.1' id='input_7_178_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_178_1' id='input_7_178_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_178_2_container' >\n                                        <input type='text' name='input_178.2' id='input_7_178_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_178_2' id='input_7_178_2_label' class='gform-field-label gform-field-label--type-sub '>Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_178_3_container' >\n                                    <input type='text' name='input_178.3' id='input_7_178_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_178_3' id='input_7_178_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_178.4' id='input_7_178_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_7_178_5_container' >\n                                    <input type='text' name='input_178.5' id='input_7_178_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_178_5' id='input_7_178_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_7_178_6_container' >\n                                        <select name='input_178.6' id='input_7_178_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_7_178_6' id='input_7_178_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_7_179\" 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_7_179'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_179' id='input_7_179' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_180\" 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_7_180'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/jjjj'\n\t\t\t\t\tid='input_7_180'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_180'\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_7_180' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_180' 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_7_180' 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_7_181\" 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_7_181'><span class='gform-field-label__text'>Relationship to Plan Holder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_181' id='input_7_181' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_182\" 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_7_182'><span class='gform-field-label__text'>ID No:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_182' id='input_7_182' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_182\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_182'>If you do not have one, write N\/A<\/div><\/div><div id=\"field_7_183\" 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_7_183'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_183' id='input_7_183' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_131\" 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_7_132\" 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\n        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        Alternatively, you may use this section to record any particular elements\n        of your funeral that you would like us to note, such as a\n        <strong>favourite reading, hymn, poem, music or other personal wishes.<\/strong>\n    <\/p>\n\n    <p>\n        You will also receive a separate <strong>Funeral Wishes Sheet<\/strong> with your\n        Welcome Pack, which provides an opportunity to record further details about\n        your funeral wishes.\n    <\/p>\n\n<\/div><\/div><div id=\"field_7_133\" 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_7_133'><span class='gform-field-label__text'>Enter any special requests or instructions<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_133' id='input_7_133' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_7_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 &amp; Performance Clauses<\/h3><\/div><div id=\"field_7_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. EFFECT OF PAYMENT<\/h4>\n<p><strong>3.1 FULL PAYMENT<\/strong><br>Where the Plan has been paid in full, Elysium will provide the contracted services in accordance with the selected Plan, subject to the exclusions within this Contract and circumstances outside the Company\u2019s reasonable control.<br>Additional costs may arise where:<\/p>\n<ul>\n<li>The Plan Holder or Next of Kin requests services outside the Plan.<\/li>\n<li>Additional services are required which are not included within the selected Plan.<\/li>\n<li>Mandatory charges imposed by public authorities arise after the Contract is entered into.<\/li>\n<li>Applicable legislation, regulation or municipal requirements change.<\/li>\n<li>Exceptional circumstances require additional services or costs not contemplated by the Plan.<\/li>\n<\/ul>\n<p><strong>3.2 MONTHLY PAYMENT<\/strong><br>Where the Plan has not been paid in full at the time it is called upon, the outstanding balance must be addressed before Elysium is required to provide the full contracted service.<br>The Next of Kin will be notified of the outstanding balance and the arrangements required to settle it.<br>If the Next of Kin cannot or refuses to settle the outstanding balance, Elysium may decline to provide services beyond the value of payments received, subject to any applicable statutory rights.<br>Where the Contract is terminated due to non-payment, any refund will be subject to the applicable cancellation provisions and administrative charges stated in this Contract.<\/p>\n<h4>4. NON-PAYMENT<\/h4>\n<p>In the event of non-payment:<\/p>\n<ul>\n<li><strong>1 Missed Payment:<\/strong> Elysium will notify the Plan Holder of the missed payment and request that the account be brought up to date.<\/li>\n<li><strong>2 Missed Payments:<\/strong> Elysium will notify the Plan Holder and may place the Plan temporarily on hold until the account is brought up to date.<\/li>\n<li><strong>3 Missed Payments:<\/strong> Elysium will notify the Plan Holder and provide 7 days\u2019 notice to bring the account up to date. If payment is not received within that period, Elysium may terminate the Contract in accordance with the applicable cancellation provisions.<\/li>\n<\/ul>\n<p>If the Plan is called upon while payments remain outstanding, Elysium will not be obliged to provide services exceeding the value of payments received unless the outstanding balance is paid or otherwise agreed in writing.<\/p>\n<h4>5. CONSIDERATION AND CANCELLATION<\/h4>\n<p><strong>5.1 ELYSIUM 21-DAY CONSIDERATION PERIOD<\/strong><br>Elysium provides a 21-calendar-day consideration period from the date on which this Contract is signed. Day 1 of the Elysium consideration period is the date on which this Contract is signed.<br>During this period, the Plan Holder may request cancellation in accordance with the Elysium Terms and Conditions and receive a refund of monies paid in accordance with the applicable refund procedure.<\/p>\n<p><strong>5.2 STATUTORY CONSUMER WITHDRAWAL RIGHTS<\/strong><br>Nothing in this Contract removes, restricts or replaces any mandatory statutory consumer rights which apply to the Plan Holder. Where this Contract qualifies as a distance contract or an off-premises contract under applicable Cyprus consumer legislation, the Plan Holder may have a statutory 14-day right of withdrawal, subject to any applicable statutory exceptions (CyLaw). The Elysium 21-day consideration period is intended to provide an additional contractual consideration period and is not intended to reduce any statutory consumer right.<\/p>\n<p><strong>5.3 AFTER THE CONSIDERATION PERIOD<\/strong><br>After the applicable consideration period, cancellation will be dealt with in accordance with the Elysium Terms and Conditions and applicable law. Standard Elysium administrative\/cancellation fee: \u20ac495, where applicable.<\/p>\n<h4>6. LIABILITY AND THIRD-PARTY SERVICE PROVIDERS<\/h4>\n<p>Elysium is responsible for coordinating the contracted funeral plan. Elysium may use appropriately authorised or licensed third-party service providers, including Cyprus Funeral Directors, crematoria, cemeteries, transport providers and other funeral service providers.<\/p>\n<p>Where regulated funeral services are provided in Cyprus, those services will be performed by the relevant local provider in accordance with applicable Cyprus requirements. Elysium will use reasonable care in selecting and coordinating its appointed service providers.<\/p>\n<p>Elysium will not be responsible for delays or additional costs caused by decisions of public authorities, documentation delays, police\/medical examiner requirements, transport disruption, changes in law or circumstances beyond the Company's reasonable control.<\/p>\n<h4>7. FINANCIAL PROTECTION<\/h4>\n<p>Payments made by the Plan Holder to Elysium are intended to meet the obligations arising from the contracted funeral plan. The funds relating to the Company\u2019s funeral plan arrangements are managed in accordance with Elysium Funeral Plans SL\u2019s financial protection arrangements, currently including management through a ring-fenced arrangement with Amundi Group.<\/p>\n<p>When a Plan is called upon in Cyprus, Elysium will use the funds available under the Plan to arrange and settle the contracted services with its nominated Cyprus Funeral Director and\/or other contracted service providers.<\/p><\/div><div id=\"field_7_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_7_93\" 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>Unattended cremation at an appointed crematorium.<\/li>\n    <li>Cremation fee.<\/li>\n    <li>Appointed Funeral Director attending to all the necessary arrangements for the unattended cremation.<\/li>\n    <li>Collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in mainland Cyprus to a mortuary within mainland Cyprus.<\/li>\n    <li>Preparation and care of the deceased at the allocated mortuary (including full hygienic treatment and removal of pacemaker, where required).<\/li>\n    <li>Supply of a simple coffin \u2013 suitable for cremation.<\/li>\n    <li>Supply of a simple urn.<\/li>\n    <li>Return of ashes directly to the family in Cyprus.<\/li>\n    <li>24-hour bereavement line with English speaking operators.<\/li>\n    <li>National &amp; International death certificate.<\/li>\n    <li>Cremation certificate to allow ashes to be taken on board an aircraft, where appropriate.<\/li>\n<\/ul>\n\n<h5>THE ELYSIUM ASSIST PLAN \u2013 WHAT IS NOT INCLUDED<\/h5>\n<ul>\n    <li>Privilege Collections<\/li>\n    <li>Any services for a Funeral Director not appointed by Elysium.<\/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, including the costs associated with catering for the funeral guests.<\/li>\n    <li>Any 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>Repatriation from outside Cyprus.<\/li>\n    <li>Transfer to or from mainland Cyprus.<\/li>\n    <li>Audio or visual equipment.<\/li>\n    <li>Travel or transport costs.<\/li>\n    <li>Any other goods or services not listed in the inclusions section.<\/li>\n<\/ul><\/div><div id=\"field_7_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>CLARITY PLAN \u2013 WHAT IS INCLUDED<\/h5>\n<p>The Clarity Plan provides a direct cremation service through an Elysium-appointed Cyprus Funeral Director. The Plan includes:<\/p>\n<ul>\n<li>Appointment of a Cyprus Funeral Director.<\/li>\n<li>Necessary administrative coordination.<\/li>\n<li>Collection and transportation of the deceased within the Republic of Cyprus, subject to the Plan terms.<\/li>\n<li>Transfer to an appointed mortuary.<\/li>\n<li>Preparation and care of the deceased as required.<\/li>\n<li>Simple coffin suitable for cremation.<\/li>\n<li>Cremation fee.<\/li>\n<li>Simple urn.<\/li>\n<li>Return of ashes to the family in Cyprus.<\/li>\n<li>Required funeral documentation.<\/li>\n<li>Cremation documentation where applicable.<\/li>\n<li>24-hour bereavement line with English-speaking operators.<\/li>\n<\/ul>\n<h5>CLARITY PLAN \u2013 WHAT IS NOT INCLUDED<\/h5>\n<ul>\n<li>Services provided by a Funeral Director not appointed by Elysium.<\/li>\n<li>Face-to-face appointments beyond those provided by the appointed provider.<\/li>\n<li>Viewing of the deceased.<\/li>\n<li>Dressing of the deceased in personal clothing or inclusion of personal items in the coffin.<\/li>\n<li>Family attendance at the crematorium unless specifically included.<\/li>\n<li>A service at the crematorium.<\/li>\n<li>Church, religious or humanist ceremony costs unless specifically included.<\/li>\n<li>Additional mortuary storage.<\/li>\n<li>Choice of cremation date, time or location where unavailable or subject to additional charges.<\/li>\n<li>Wake or catering.<\/li>\n<li>Obituary notices.<\/li>\n<li>Flowers or floral tributes.<\/li>\n<li>Interment or alternative placement of ashes.<\/li>\n<li>Cemetery or memorial charges.<\/li>\n<li>Headstones, plaques or memorials.<\/li>\n<li>Repatriation outside Cyprus.<\/li>\n<li>Travel or transportation costs for family members or funeral guests.<\/li>\n<li>Audio or visual equipment.<\/li>\n<li>Any other goods or services not expressly included.<\/li>\n<\/ul><\/div><div id=\"field_7_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<h5>TRANQUILITY PLAN \u2013 WHAT IS INCLUDED<\/h5>\n<ul>\n<li>An Elysium-appointed Cyprus Funeral Director attending to the necessary funeral arrangements.<\/li>\n<li>Advice regarding certification and registration of the death.<\/li>\n<li>Collection and transportation of the deceased from a residence, care home, hospital or other permitted resting place within the Republic of Cyprus to the mortuary.<\/li>\n<li>Care and preparation of the deceased at the funeral home.<\/li>\n<li>Simple wood-effect coffin suitable for burial or cremation.<\/li>\n<li>Up to 4 days in the Chapel of Rest\/mortuary facilities, subject to local availability and the terms of the Plan.<\/li>\n<li>Up to 1 day allowing family and friends to pay their respects, where available.<\/li>\n<li>Transportation of the deceased to the appointed crematorium or chosen cemetery.<\/li>\n<li>Cremation fee where cremation is selected.<\/li>\n<li>Death certificate documentation where applicable.<\/li>\n<li>Simple urn where cremation is selected.<\/li>\n<li>Cremation documentation where applicable.<\/li>\n<li>24-hour bereavement line with English-speaking operators.<\/li>\n<li>Applicable Privilege Collection selected under the Plan.<\/li>\n<\/ul>\n<h5>TRANQUILITY PLAN \u2013 WHAT IS NOT INCLUDED<\/h5>\n<ul>\n<li>Funeral Director services not appointed by Elysium.<\/li>\n<li>Costs associated with a religious, humanist or other funeral ceremony unless expressly included.<\/li>\n<li>Additional venue costs.<\/li>\n<li>Wake and catering.<\/li>\n<li>Obituary notices.<\/li>\n<li>Additional flowers or floral tributes.<\/li>\n<li>Burial plot or cemetery charges.<\/li>\n<li>Headstone, memorials or associated stonework.<\/li>\n<li>Cemetery maintenance.<\/li>\n<li>Gifts or charitable donations unless included within the applicable Privilege Collection.<\/li>\n<li>Transportation of funeral guests.<\/li>\n<li>Hymn cards or orders of service unless included.<\/li>\n<li>Audio or visual equipment.<\/li>\n<li>Interment or alternative distribution of ashes.<\/li>\n<li>Repatriation outside Cyprus.<\/li>\n<li>Transfers between Cyprus and another country unless specifically included.<\/li>\n<li>Additional viewing beyond that included within the Plan.<\/li>\n<li>Any other goods or services not expressly included.<\/li>\n<\/ul><\/div><div id=\"field_7_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>SERENITY PLAN \u2013 WHAT IS INCLUDED<\/h5>\n<ul>\n<li>An Elysium-appointed Cyprus Funeral Director attending to the necessary arrangements before and on the day of the funeral.<\/li>\n<li>Advice regarding certification and registration of the death.<\/li>\n<li>Collection and transportation of the deceased from a residence, care home, hospital or other permitted resting place within the Republic of Cyprus to the mortuary.<\/li>\n<li>Care and preparation of the deceased.<\/li>\n<li>Quality veneered coffin suitable for burial or cremation.<\/li>\n<li>Minister or celebrant for the funeral service where included.<\/li>\n<li>Relevant funeral staff required to conduct the funeral service.<\/li>\n<li>Cremation fee where cremation is selected.<\/li>\n<li>Up to 5 days in the Chapel of Rest\/mortuary facilities, subject to local availability and the terms of the Plan.<\/li>\n<li>Up to 1 day allowing family and friends to pay their respects, where available.<\/li>\n<li>Transportation of the deceased to the appointed cemetery or crematorium.<\/li>\n<li>Death certificate documentation where applicable.<\/li>\n<li>24-hour bereavement line with English-speaking operators.<\/li>\n<li>Small floral tribute.<\/li>\n<li>Simple urn where cremation is selected.<\/li>\n<li>Cremation documentation where applicable.<\/li>\n<li>Applicable Privilege Collection selected under the Plan.<\/li>\n<\/ul>\n<h5>SERENITY PLAN \u2013 WHAT IS NOT INCLUDED<\/h5>\n<ul>\n<li>Funeral Director services not appointed by Elysium.<\/li>\n<li>Additional venue costs.<\/li>\n<li>Church or religious venue costs unless expressly included.<\/li>\n<li>Wake or catering.<\/li>\n<li>Obituary notices.<\/li>\n<li>Additional flowers or floral tributes.<\/li>\n<li>Burial plot or cemetery charges.<\/li>\n<li>Headstones, memorials or associated stonework.<\/li>\n<li>Cemetery maintenance.<\/li>\n<li>Gifts or charitable donations unless included within the applicable Privilege Collection.<\/li>\n<li>Transportation of funeral guests.<\/li>\n<li>Hymn cards or orders of service unless included.<\/li>\n<li>Audio or visual equipment.<\/li>\n<li>Interment or alternative distribution of ashes.<\/li>\n<li>Repatriation outside Cyprus unless specifically included.<\/li>\n<li>Transfers between Cyprus and another country unless specifically included.<\/li>\n<li>Additional viewing beyond the period included within the Plan.<\/li>\n<li>Any other goods or services not expressly included.<\/li>\n<\/ul><\/div><div id=\"field_7_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<h5>UNITY REPATRIATION PLAN \u2013 WHAT IS INCLUDED<\/h5>\n<p>The Unity Repatriation Plan is intended to coordinate the repatriation of the deceased from the Republic of Cyprus to the United Kingdom or another agreed destination, subject to the destination being available under the Plan. The Plan includes:<\/p>\n<ul>\n<li>Coordination of legal and administrative formalities required for repatriation from Cyprus.<\/li>\n<li>Liaison with the Cyprus Funeral Director.<\/li>\n<li>Liaison with the Elysium-appointed Funeral Director in the receiving country.<\/li>\n<li>Supervision and coordination of the repatriation process.<\/li>\n<li>Appointed Funeral Director in Cyprus attending to necessary arrangements up to delivery of the coffin for transportation.<\/li>\n<li>Appointed Funeral Director in receiving country attending to arrangements following receipt of the deceased.<\/li>\n<li>Advice regarding certification and registration of the death.<\/li>\n<li>Collection and transportation of the deceased within Cyprus to the mortuary.<\/li>\n<li>Care and preparation of the deceased for transportation.<\/li>\n<li>Up to 4 days\u2019 mortuary expenses in Cyprus, subject to the Plan.<\/li>\n<li>Coffin suitable for transportation.<\/li>\n<li>Transportation to the departure airport.<\/li>\n<li>Transportation\/flight of the deceased to the receiving country where included.<\/li>\n<li>Receipt of the deceased by the Elysium-appointed Funeral Director in the receiving country.<\/li>\n<li>Contribution towards basic funeral service in receiving country (\u20ac1,000 \/ GBP equivalent).<\/li>\n<li>24-hour bereavement line with English-speaking operators.<\/li>\n<\/ul>\n<h5>UNITY REPATRIATION PLAN \u2013 WHAT IS NOT INCLUDED<\/h5>\n<ul>\n<li>Services provided by a Funeral Director not appointed by Elysium without prior written authorisation.<\/li>\n<li>Additional venue costs, wake, catering, obituaries, or flowers.<\/li>\n<li>Burial plot or cemetery charges, headstones or memorials.<\/li>\n<li>Transportation of funeral guests or viewing facilities unless included.<\/li>\n<li>Additional airport handling charges, transport costs, or authority fees outside the Plan.<\/li>\n<\/ul><\/div><div id=\"field_7_138\" 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_7_128\" 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\">Cyprus Specific Provisions &amp; Legal Framework<\/h3><\/div><div id=\"field_7_129\" 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. CYPRUS-SPECIFIC FUNERAL PROVISIONS<\/h4>\n<p><strong>9.1 APPOINTED CYPRUS FUNERAL DIRECTOR:<\/strong> Where the Plan is being provided in Cyprus, Elysium will appoint an appropriately licensed, authorised or otherwise legally qualified local Funeral Director or funeral service provider to provide the regulated local funeral services.<\/p>\n<p><strong>9.2 DEATH REGISTRATION:<\/strong> Where a death occurs in Cyprus, the death is registered with the Registrar of the district in which the death occurred. An original medical death certificate is required for registration and a death certificate is issued following registration.<\/p>\n<p><strong>9.3 CREMATION:<\/strong> Where cremation is selected, Elysium will coordinate the service through an appropriate local provider and facility, subject to the availability of the service and compliance with applicable Cyprus law and requirements.<\/p>\n<p><strong>9.4 BURIAL:<\/strong> Where burial is selected, Elysium will coordinate the contracted burial services through the appointed Funeral Director. The Plan does not include the purchase or concession of a burial plot unless expressly stated.<\/p>\n<h4>10. REPATRIATION FROM CYPRUS<\/h4>\n<p>Where the Plan includes repatriation, Elysium will coordinate with the appointed Cyprus Funeral Director and the Funeral Director in the receiving country in accordance with Cyprus Government guidance. Certified cremation documentation applies for transfers of cremated remains.<\/p>\n<h4>11. GEOGRAPHICAL COVERAGE<\/h4>\n<p>This Contract applies to funeral services within the Republic of Cyprus. Services in areas outside the effective jurisdiction of the Republic of Cyprus (including the northern part of the island) and transfers across the island are excluded unless specifically agreed in writing.<\/p><\/div><div id=\"field_7_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_7_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>12. SOCIAL CONTRIBUTIONS - (NON-CONTRACTUAL)<\/h4>\n<p>Elysium may, at its discretion: Make donations to charitable causes \/ Plant trees \/ Provide other social or environmental contributions.<br>These activities are voluntary and do not form part of the contracted funeral service unless specifically stated as a contractual benefit within the selected Plan or Privilege Collection.<\/p><\/div><div id=\"field_7_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_7_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_7_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_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>13. DATA PROTECTION<\/h4>\n<p>Personal information supplied by the Plan Holder will be processed by Elysium Funeral Plans SL in accordance with applicable data protection legislation, including: General Data Protection Regulation (GDPR), Spanish Organic Law 3\/2018 (where applicable), and applicable Cyprus data protection requirements.<\/p>\n<h4>14. APPLICABLE LAW, CONSUMER RIGHTS AND DISPUTE RESOLUTION<\/h4>\n<p>This Contract is entered into by Elysium Funeral Plans SL. The contractual relationship shall be interpreted subject to applicable laws including Spanish, European, and mandatory Cyprus legislation applicable to funeral services.<\/p>\n<h4>15. COMPLAINTS<\/h4>\n<p>Any complaint regarding the Contract or provision of contracted services should initially be made to Elysium Funeral Plans SL via email: clientcare@elysiumfuneralplans.com.<\/p>\n<h4>16. FORCE MAJEURE AND EXCEPTIONAL CIRCUMSTANCES<\/h4>\n<p>Elysium will not be responsible for failure or delay in providing a contracted service where such failure or delay arises from circumstances beyond its reasonable control.<\/p>\n<h4>17. CHANGES TO THE CONTRACT<\/h4>\n<p>No material amendment to this Contract shall be effective unless agreed in writing by the Company and the Plan Holder.<\/p>\n<h4>18. ENTIRE AGREEMENT<\/h4>\n<p>This Contract, together with the applicable Elysium Terms and Conditions and selected Plan documentation, represents the entire agreement between the parties.<\/p>\n<h4>19. PLAN HOLDER DECLARATION AND ACCEPTANCE<\/h4>\n<p>The Plan Holder declares that they have read, understood, and agreed to all 16 items of declaration outlined in Section 21 of this Contract.<\/p><\/div><div id=\"field_7_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\">20. SIGNATURES<\/h3><\/div><fieldset id=\"field_7_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\">(Vereist)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_58' id='input_7_58_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_7_58_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_7_58_data' name='input_7_58_data' class='gfield_signature_data' \/><canvas id=\"input_7_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_7_58_textinput' name='input_7_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_7_58_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_7_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_7_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_7_58_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_7_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_7_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_7_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_7_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_7_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_7_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_7_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_7_59'><span class='gform-field-label__text'>PLAN HOLDER 1: NAME<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_7_59' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_60'><span class='gform-field-label__text'>PLAN HOLDER 1: DATE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_60' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_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\">(Vereist)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_61' id='input_7_61_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_7_61_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_7_61_data' name='input_7_61_data' class='gfield_signature_data' \/><canvas id=\"input_7_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_7_61_textinput' name='input_7_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_7_61_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_7_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_7_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_7_61_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_7_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_7_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_7_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_7_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_7_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_7_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_7_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_7_62'><span class='gform-field-label__text'>PLAN HOLDER 2: NAME<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_7_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_63'><span class='gform-field-label__text'>PLAN HOLDER 2: DATE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/jjjj'\n\t\t\t\t\tid='input_7_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_7_63' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_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_7_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_7_145\" 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_7_139\" 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_7_139'><span class='gform-field-label__text'>Associate Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_139' id='input_7_139' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_139\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_139'>Please leave blank if not known:<\/div><\/div><div id=\"field_7_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\">FOR ELYSIUM FUNERAL PLANS SL \u2013 OFFICE USE ONLY<\/h3><\/div><fieldset id=\"field_7_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_7_65_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_7_65_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_7_65_data' name='input_7_65_data' class='gfield_signature_data' \/><canvas id=\"input_7_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_7_65_textinput' name='input_7_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_7_65_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_7_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_7_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_7_65_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_7_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_7_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_7_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_7_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_7_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_7_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_7_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_7_66'><span class='gform-field-label__text'>NAME<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_7_66' type='text' value='Elisa Belinda Summers' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_67'><span class='gform-field-label__text'>POSITION<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_7_67' type='text' value='Director' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_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_7_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_7_68' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_68\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_68'>Office Only<\/div><\/div><div id=\"field_7_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_7_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_7'><span class='gform-field-label__text'>Coupon<\/span><\/label><div class='ginput_container' id='gf_coupons_container_7'><div class='ginput_container_coupon'><input id='gf_coupon_code_7' class='gf_coupon_code' onkeyup='DisableApplyButton(7);' onchange='DisableApplyButton(7);' onpaste='setTimeout(function(){DisableApplyButton(7);}, 50);' type='text'    \/><input type='button' disabled='disabled' onclick='ApplyCouponCode(7);' value='Toepassen' 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='even wachten'\/><\/div><div id='gf_coupon_info'><\/div><input type='hidden' id='gf_coupon_codes_7' name='input_127' value=''  \/><input type='hidden' id='gf_total_no_discount_7'\/><input type='hidden' id='gf_coupons_7' name='gf_coupons_7' value='' \/><\/div><\/div><div id=\"field_7_126\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_7_ gfield_total gfield_total_7_ 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_7_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_7_126' value='0,00 &#8364;' class='gform-text-input-reset ginput_total ginput_total_7' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_7_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\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_144'>\n\t\t\t<div class='gchoice gchoice_7_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_7_144_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_144_0' id='label_7_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_7_144_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_144' type='radio' value='Pay using Card'  id='choice_7_144_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_144_1' id='label_7_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_7_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_7_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_7_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_7_117'><div class='ginput_full gform-grid-col' id='input_7_117_1_container' data-payment-element='true'><div id='input_7_117_1' class='StripeElement--payment-element'><\/div><\/div><!-- .ginput_full --><\/div><!-- .ginput_container --><div class=\"gfield_description validation_message gfield_validation_message\">Configuratie vereist: om het Stripe veld te gebruiken, configureer je <a href=\"\" target=\"_blank\">Stripe instellingen<\/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_7' 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_7' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_7' id='gform_theme_7' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_7' id='gform_style_settings_7' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_7' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='7' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='HDyDWRAR4q76Jd7W+VRnxbyPLfD6dQFtThLXQ5wthokZP+QnKrj0Jj39ugg8Mr29vLPIh4NxpLedmknwvYqfDn44lciM006udszUP+lNJTdkpyU=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_7' value='["{\"134.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"135.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"136.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"148.1\":\"bac26c4067edc4d233c95d0e857471bf\",\"137.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"187\":[\"cd36b21f870c1a0b4e2061a178022d89\",\"bb67716376a1343d1c804faf967601c2\",\"5f723cd0a141acad9efd1ab636d36593\",\"511e8d9feda359014f65dceda20631e8\"],\"101.1\":\"c3ce84f809a3ae07a694b04e714595f2\",\"110\":[\"806b638becb51c4dcc2d2700403381a2\",\"dd02d3a70f0899c63cd04e7dbaff7e8f\",\"94c0971fd8ba211edc0596e421665729\",\"6e4f2f12379e6dcb3f7243a9794febd0\",\"a80eb461e40181fdced3835b097c6aab\",\"bf70bd76c3c454b031288c11a7f51756\"],\"146\":[\"4c86c039a2b12578f468c0cf285a0a22\",\"c8c3ceb13ddbc15d2a6a9e9f8bc38b1f\",\"cc588965216ae2454fedff7362222453\"],\"151.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"152.6\":[\"739b5d11f818274e47cb05d27d84b5dd\",\"bfb87b712909c3fd401b8c0090600111\",\"d5a7cdb648b8a7b696f29525afa5ae14\",\"dec46e659618af79f3579a1faa1ba8db\",\"46a63d8d3d0ba26bc9e12ffa86251452\",\"cccca9de67dece862ac02e6428511c6b\",\"8cc854237bced1733a211f336ed8bd8d\",\"8d1c4a6ec3a1c10d2ecb1e992ae5eb90\",\"1bd4ab4ba6bcc46bc6f75396b1129e1b\",\"9d7516d6e713a6e658cbffbec9ea91e5\",\"2fffe250798cda7659c5e2725b3a61c3\",\"8c47352fa8295760674e4d348576bfd5\",\"ba398040811a0635a078f414270fe2dd\",\"36917e14c4820698d82ee52515e33b38\",\"a292c8056f326ade7b3bd2df4ecc0c31\",\"80b193876d81fe614d26bb47c621c245\",\"8790e2672db8081565ecc91254a7585b\",\"563598d3ed44157d1adebf3a587e44ff\",\"00f5d16cba25e04e4ea5f0d986655b82\",\"7a17164ef52ec810ae27beebbf6c03a3\",\"7df15eb403c526a3fdaebab225fb05e0\",\"1dfe3436e09bdd82ea969a4a4b7b27d9\",\"74eb56c7e692d9000eef3244bb23fbcc\",\"d0fc3bc2a7f8025c29b4bf12342629e6\",\"c04343c837d9982cdf3b3df242e5bfc8\",\"0ad6157fb694987235f1bd3430d201d9\",\"07f5e4ca8060ba20068649743956fb79\",\"8b4a98b19c6cea8dee14a10f52aad790\",\"2bda5e3317f6f174f5f5112b766d2cdc\",\"22d27dad19b896166edd94a173def516\",\"d1b84c152556747b884a38d1b5dcb1db\",\"bb1ebcd0c42980dbbeb13ea90ac9a533\",\"ef680eb80dd452e35b1b73af41ac4e30\",\"6d200d9bc6211a0f9ea739000168f2dc\",\"61301c2e6bf7633155b148a757d61d83\",\"a8d839302fdc571d49f12cc7922056b1\",\"834d310bdc0dad274167c813e15930be\",\"8be0f9632c5ff7a8f9a446a5889cdf6f\",\"627cc398cd0384fc03e8c58969468894\",\"0526f60b2ac8047d811d40fc5af9b358\",\"9ff8febd071ef3576882e84604bcfa88\",\"475f37b386f51c851557303d26016a50\",\"c3126a550816da80bcd30cea11c56c98\",\"2706ec9476acb8689addbdfe42d01613\",\"d3254d57bfb4d3ba3964265e0cff30b7\",\"6336a315da77015e8673f48c713f6147\",\"73214cf2219a9d060a7089476b339508\",\"a2e4d16ec30e73faf498121e842c2226\",\"67746f0c1ee5c440a2194aad48aee608\",\"6eaa68c7c55006a0a5d1dbc16737442e\",\"96ac8322e621f4d323974f06fd8727d3\",\"b9840e97deca4255c1f634d617b52a7e\",\"62c46c20b05b615a7ef852931f8079e0\",\"ef7d2d47e4466a0141c874d69d84395c\",\"91812caa37ac8c4a0ba06e44ea250e9a\",\"6b696d6f4441fafa5a0ce301f03489c5\",\"aba2539f5629720fcd2f74bc911c27d1\",\"526640159281e3f52c7e7247595de7dd\",\"909c38ca5306c8b2ea1c0a9ffcf14527\",\"bd9cdd86e842c2cec78d702e012904cb\",\"03e8d174c52f1f5b3077e1b653c174ba\",\"05847a6664943fbb16d39c0ddb7fac9c\",\"f4081d5da3b7c745740c19369f57c4fb\",\"d4bc000b5ddc2844d1fb2f38dfa8d2af\",\"ec9d0c43afe2bdccc2a2b8c32eaeecb4\",\"a5a48d0703e3fb7f9a9f0ef1d50c1527\",\"89ad1258aa10a3664daab44d4d52cd4c\",\"15c6bc3d30b1fb794d3c042e5a5e589f\",\"549b9b17ca76b060699dfaca5c70754b\",\"be09b769df9694502bec4222b0532895\",\"896d3e3e95c8471d10cb1d27aabfc556\",\"0f130ba7e9d1cd95e16e4e2f96bd25f5\",\"a55ad547f4be2fe0f60dd22cbdb6675a\",\"c5ba682819e42f2eed0c978fa627ae2d\",\"1efba445fa680c2244b9ca0594450cdc\",\"8c38e04d3b422605777cdbf8ba086651\",\"e335c163f1b11cda232749b1343154eb\",\"8777c8d322e96d588669f35a59d3f51c\",\"c0b3535f02553e7be12199e845f34cee\",\"b18b23b6491792aa25dfb817b3316c50\",\"79ede5ba04d9fdae680a87971c760a4f\",\"483d54fff129a4c84286be3cdb708970\",\"474e61713d58f3050d45c52fb5e55da2\",\"cdffc7799583c1ddf68ec9d3b29cbc13\",\"76eb05899c1ebc38d286c1f32c661753\",\"3420354eb0279ecd88f457e436507015\",\"31b366f0589f2661522f4a82daf657f8\",\"3e3578c95d8124137eb535a7619e4d69\",\"069ce0d56e3d4572e1f550dcd242d6ff\",\"36d5907baaa266994ebbd49f173914c8\",\"eb77677818568d0b3a9b67f1625ab9a3\",\"a9d1a77660f05b278905ef92866273bb\",\"976d2323b45a2c51fb8c2b564a5e92ef\",\"13ffa5f57e8b5ee33bae3fd2bc601040\",\"59de4f9ef3b11c54a17a9ea0e43fa713\",\"0028e0c56617d2e36277dd2e342116cc\",\"b0f60ae7c536f974260698dfeec2b78f\",\"dab7a39ace861370d6753279df1c0bd1\",\"286c2597584f2975865e6a83d0776369\",\"286d228018f0c0b615c4a568514bf347\",\"b2ef18e0a5ff94d37610de53a0ec951e\",\"84b358ec24129315a3acdb6a165b840b\",\"bd4f3c6f45b6f3a971c82b4b0476231a\",\"f4e1a684ebba72aac5e2e1d9aaf0aeb7\",\"c52eb9ffd8a28247565b02cb1d123213\",\"4043410627ecb13ef9d3456886aa6dda\",\"4d79d3b7acca084578ceb3ba31dbdafb\",\"9ef274e042411c2e16e26b89b9e22170\",\"db8f06616911faa9c68e5047cdac4c17\",\"d79b2d0eecf13f2263c50757c6a291d7\",\"4d3920a845a8142d27876a43a1049fab\",\"e30b6052db51fca80402e4f5e24b9c37\",\"4b815495f216af14ec40dcce18350784\",\"859723a3e401929bd3ad7fb614c8ccf4\",\"837b9c0e2b7e0314632ecf1d1509ef2d\",\"31a0c73fe55906582c037d00167db38a\",\"a4bd5f53651c22c941172fe364932a85\",\"1da2ef3f76e46e44d47e9fdb66ad516d\",\"8f9f0353677982860b0183a015aa5d26\",\"7cc35f8def95ac685c82da580c7dc488\",\"82c45508196d16a013eef19b9c3a7fa1\",\"245a62b37bb87c3c9e80a10035886dce\",\"5db32648935bb4df75b8e63126589a5e\",\"bc0c9be4a94631b6fc0ff52515993ab9\",\"ca2bcb7e382165bef8b9735cf60e7652\",\"d9736914ad032cc88a1f27d9618e5f0d\",\"945cd07c15b679e1f1b011ce68831854\",\"351b8cb32fca6570d3f79887c0e51460\",\"1622e4573a00665fe433d57d1f4fdbc5\",\"dabf4f4bc70347e0eb1a11ab8f100d8f\",\"25d7b550dc473056a30934b4a1bdefa7\",\"dbe45f4e73ef66869117da4c73797e2f\",\"69b21d15fe925d8cb2375d56b4df5c95\",\"28529529c24473f9b158a3a697547efb\",\"db2cdb180d6409618ec717707520d243\",\"2f22dd1ae20db18364dca50b5d8b7718\",\"04a7aea5ffc00f283176f93196e87cc8\",\"1caa015e3d3152b1f5b2187af1e3c9e7\",\"716542f654f0913bcb8a9cf6ae048de1\",\"a448c4f29d229013c4be91bcda2f1737\",\"38f6abee8a5892be3496d47de0ee1ba8\",\"8ce026edaf119399abba0a275b5176c8\",\"6addcc72c6e63322b3bc7aa27eddb8e5\",\"af462e75e52425ead9f05d3d0e2dcacb\",\"ebd49bde9e87a966952ec491c3519e19\",\"7b8bd7d7062d746d8d646a45813cc175\",\"a7ec568c053708fc6425e5e443ad3b61\",\"1b43fc8e41f961b4ccd1242051255987\",\"f8e850b8e825506327e7eff549827316\",\"15dd5fcd674edab3d47b45ebbfaf5b33\",\"5fd18281b58c343007259b1c8a404f38\",\"68d3a8352cc6fef690de39650857a1d8\",\"98acbf8f37b703536aa1959dea08a66e\",\"8e470d15a8c9a1c88445b88ff315b648\",\"137b087439de01b9c37e2e664074d02e\",\"0fc2e98fdd1b4f7ea779d6e185ea2944\",\"d5f30b2fa638b4a073caf809c6054d1c\",\"f85e78745aab49b199a632820a2d7528\",\"2fae9c575f3fca9d9a036f617da2ebd7\",\"173e6e28680e1ed40cd3019304f8ba3a\",\"14d4249b5fa987678deaaf6a29d365f0\",\"60651c9542d8d1c84334f0fe9e77a765\",\"40b97a7490f527dee651f35a0949b79e\",\"b32803fdcda5d76aab9809f897eb4b80\",\"225d5a424d15c6c418b2b15bebf0aea0\",\"cbcf6dc5a3d683d94a669c17b26670a0\",\"438513f79bc1c298950f2c18eb3ed521\",\"ed3f4e625e13552795f93054c3b519e1\",\"476db47d33ea32c37684643672a60a92\",\"13333d6777d97694d2c9342010d3decf\",\"b693c429a7814b1910fbf20a1130a4dd\",\"3b036d9ba95b11c654280f44ec5b9d81\",\"78582d6158e455f07e96873365c867f9\",\"bbdc5addc5b58d98ce48848a2a3dee61\",\"62e5abe4fa43d5b41e724b7b8dedabac\",\"53106711d65fcabf604f024abf33b126\",\"77c7010ae1d8a70f9e3dcc1a33f222bb\",\"af3ceeb0908302ffe1bd09d70d0b30fd\",\"c3978361ff07e876a012c0d4b10b0e43\",\"06c98b512ce0fa42bbbf47b2542a9493\",\"4f4d85dcb07bc061425beb202d8ed728\",\"570ccb5f5bca79c0c78f7a24953f4d70\",\"69f9a4b076a2332dd8a7a6f80627c069\",\"974eb0422afb8b2bac82b7dab9ecdef1\",\"f24548fff6404e18a9360a3bf740b6dc\",\"2949cfff6033e4a0a74350698b8bb9b8\",\"43da320338e75c38cd49911872841099\",\"500365a16a9070f4a286dd0519284707\",\"59b483f63bf78395d9344e0fa5864f99\",\"8a1683716a1f90e7dbe50a77145a1509\",\"ba09811c900802261c113ce66533ce4e\",\"81bddb68fa133fe9fa5b79ed904fa2c7\",\"5e6bb3cafb4ac4da82649e6f1d956d85\",\"91ba555e9e53b7e26524ac253f354598\",\"9c93720bce5e3123bc02d7820a0233d9\",\"305a7b84a1c65373c27cfa530f51aa96\",\"ad9e1395a018183ec44071d4e0fd67fe\",\"ce827f3f49e7dee36b0b18cfac880386\",\"7b25c2ba6e4d16f0aefc3d6523f56f92\",\"1a7645888594c526c6f5c7072bf6f5d6\",\"8ff989008a445e8f261195c4a8f58654\",\"57b6c6f6e386b04bc3d79d3b889cccc7\",\"8f8e54a047d9ca23f07821c2f9a1caa7\",\"8e57e6213a7cc77d830768165f0886be\",\"d72bac4f3deefa0f6a1fba10986b6720\",\"be43f4eba1ab944ad6cd10b190f81ec0\",\"ff116ec456d1c02c3206b9524d41ba10\",\"98444cbf2145d2abf6e0fddac6d437ce\",\"29eadd38f32c62eebc20e19465ef282f\",\"90892f6324ddba304f6af7718e2449cb\",\"56cbc0d543bc083188db152041d015b9\",\"b5b7f49d69bab65fa5be497521cf8fe5\",\"7603942e0456ca03c1bf8894fe39f680\",\"089b2c8b93ea2bfd0c58a06227af2589\",\"1ea124ccccc5ef08001484ca633ee4d9\",\"489ac9843bf13c8fe3cd03dd400407b4\",\"09385a5772f9fecd8258b384b63f77fd\",\"920339cf772fa03b00662a84d37923fb\",\"5aef5953e7b89888383af57928f3a8ee\",\"668db5c8a16a43d4c267544015540dad\",\"b994cb2b54918d860780e3351b221956\",\"0f51922aa39a72a7ef1adfa9b32f7c21\",\"e8873b989b405f5e1389d539c6d0b145\",\"bbdfbd90a8f8c7bb10513a662f290c5e\",\"7ced868ca4d08c14a60cad19d9208cf8\",\"62b73d3463c4e374f5cf87753e4c1112\",\"4563c57b0905e2709d179cd9d525febd\",\"e3e7d7c6abaebb91b6028b9f5b3e0518\",\"59102b5c45e169a0bc452d3ec31f854e\",\"6a63696049639eaa2acb4d3d877357c0\",\"df3ebdf9b7d314c2a24bf4c632e918a8\",\"9e825c0d93ccafef3dc0bc8062f30ec1\",\"c6eb2aa54f8f8f8fc1df99da0b27cbb1\",\"6de287894849476df4863b97c2bc2dbe\",\"b07e4b00929c69b4c3bb2379c0e1b249\",\"e697e31cde13cf00ec3af284f70c86f0\",\"7cea2c98db7d62ce0a263e857b5fde45\",\"809c21f0683f9deed72809d2e4885262\",\"101d75667da3d915f25f7bd647aa3d7e\",\"e5c72ffea1fb6f181f58baef90656d39\",\"68559641ffbae4fb602582543b1e2ea7\",\"86c8f54ad49364c4874a0433c722ac51\",\"10eb932b1a080c78d47c9a94ab1bba72\",\"0facb2950b4e2f6f9041f1bc4b40290e\",\"f2ba6ac2607cd001540e2ac9cf2fa687\",\"b040d90fafeb1f5552a578c36d79774b\",\"0b4d45d42d2d7d9a69cb06fa5dd2cb0c\",\"35d985bae1fed5c389ed580570174ca5\",\"4b55d44c7b9a2d647bbf6b67b2366e76\"],\"158\":[\"bac26c4067edc4d233c95d0e857471bf\",\"c1354d02601f038e5aadd4d0a581481d\"],\"160.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"161.6\":[\"739b5d11f818274e47cb05d27d84b5dd\",\"bfb87b712909c3fd401b8c0090600111\",\"d5a7cdb648b8a7b696f29525afa5ae14\",\"dec46e659618af79f3579a1faa1ba8db\",\"46a63d8d3d0ba26bc9e12ffa86251452\",\"cccca9de67dece862ac02e6428511c6b\",\"8cc854237bced1733a211f336ed8bd8d\",\"8d1c4a6ec3a1c10d2ecb1e992ae5eb90\",\"1bd4ab4ba6bcc46bc6f75396b1129e1b\",\"9d7516d6e713a6e658cbffbec9ea91e5\",\"2fffe250798cda7659c5e2725b3a61c3\",\"8c47352fa8295760674e4d348576bfd5\",\"ba398040811a0635a078f414270fe2dd\",\"36917e14c4820698d82ee52515e33b38\",\"a292c8056f326ade7b3bd2df4ecc0c31\",\"80b193876d81fe614d26bb47c621c245\",\"8790e2672db8081565ecc91254a7585b\",\"563598d3ed44157d1adebf3a587e44ff\",\"00f5d16cba25e04e4ea5f0d986655b82\",\"7a17164ef52ec810ae27beebbf6c03a3\",\"7df15eb403c526a3fdaebab225fb05e0\",\"1dfe3436e09bdd82ea969a4a4b7b27d9\",\"74eb56c7e692d9000eef3244bb23fbcc\",\"d0fc3bc2a7f8025c29b4bf12342629e6\",\"c04343c837d9982cdf3b3df242e5bfc8\",\"0ad6157fb694987235f1bd3430d201d9\",\"07f5e4ca8060ba20068649743956fb79\",\"8b4a98b19c6cea8dee14a10f52aad790\",\"2bda5e3317f6f174f5f5112b766d2cdc\",\"22d27dad19b896166edd94a173def516\",\"d1b84c152556747b884a38d1b5dcb1db\",\"bb1ebcd0c42980dbbeb13ea90ac9a533\",\"ef680eb80dd452e35b1b73af41ac4e30\",\"6d200d9bc6211a0f9ea739000168f2dc\",\"61301c2e6bf7633155b148a757d61d83\",\"a8d839302fdc571d49f12cc7922056b1\",\"834d310bdc0dad274167c813e15930be\",\"8be0f9632c5ff7a8f9a446a5889cdf6f\",\"627cc398cd0384fc03e8c58969468894\",\"0526f60b2ac8047d811d40fc5af9b358\",\"9ff8febd071ef3576882e84604bcfa88\",\"475f37b386f51c851557303d26016a50\",\"c3126a550816da80bcd30cea11c56c98\",\"2706ec9476acb8689addbdfe42d01613\",\"d3254d57bfb4d3ba3964265e0cff30b7\",\"6336a315da77015e8673f48c713f6147\",\"73214cf2219a9d060a7089476b339508\",\"a2e4d16ec30e73faf498121e842c2226\",\"67746f0c1ee5c440a2194aad48aee608\",\"6eaa68c7c55006a0a5d1dbc16737442e\",\"96ac8322e621f4d323974f06fd8727d3\",\"b9840e97deca4255c1f634d617b52a7e\",\"62c46c20b05b615a7ef852931f8079e0\",\"ef7d2d47e4466a0141c874d69d84395c\",\"91812caa37ac8c4a0ba06e44ea250e9a\",\"6b696d6f4441fafa5a0ce301f03489c5\",\"aba2539f5629720fcd2f74bc911c27d1\",\"526640159281e3f52c7e7247595de7dd\",\"909c38ca5306c8b2ea1c0a9ffcf14527\",\"bd9cdd86e842c2cec78d702e012904cb\",\"03e8d174c52f1f5b3077e1b653c174ba\",\"05847a6664943fbb16d39c0ddb7fac9c\",\"f4081d5da3b7c745740c19369f57c4fb\",\"d4bc000b5ddc2844d1fb2f38dfa8d2af\",\"ec9d0c43afe2bdccc2a2b8c32eaeecb4\",\"a5a48d0703e3fb7f9a9f0ef1d50c1527\",\"89ad1258aa10a3664daab44d4d52cd4c\",\"15c6bc3d30b1fb794d3c042e5a5e589f\",\"549b9b17ca76b060699dfaca5c70754b\",\"be09b769df9694502bec4222b0532895\",\"896d3e3e95c8471d10cb1d27aabfc556\",\"0f130ba7e9d1cd95e16e4e2f96bd25f5\",\"a55ad547f4be2fe0f60dd22cbdb6675a\",\"c5ba682819e42f2eed0c978fa627ae2d\",\"1efba445fa680c2244b9ca0594450cdc\",\"8c38e04d3b422605777cdbf8ba086651\",\"e335c163f1b11cda232749b1343154eb\",\"8777c8d322e96d588669f35a59d3f51c\",\"c0b3535f02553e7be12199e845f34cee\",\"b18b23b6491792aa25dfb817b3316c50\",\"79ede5ba04d9fdae680a87971c760a4f\",\"483d54fff129a4c84286be3cdb708970\",\"474e61713d58f3050d45c52fb5e55da2\",\"cdffc7799583c1ddf68ec9d3b29cbc13\",\"76eb05899c1ebc38d286c1f32c661753\",\"3420354eb0279ecd88f457e436507015\",\"31b366f0589f2661522f4a82daf657f8\",\"3e3578c95d8124137eb535a7619e4d69\",\"069ce0d56e3d4572e1f550dcd242d6ff\",\"36d5907baaa266994ebbd49f173914c8\",\"eb77677818568d0b3a9b67f1625ab9a3\",\"a9d1a77660f05b278905ef92866273bb\",\"976d2323b45a2c51fb8c2b564a5e92ef\",\"13ffa5f57e8b5ee33bae3fd2bc601040\",\"59de4f9ef3b11c54a17a9ea0e43fa713\",\"0028e0c56617d2e36277dd2e342116cc\",\"b0f60ae7c536f974260698dfeec2b78f\",\"dab7a39ace861370d6753279df1c0bd1\",\"286c2597584f2975865e6a83d0776369\",\"286d228018f0c0b615c4a568514bf347\",\"b2ef18e0a5ff94d37610de53a0ec951e\",\"84b358ec24129315a3acdb6a165b840b\",\"bd4f3c6f45b6f3a971c82b4b0476231a\",\"f4e1a684ebba72aac5e2e1d9aaf0aeb7\",\"c52eb9ffd8a28247565b02cb1d123213\",\"4043410627ecb13ef9d3456886aa6dda\",\"4d79d3b7acca084578ceb3ba31dbdafb\",\"9ef274e042411c2e16e26b89b9e22170\",\"db8f06616911faa9c68e5047cdac4c17\",\"d79b2d0eecf13f2263c50757c6a291d7\",\"4d3920a845a8142d27876a43a1049fab\",\"e30b6052db51fca80402e4f5e24b9c37\",\"4b815495f216af14ec40dcce18350784\",\"859723a3e401929bd3ad7fb614c8ccf4\",\"837b9c0e2b7e0314632ecf1d1509ef2d\",\"31a0c73fe55906582c037d00167db38a\",\"a4bd5f53651c22c941172fe364932a85\",\"1da2ef3f76e46e44d47e9fdb66ad516d\",\"8f9f0353677982860b0183a015aa5d26\",\"7cc35f8def95ac685c82da580c7dc488\",\"82c45508196d16a013eef19b9c3a7fa1\",\"245a62b37bb87c3c9e80a10035886dce\",\"5db32648935bb4df75b8e63126589a5e\",\"bc0c9be4a94631b6fc0ff52515993ab9\",\"ca2bcb7e382165bef8b9735cf60e7652\",\"d9736914ad032cc88a1f27d9618e5f0d\",\"945cd07c15b679e1f1b011ce68831854\",\"351b8cb32fca6570d3f79887c0e51460\",\"1622e4573a00665fe433d57d1f4fdbc5\",\"dabf4f4bc70347e0eb1a11ab8f100d8f\",\"25d7b550dc473056a30934b4a1bdefa7\",\"dbe45f4e73ef66869117da4c73797e2f\",\"69b21d15fe925d8cb2375d56b4df5c95\",\"28529529c24473f9b158a3a697547efb\",\"db2cdb180d6409618ec717707520d243\",\"2f22dd1ae20db18364dca50b5d8b7718\",\"04a7aea5ffc00f283176f93196e87cc8\",\"1caa015e3d3152b1f5b2187af1e3c9e7\",\"716542f654f0913bcb8a9cf6ae048de1\",\"a448c4f29d229013c4be91bcda2f1737\",\"38f6abee8a5892be3496d47de0ee1ba8\",\"8ce026edaf119399abba0a275b5176c8\",\"6addcc72c6e63322b3bc7aa27eddb8e5\",\"af462e75e52425ead9f05d3d0e2dcacb\",\"ebd49bde9e87a966952ec491c3519e19\",\"7b8bd7d7062d746d8d646a45813cc175\",\"a7ec568c053708fc6425e5e443ad3b61\",\"1b43fc8e41f961b4ccd1242051255987\",\"f8e850b8e825506327e7eff549827316\",\"15dd5fcd674edab3d47b45ebbfaf5b33\",\"5fd18281b58c343007259b1c8a404f38\",\"68d3a8352cc6fef690de39650857a1d8\",\"98acbf8f37b703536aa1959dea08a66e\",\"8e470d15a8c9a1c88445b88ff315b648\",\"137b087439de01b9c37e2e664074d02e\",\"0fc2e98fdd1b4f7ea779d6e185ea2944\",\"d5f30b2fa638b4a073caf809c6054d1c\",\"f85e78745aab49b199a632820a2d7528\",\"2fae9c575f3fca9d9a036f617da2ebd7\",\"173e6e28680e1ed40cd3019304f8ba3a\",\"14d4249b5fa987678deaaf6a29d365f0\",\"60651c9542d8d1c84334f0fe9e77a765\",\"40b97a7490f527dee651f35a0949b79e\",\"b32803fdcda5d76aab9809f897eb4b80\",\"225d5a424d15c6c418b2b15bebf0aea0\",\"cbcf6dc5a3d683d94a669c17b26670a0\",\"438513f79bc1c298950f2c18eb3ed521\",\"ed3f4e625e13552795f93054c3b519e1\",\"476db47d33ea32c37684643672a60a92\",\"13333d6777d97694d2c9342010d3decf\",\"b693c429a7814b1910fbf20a1130a4dd\",\"3b036d9ba95b11c654280f44ec5b9d81\",\"78582d6158e455f07e96873365c867f9\",\"bbdc5addc5b58d98ce48848a2a3dee61\",\"62e5abe4fa43d5b41e724b7b8dedabac\",\"53106711d65fcabf604f024abf33b126\",\"77c7010ae1d8a70f9e3dcc1a33f222bb\",\"af3ceeb0908302ffe1bd09d70d0b30fd\",\"c3978361ff07e876a012c0d4b10b0e43\",\"06c98b512ce0fa42bbbf47b2542a9493\",\"4f4d85dcb07bc061425beb202d8ed728\",\"570ccb5f5bca79c0c78f7a24953f4d70\",\"69f9a4b076a2332dd8a7a6f80627c069\",\"974eb0422afb8b2bac82b7dab9ecdef1\",\"f24548fff6404e18a9360a3bf740b6dc\",\"2949cfff6033e4a0a74350698b8bb9b8\",\"43da320338e75c38cd49911872841099\",\"500365a16a9070f4a286dd0519284707\",\"59b483f63bf78395d9344e0fa5864f99\",\"8a1683716a1f90e7dbe50a77145a1509\",\"ba09811c900802261c113ce66533ce4e\",\"81bddb68fa133fe9fa5b79ed904fa2c7\",\"5e6bb3cafb4ac4da82649e6f1d956d85\",\"91ba555e9e53b7e26524ac253f354598\",\"9c93720bce5e3123bc02d7820a0233d9\",\"305a7b84a1c65373c27cfa530f51aa96\",\"ad9e1395a018183ec44071d4e0fd67fe\",\"ce827f3f49e7dee36b0b18cfac880386\",\"7b25c2ba6e4d16f0aefc3d6523f56f92\",\"1a7645888594c526c6f5c7072bf6f5d6\",\"8ff989008a445e8f261195c4a8f58654\",\"57b6c6f6e386b04bc3d79d3b889cccc7\",\"8f8e54a047d9ca23f07821c2f9a1caa7\",\"8e57e6213a7cc77d830768165f0886be\",\"d72bac4f3deefa0f6a1fba10986b6720\",\"be43f4eba1ab944ad6cd10b190f81ec0\",\"ff116ec456d1c02c3206b9524d41ba10\",\"98444cbf2145d2abf6e0fddac6d437ce\",\"29eadd38f32c62eebc20e19465ef282f\",\"90892f6324ddba304f6af7718e2449cb\",\"56cbc0d543bc083188db152041d015b9\",\"b5b7f49d69bab65fa5be497521cf8fe5\",\"7603942e0456ca03c1bf8894fe39f680\",\"089b2c8b93ea2bfd0c58a06227af2589\",\"1ea124ccccc5ef08001484ca633ee4d9\",\"489ac9843bf13c8fe3cd03dd400407b4\",\"09385a5772f9fecd8258b384b63f77fd\",\"920339cf772fa03b00662a84d37923fb\",\"5aef5953e7b89888383af57928f3a8ee\",\"668db5c8a16a43d4c267544015540dad\",\"b994cb2b54918d860780e3351b221956\",\"0f51922aa39a72a7ef1adfa9b32f7c21\",\"e8873b989b405f5e1389d539c6d0b145\",\"bbdfbd90a8f8c7bb10513a662f290c5e\",\"7ced868ca4d08c14a60cad19d9208cf8\",\"62b73d3463c4e374f5cf87753e4c1112\",\"4563c57b0905e2709d179cd9d525febd\",\"e3e7d7c6abaebb91b6028b9f5b3e0518\",\"59102b5c45e169a0bc452d3ec31f854e\",\"6a63696049639eaa2acb4d3d877357c0\",\"df3ebdf9b7d314c2a24bf4c632e918a8\",\"9e825c0d93ccafef3dc0bc8062f30ec1\",\"c6eb2aa54f8f8f8fc1df99da0b27cbb1\",\"6de287894849476df4863b97c2bc2dbe\",\"b07e4b00929c69b4c3bb2379c0e1b249\",\"e697e31cde13cf00ec3af284f70c86f0\",\"7cea2c98db7d62ce0a263e857b5fde45\",\"809c21f0683f9deed72809d2e4885262\",\"101d75667da3d915f25f7bd647aa3d7e\",\"e5c72ffea1fb6f181f58baef90656d39\",\"68559641ffbae4fb602582543b1e2ea7\",\"86c8f54ad49364c4874a0433c722ac51\",\"10eb932b1a080c78d47c9a94ab1bba72\",\"0facb2950b4e2f6f9041f1bc4b40290e\",\"f2ba6ac2607cd001540e2ac9cf2fa687\",\"b040d90fafeb1f5552a578c36d79774b\",\"0b4d45d42d2d7d9a69cb06fa5dd2cb0c\",\"35d985bae1fed5c389ed580570174ca5\",\"4b55d44c7b9a2d647bbf6b67b2366e76\"],\"188\":[\"cd36b21f870c1a0b4e2061a178022d89\",\"bb67716376a1343d1c804faf967601c2\",\"5f723cd0a141acad9efd1ab636d36593\",\"511e8d9feda359014f65dceda20631e8\"],\"107.1\":\"fd2793b93e65e215faa1ca5b3c44af6a\",\"111\":[\"830cac64838d5f967fa2cc4ad3033694\",\"806b638becb51c4dcc2d2700403381a2\",\"dd02d3a70f0899c63cd04e7dbaff7e8f\",\"94c0971fd8ba211edc0596e421665729\",\"6e4f2f12379e6dcb3f7243a9794febd0\",\"a80eb461e40181fdced3835b097c6aab\",\"bf70bd76c3c454b031288c11a7f51756\"],\"147\":[\"4c86c039a2b12578f468c0cf285a0a22\",\"c8c3ceb13ddbc15d2a6a9e9f8bc38b1f\",\"cc588965216ae2454fedff7362222453\"],\"167.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"168.6\":[\"739b5d11f818274e47cb05d27d84b5dd\",\"bfb87b712909c3fd401b8c0090600111\",\"d5a7cdb648b8a7b696f29525afa5ae14\",\"dec46e659618af79f3579a1faa1ba8db\",\"46a63d8d3d0ba26bc9e12ffa86251452\",\"cccca9de67dece862ac02e6428511c6b\",\"8cc854237bced1733a211f336ed8bd8d\",\"8d1c4a6ec3a1c10d2ecb1e992ae5eb90\",\"1bd4ab4ba6bcc46bc6f75396b1129e1b\",\"9d7516d6e713a6e658cbffbec9ea91e5\",\"2fffe250798cda7659c5e2725b3a61c3\",\"8c47352fa8295760674e4d348576bfd5\",\"ba398040811a0635a078f414270fe2dd\",\"36917e14c4820698d82ee52515e33b38\",\"a292c8056f326ade7b3bd2df4ecc0c31\",\"80b193876d81fe614d26bb47c621c245\",\"8790e2672db8081565ecc91254a7585b\",\"563598d3ed44157d1adebf3a587e44ff\",\"00f5d16cba25e04e4ea5f0d986655b82\",\"7a17164ef52ec810ae27beebbf6c03a3\",\"7df15eb403c526a3fdaebab225fb05e0\",\"1dfe3436e09bdd82ea969a4a4b7b27d9\",\"74eb56c7e692d9000eef3244bb23fbcc\",\"d0fc3bc2a7f8025c29b4bf12342629e6\",\"c04343c837d9982cdf3b3df242e5bfc8\",\"0ad6157fb694987235f1bd3430d201d9\",\"07f5e4ca8060ba20068649743956fb79\",\"8b4a98b19c6cea8dee14a10f52aad790\",\"2bda5e3317f6f174f5f5112b766d2cdc\",\"22d27dad19b896166edd94a173def516\",\"d1b84c152556747b884a38d1b5dcb1db\",\"bb1ebcd0c42980dbbeb13ea90ac9a533\",\"ef680eb80dd452e35b1b73af41ac4e30\",\"6d200d9bc6211a0f9ea739000168f2dc\",\"61301c2e6bf7633155b148a757d61d83\",\"a8d839302fdc571d49f12cc7922056b1\",\"834d310bdc0dad274167c813e15930be\",\"8be0f9632c5ff7a8f9a446a5889cdf6f\",\"627cc398cd0384fc03e8c58969468894\",\"0526f60b2ac8047d811d40fc5af9b358\",\"9ff8febd071ef3576882e84604bcfa88\",\"475f37b386f51c851557303d26016a50\",\"c3126a550816da80bcd30cea11c56c98\",\"2706ec9476acb8689addbdfe42d01613\",\"d3254d57bfb4d3ba3964265e0cff30b7\",\"6336a315da77015e8673f48c713f6147\",\"73214cf2219a9d060a7089476b339508\",\"a2e4d16ec30e73faf498121e842c2226\",\"67746f0c1ee5c440a2194aad48aee608\",\"6eaa68c7c55006a0a5d1dbc16737442e\",\"96ac8322e621f4d323974f06fd8727d3\",\"b9840e97deca4255c1f634d617b52a7e\",\"62c46c20b05b615a7ef852931f8079e0\",\"ef7d2d47e4466a0141c874d69d84395c\",\"91812caa37ac8c4a0ba06e44ea250e9a\",\"6b696d6f4441fafa5a0ce301f03489c5\",\"aba2539f5629720fcd2f74bc911c27d1\",\"526640159281e3f52c7e7247595de7dd\",\"909c38ca5306c8b2ea1c0a9ffcf14527\",\"bd9cdd86e842c2cec78d702e012904cb\",\"03e8d174c52f1f5b3077e1b653c174ba\",\"05847a6664943fbb16d39c0ddb7fac9c\",\"f4081d5da3b7c745740c19369f57c4fb\",\"d4bc000b5ddc2844d1fb2f38dfa8d2af\",\"ec9d0c43afe2bdccc2a2b8c32eaeecb4\",\"a5a48d0703e3fb7f9a9f0ef1d50c1527\",\"89ad1258aa10a3664daab44d4d52cd4c\",\"15c6bc3d30b1fb794d3c042e5a5e589f\",\"549b9b17ca76b060699dfaca5c70754b\",\"be09b769df9694502bec4222b0532895\",\"896d3e3e95c8471d10cb1d27aabfc556\",\"0f130ba7e9d1cd95e16e4e2f96bd25f5\",\"a55ad547f4be2fe0f60dd22cbdb6675a\",\"c5ba682819e42f2eed0c978fa627ae2d\",\"1efba445fa680c2244b9ca0594450cdc\",\"8c38e04d3b422605777cdbf8ba086651\",\"e335c163f1b11cda232749b1343154eb\",\"8777c8d322e96d588669f35a59d3f51c\",\"c0b3535f02553e7be12199e845f34cee\",\"b18b23b6491792aa25dfb817b3316c50\",\"79ede5ba04d9fdae680a87971c760a4f\",\"483d54fff129a4c84286be3cdb708970\",\"474e61713d58f3050d45c52fb5e55da2\",\"cdffc7799583c1ddf68ec9d3b29cbc13\",\"76eb05899c1ebc38d286c1f32c661753\",\"3420354eb0279ecd88f457e436507015\",\"31b366f0589f2661522f4a82daf657f8\",\"3e3578c95d8124137eb535a7619e4d69\",\"069ce0d56e3d4572e1f550dcd242d6ff\",\"36d5907baaa266994ebbd49f173914c8\",\"eb77677818568d0b3a9b67f1625ab9a3\",\"a9d1a77660f05b278905ef92866273bb\",\"976d2323b45a2c51fb8c2b564a5e92ef\",\"13ffa5f57e8b5ee33bae3fd2bc601040\",\"59de4f9ef3b11c54a17a9ea0e43fa713\",\"0028e0c56617d2e36277dd2e342116cc\",\"b0f60ae7c536f974260698dfeec2b78f\",\"dab7a39ace861370d6753279df1c0bd1\",\"286c2597584f2975865e6a83d0776369\",\"286d228018f0c0b615c4a568514bf347\",\"b2ef18e0a5ff94d37610de53a0ec951e\",\"84b358ec24129315a3acdb6a165b840b\",\"bd4f3c6f45b6f3a971c82b4b0476231a\",\"f4e1a684ebba72aac5e2e1d9aaf0aeb7\",\"c52eb9ffd8a28247565b02cb1d123213\",\"4043410627ecb13ef9d3456886aa6dda\",\"4d79d3b7acca084578ceb3ba31dbdafb\",\"9ef274e042411c2e16e26b89b9e22170\",\"db8f06616911faa9c68e5047cdac4c17\",\"d79b2d0eecf13f2263c50757c6a291d7\",\"4d3920a845a8142d27876a43a1049fab\",\"e30b6052db51fca80402e4f5e24b9c37\",\"4b815495f216af14ec40dcce18350784\",\"859723a3e401929bd3ad7fb614c8ccf4\",\"837b9c0e2b7e0314632ecf1d1509ef2d\",\"31a0c73fe55906582c037d00167db38a\",\"a4bd5f53651c22c941172fe364932a85\",\"1da2ef3f76e46e44d47e9fdb66ad516d\",\"8f9f0353677982860b0183a015aa5d26\",\"7cc35f8def95ac685c82da580c7dc488\",\"82c45508196d16a013eef19b9c3a7fa1\",\"245a62b37bb87c3c9e80a10035886dce\",\"5db32648935bb4df75b8e63126589a5e\",\"bc0c9be4a94631b6fc0ff52515993ab9\",\"ca2bcb7e382165bef8b9735cf60e7652\",\"d9736914ad032cc88a1f27d9618e5f0d\",\"945cd07c15b679e1f1b011ce68831854\",\"351b8cb32fca6570d3f79887c0e51460\",\"1622e4573a00665fe433d57d1f4fdbc5\",\"dabf4f4bc70347e0eb1a11ab8f100d8f\",\"25d7b550dc473056a30934b4a1bdefa7\",\"dbe45f4e73ef66869117da4c73797e2f\",\"69b21d15fe925d8cb2375d56b4df5c95\",\"28529529c24473f9b158a3a697547efb\",\"db2cdb180d6409618ec717707520d243\",\"2f22dd1ae20db18364dca50b5d8b7718\",\"04a7aea5ffc00f283176f93196e87cc8\",\"1caa015e3d3152b1f5b2187af1e3c9e7\",\"716542f654f0913bcb8a9cf6ae048de1\",\"a448c4f29d229013c4be91bcda2f1737\",\"38f6abee8a5892be3496d47de0ee1ba8\",\"8ce026edaf119399abba0a275b5176c8\",\"6addcc72c6e63322b3bc7aa27eddb8e5\",\"af462e75e52425ead9f05d3d0e2dcacb\",\"ebd49bde9e87a966952ec491c3519e19\",\"7b8bd7d7062d746d8d646a45813cc175\",\"a7ec568c053708fc6425e5e443ad3b61\",\"1b43fc8e41f961b4ccd1242051255987\",\"f8e850b8e825506327e7eff549827316\",\"15dd5fcd674edab3d47b45ebbfaf5b33\",\"5fd18281b58c343007259b1c8a404f38\",\"68d3a8352cc6fef690de39650857a1d8\",\"98acbf8f37b703536aa1959dea08a66e\",\"8e470d15a8c9a1c88445b88ff315b648\",\"137b087439de01b9c37e2e664074d02e\",\"0fc2e98fdd1b4f7ea779d6e185ea2944\",\"d5f30b2fa638b4a073caf809c6054d1c\",\"f85e78745aab49b199a632820a2d7528\",\"2fae9c575f3fca9d9a036f617da2ebd7\",\"173e6e28680e1ed40cd3019304f8ba3a\",\"14d4249b5fa987678deaaf6a29d365f0\",\"60651c9542d8d1c84334f0fe9e77a765\",\"40b97a7490f527dee651f35a0949b79e\",\"b32803fdcda5d76aab9809f897eb4b80\",\"225d5a424d15c6c418b2b15bebf0aea0\",\"cbcf6dc5a3d683d94a669c17b26670a0\",\"438513f79bc1c298950f2c18eb3ed521\",\"ed3f4e625e13552795f93054c3b519e1\",\"476db47d33ea32c37684643672a60a92\",\"13333d6777d97694d2c9342010d3decf\",\"b693c429a7814b1910fbf20a1130a4dd\",\"3b036d9ba95b11c654280f44ec5b9d81\",\"78582d6158e455f07e96873365c867f9\",\"bbdc5addc5b58d98ce48848a2a3dee61\",\"62e5abe4fa43d5b41e724b7b8dedabac\",\"53106711d65fcabf604f024abf33b126\",\"77c7010ae1d8a70f9e3dcc1a33f222bb\",\"af3ceeb0908302ffe1bd09d70d0b30fd\",\"c3978361ff07e876a012c0d4b10b0e43\",\"06c98b512ce0fa42bbbf47b2542a9493\",\"4f4d85dcb07bc061425beb202d8ed728\",\"570ccb5f5bca79c0c78f7a24953f4d70\",\"69f9a4b076a2332dd8a7a6f80627c069\",\"974eb0422afb8b2bac82b7dab9ecdef1\",\"f24548fff6404e18a9360a3bf740b6dc\",\"2949cfff6033e4a0a74350698b8bb9b8\",\"43da320338e75c38cd49911872841099\",\"500365a16a9070f4a286dd0519284707\",\"59b483f63bf78395d9344e0fa5864f99\",\"8a1683716a1f90e7dbe50a77145a1509\",\"ba09811c900802261c113ce66533ce4e\",\"81bddb68fa133fe9fa5b79ed904fa2c7\",\"5e6bb3cafb4ac4da82649e6f1d956d85\",\"91ba555e9e53b7e26524ac253f354598\",\"9c93720bce5e3123bc02d7820a0233d9\",\"305a7b84a1c65373c27cfa530f51aa96\",\"ad9e1395a018183ec44071d4e0fd67fe\",\"ce827f3f49e7dee36b0b18cfac880386\",\"7b25c2ba6e4d16f0aefc3d6523f56f92\",\"1a7645888594c526c6f5c7072bf6f5d6\",\"8ff989008a445e8f261195c4a8f58654\",\"57b6c6f6e386b04bc3d79d3b889cccc7\",\"8f8e54a047d9ca23f07821c2f9a1caa7\",\"8e57e6213a7cc77d830768165f0886be\",\"d72bac4f3deefa0f6a1fba10986b6720\",\"be43f4eba1ab944ad6cd10b190f81ec0\",\"ff116ec456d1c02c3206b9524d41ba10\",\"98444cbf2145d2abf6e0fddac6d437ce\",\"29eadd38f32c62eebc20e19465ef282f\",\"90892f6324ddba304f6af7718e2449cb\",\"56cbc0d543bc083188db152041d015b9\",\"b5b7f49d69bab65fa5be497521cf8fe5\",\"7603942e0456ca03c1bf8894fe39f680\",\"089b2c8b93ea2bfd0c58a06227af2589\",\"1ea124ccccc5ef08001484ca633ee4d9\",\"489ac9843bf13c8fe3cd03dd400407b4\",\"09385a5772f9fecd8258b384b63f77fd\",\"920339cf772fa03b00662a84d37923fb\",\"5aef5953e7b89888383af57928f3a8ee\",\"668db5c8a16a43d4c267544015540dad\",\"b994cb2b54918d860780e3351b221956\",\"0f51922aa39a72a7ef1adfa9b32f7c21\",\"e8873b989b405f5e1389d539c6d0b145\",\"bbdfbd90a8f8c7bb10513a662f290c5e\",\"7ced868ca4d08c14a60cad19d9208cf8\",\"62b73d3463c4e374f5cf87753e4c1112\",\"4563c57b0905e2709d179cd9d525febd\",\"e3e7d7c6abaebb91b6028b9f5b3e0518\",\"59102b5c45e169a0bc452d3ec31f854e\",\"6a63696049639eaa2acb4d3d877357c0\",\"df3ebdf9b7d314c2a24bf4c632e918a8\",\"9e825c0d93ccafef3dc0bc8062f30ec1\",\"c6eb2aa54f8f8f8fc1df99da0b27cbb1\",\"6de287894849476df4863b97c2bc2dbe\",\"b07e4b00929c69b4c3bb2379c0e1b249\",\"e697e31cde13cf00ec3af284f70c86f0\",\"7cea2c98db7d62ce0a263e857b5fde45\",\"809c21f0683f9deed72809d2e4885262\",\"101d75667da3d915f25f7bd647aa3d7e\",\"e5c72ffea1fb6f181f58baef90656d39\",\"68559641ffbae4fb602582543b1e2ea7\",\"86c8f54ad49364c4874a0433c722ac51\",\"10eb932b1a080c78d47c9a94ab1bba72\",\"0facb2950b4e2f6f9041f1bc4b40290e\",\"f2ba6ac2607cd001540e2ac9cf2fa687\",\"b040d90fafeb1f5552a578c36d79774b\",\"0b4d45d42d2d7d9a69cb06fa5dd2cb0c\",\"35d985bae1fed5c389ed580570174ca5\",\"4b55d44c7b9a2d647bbf6b67b2366e76\"],\"175\":[\"bac26c4067edc4d233c95d0e857471bf\",\"c1354d02601f038e5aadd4d0a581481d\"],\"177.2\":[\"a06e07ee5ab085e4640ff5d8050b1bf9\",\"929e100567b58c8a1810d6f4b56e2f61\",\"67efc54d4164e895eb5bb78f758e614d\",\"17864c45e3fd8cda47d0fe328979d278\",\"8e45cef4a65146ac0200c9fd65f64c4e\",\"a009512f470647b0bba7dbc2bf8644aa\",\"bd7ea47554d8b1d8543930eb5e68729a\",\"199205b35ae13856eec694d4f4f5f0e8\"],\"178.6\":[\"739b5d11f818274e47cb05d27d84b5dd\",\"bfb87b712909c3fd401b8c0090600111\",\"d5a7cdb648b8a7b696f29525afa5ae14\",\"dec46e659618af79f3579a1faa1ba8db\",\"46a63d8d3d0ba26bc9e12ffa86251452\",\"cccca9de67dece862ac02e6428511c6b\",\"8cc854237bced1733a211f336ed8bd8d\",\"8d1c4a6ec3a1c10d2ecb1e992ae5eb90\",\"1bd4ab4ba6bcc46bc6f75396b1129e1b\",\"9d7516d6e713a6e658cbffbec9ea91e5\",\"2fffe250798cda7659c5e2725b3a61c3\",\"8c47352fa8295760674e4d348576bfd5\",\"ba398040811a0635a078f414270fe2dd\",\"36917e14c4820698d82ee52515e33b38\",\"a292c8056f326ade7b3bd2df4ecc0c31\",\"80b193876d81fe614d26bb47c621c245\",\"8790e2672db8081565ecc91254a7585b\",\"563598d3ed44157d1adebf3a587e44ff\",\"00f5d16cba25e04e4ea5f0d986655b82\",\"7a17164ef52ec810ae27beebbf6c03a3\",\"7df15eb403c526a3fdaebab225fb05e0\",\"1dfe3436e09bdd82ea969a4a4b7b27d9\",\"74eb56c7e692d9000eef3244bb23fbcc\",\"d0fc3bc2a7f8025c29b4bf12342629e6\",\"c04343c837d9982cdf3b3df242e5bfc8\",\"0ad6157fb694987235f1bd3430d201d9\",\"07f5e4ca8060ba20068649743956fb79\",\"8b4a98b19c6cea8dee14a10f52aad790\",\"2bda5e3317f6f174f5f5112b766d2cdc\",\"22d27dad19b896166edd94a173def516\",\"d1b84c152556747b884a38d1b5dcb1db\",\"bb1ebcd0c42980dbbeb13ea90ac9a533\",\"ef680eb80dd452e35b1b73af41ac4e30\",\"6d200d9bc6211a0f9ea739000168f2dc\",\"61301c2e6bf7633155b148a757d61d83\",\"a8d839302fdc571d49f12cc7922056b1\",\"834d310bdc0dad274167c813e15930be\",\"8be0f9632c5ff7a8f9a446a5889cdf6f\",\"627cc398cd0384fc03e8c58969468894\",\"0526f60b2ac8047d811d40fc5af9b358\",\"9ff8febd071ef3576882e84604bcfa88\",\"475f37b386f51c851557303d26016a50\",\"c3126a550816da80bcd30cea11c56c98\",\"2706ec9476acb8689addbdfe42d01613\",\"d3254d57bfb4d3ba3964265e0cff30b7\",\"6336a315da77015e8673f48c713f6147\",\"73214cf2219a9d060a7089476b339508\",\"a2e4d16ec30e73faf498121e842c2226\",\"67746f0c1ee5c440a2194aad48aee608\",\"6eaa68c7c55006a0a5d1dbc16737442e\",\"96ac8322e621f4d323974f06fd8727d3\",\"b9840e97deca4255c1f634d617b52a7e\",\"62c46c20b05b615a7ef852931f8079e0\",\"ef7d2d47e4466a0141c874d69d84395c\",\"91812caa37ac8c4a0ba06e44ea250e9a\",\"6b696d6f4441fafa5a0ce301f03489c5\",\"aba2539f5629720fcd2f74bc911c27d1\",\"526640159281e3f52c7e7247595de7dd\",\"909c38ca5306c8b2ea1c0a9ffcf14527\",\"bd9cdd86e842c2cec78d702e012904cb\",\"03e8d174c52f1f5b3077e1b653c174ba\",\"05847a6664943fbb16d39c0ddb7fac9c\",\"f4081d5da3b7c745740c19369f57c4fb\",\"d4bc000b5ddc2844d1fb2f38dfa8d2af\",\"ec9d0c43afe2bdccc2a2b8c32eaeecb4\",\"a5a48d0703e3fb7f9a9f0ef1d50c1527\",\"89ad1258aa10a3664daab44d4d52cd4c\",\"15c6bc3d30b1fb794d3c042e5a5e589f\",\"549b9b17ca76b060699dfaca5c70754b\",\"be09b769df9694502bec4222b0532895\",\"896d3e3e95c8471d10cb1d27aabfc556\",\"0f130ba7e9d1cd95e16e4e2f96bd25f5\",\"a55ad547f4be2fe0f60dd22cbdb6675a\",\"c5ba682819e42f2eed0c978fa627ae2d\",\"1efba445fa680c2244b9ca0594450cdc\",\"8c38e04d3b422605777cdbf8ba086651\",\"e335c163f1b11cda232749b1343154eb\",\"8777c8d322e96d588669f35a59d3f51c\",\"c0b3535f02553e7be12199e845f34cee\",\"b18b23b6491792aa25dfb817b3316c50\",\"79ede5ba04d9fdae680a87971c760a4f\",\"483d54fff129a4c84286be3cdb708970\",\"474e61713d58f3050d45c52fb5e55da2\",\"cdffc7799583c1ddf68ec9d3b29cbc13\",\"76eb05899c1ebc38d286c1f32c661753\",\"3420354eb0279ecd88f457e436507015\",\"31b366f0589f2661522f4a82daf657f8\",\"3e3578c95d8124137eb535a7619e4d69\",\"069ce0d56e3d4572e1f550dcd242d6ff\",\"36d5907baaa266994ebbd49f173914c8\",\"eb77677818568d0b3a9b67f1625ab9a3\",\"a9d1a77660f05b278905ef92866273bb\",\"976d2323b45a2c51fb8c2b564a5e92ef\",\"13ffa5f57e8b5ee33bae3fd2bc601040\",\"59de4f9ef3b11c54a17a9ea0e43fa713\",\"0028e0c56617d2e36277dd2e342116cc\",\"b0f60ae7c536f974260698dfeec2b78f\",\"dab7a39ace861370d6753279df1c0bd1\",\"286c2597584f2975865e6a83d0776369\",\"286d228018f0c0b615c4a568514bf347\",\"b2ef18e0a5ff94d37610de53a0ec951e\",\"84b358ec24129315a3acdb6a165b840b\",\"bd4f3c6f45b6f3a971c82b4b0476231a\",\"f4e1a684ebba72aac5e2e1d9aaf0aeb7\",\"c52eb9ffd8a28247565b02cb1d123213\",\"4043410627ecb13ef9d3456886aa6dda\",\"4d79d3b7acca084578ceb3ba31dbdafb\",\"9ef274e042411c2e16e26b89b9e22170\",\"db8f06616911faa9c68e5047cdac4c17\",\"d79b2d0eecf13f2263c50757c6a291d7\",\"4d3920a845a8142d27876a43a1049fab\",\"e30b6052db51fca80402e4f5e24b9c37\",\"4b815495f216af14ec40dcce18350784\",\"859723a3e401929bd3ad7fb614c8ccf4\",\"837b9c0e2b7e0314632ecf1d1509ef2d\",\"31a0c73fe55906582c037d00167db38a\",\"a4bd5f53651c22c941172fe364932a85\",\"1da2ef3f76e46e44d47e9fdb66ad516d\",\"8f9f0353677982860b0183a015aa5d26\",\"7cc35f8def95ac685c82da580c7dc488\",\"82c45508196d16a013eef19b9c3a7fa1\",\"245a62b37bb87c3c9e80a10035886dce\",\"5db32648935bb4df75b8e63126589a5e\",\"bc0c9be4a94631b6fc0ff52515993ab9\",\"ca2bcb7e382165bef8b9735cf60e7652\",\"d9736914ad032cc88a1f27d9618e5f0d\",\"945cd07c15b679e1f1b011ce68831854\",\"351b8cb32fca6570d3f79887c0e51460\",\"1622e4573a00665fe433d57d1f4fdbc5\",\"dabf4f4bc70347e0eb1a11ab8f100d8f\",\"25d7b550dc473056a30934b4a1bdefa7\",\"dbe45f4e73ef66869117da4c73797e2f\",\"69b21d15fe925d8cb2375d56b4df5c95\",\"28529529c24473f9b158a3a697547efb\",\"db2cdb180d6409618ec717707520d243\",\"2f22dd1ae20db18364dca50b5d8b7718\",\"04a7aea5ffc00f283176f93196e87cc8\",\"1caa015e3d3152b1f5b2187af1e3c9e7\",\"716542f654f0913bcb8a9cf6ae048de1\",\"a448c4f29d229013c4be91bcda2f1737\",\"38f6abee8a5892be3496d47de0ee1ba8\",\"8ce026edaf119399abba0a275b5176c8\",\"6addcc72c6e63322b3bc7aa27eddb8e5\",\"af462e75e52425ead9f05d3d0e2dcacb\",\"ebd49bde9e87a966952ec491c3519e19\",\"7b8bd7d7062d746d8d646a45813cc175\",\"a7ec568c053708fc6425e5e443ad3b61\",\"1b43fc8e41f961b4ccd1242051255987\",\"f8e850b8e825506327e7eff549827316\",\"15dd5fcd674edab3d47b45ebbfaf5b33\",\"5fd18281b58c343007259b1c8a404f38\",\"68d3a8352cc6fef690de39650857a1d8\",\"98acbf8f37b703536aa1959dea08a66e\",\"8e470d15a8c9a1c88445b88ff315b648\",\"137b087439de01b9c37e2e664074d02e\",\"0fc2e98fdd1b4f7ea779d6e185ea2944\",\"d5f30b2fa638b4a073caf809c6054d1c\",\"f85e78745aab49b199a632820a2d7528\",\"2fae9c575f3fca9d9a036f617da2ebd7\",\"173e6e28680e1ed40cd3019304f8ba3a\",\"14d4249b5fa987678deaaf6a29d365f0\",\"60651c9542d8d1c84334f0fe9e77a765\",\"40b97a7490f527dee651f35a0949b79e\",\"b32803fdcda5d76aab9809f897eb4b80\",\"225d5a424d15c6c418b2b15bebf0aea0\",\"cbcf6dc5a3d683d94a669c17b26670a0\",\"438513f79bc1c298950f2c18eb3ed521\",\"ed3f4e625e13552795f93054c3b519e1\",\"476db47d33ea32c37684643672a60a92\",\"13333d6777d97694d2c9342010d3decf\",\"b693c429a7814b1910fbf20a1130a4dd\",\"3b036d9ba95b11c654280f44ec5b9d81\",\"78582d6158e455f07e96873365c867f9\",\"bbdc5addc5b58d98ce48848a2a3dee61\",\"62e5abe4fa43d5b41e724b7b8dedabac\",\"53106711d65fcabf604f024abf33b126\",\"77c7010ae1d8a70f9e3dcc1a33f222bb\",\"af3ceeb0908302ffe1bd09d70d0b30fd\",\"c3978361ff07e876a012c0d4b10b0e43\",\"06c98b512ce0fa42bbbf47b2542a9493\",\"4f4d85dcb07bc061425beb202d8ed728\",\"570ccb5f5bca79c0c78f7a24953f4d70\",\"69f9a4b076a2332dd8a7a6f80627c069\",\"974eb0422afb8b2bac82b7dab9ecdef1\",\"f24548fff6404e18a9360a3bf740b6dc\",\"2949cfff6033e4a0a74350698b8bb9b8\",\"43da320338e75c38cd49911872841099\",\"500365a16a9070f4a286dd0519284707\",\"59b483f63bf78395d9344e0fa5864f99\",\"8a1683716a1f90e7dbe50a77145a1509\",\"ba09811c900802261c113ce66533ce4e\",\"81bddb68fa133fe9fa5b79ed904fa2c7\",\"5e6bb3cafb4ac4da82649e6f1d956d85\",\"91ba555e9e53b7e26524ac253f354598\",\"9c93720bce5e3123bc02d7820a0233d9\",\"305a7b84a1c65373c27cfa530f51aa96\",\"ad9e1395a018183ec44071d4e0fd67fe\",\"ce827f3f49e7dee36b0b18cfac880386\",\"7b25c2ba6e4d16f0aefc3d6523f56f92\",\"1a7645888594c526c6f5c7072bf6f5d6\",\"8ff989008a445e8f261195c4a8f58654\",\"57b6c6f6e386b04bc3d79d3b889cccc7\",\"8f8e54a047d9ca23f07821c2f9a1caa7\",\"8e57e6213a7cc77d830768165f0886be\",\"d72bac4f3deefa0f6a1fba10986b6720\",\"be43f4eba1ab944ad6cd10b190f81ec0\",\"ff116ec456d1c02c3206b9524d41ba10\",\"98444cbf2145d2abf6e0fddac6d437ce\",\"29eadd38f32c62eebc20e19465ef282f\",\"90892f6324ddba304f6af7718e2449cb\",\"56cbc0d543bc083188db152041d015b9\",\"b5b7f49d69bab65fa5be497521cf8fe5\",\"7603942e0456ca03c1bf8894fe39f680\",\"089b2c8b93ea2bfd0c58a06227af2589\",\"1ea124ccccc5ef08001484ca633ee4d9\",\"489ac9843bf13c8fe3cd03dd400407b4\",\"09385a5772f9fecd8258b384b63f77fd\",\"920339cf772fa03b00662a84d37923fb\",\"5aef5953e7b89888383af57928f3a8ee\",\"668db5c8a16a43d4c267544015540dad\",\"b994cb2b54918d860780e3351b221956\",\"0f51922aa39a72a7ef1adfa9b32f7c21\",\"e8873b989b405f5e1389d539c6d0b145\",\"bbdfbd90a8f8c7bb10513a662f290c5e\",\"7ced868ca4d08c14a60cad19d9208cf8\",\"62b73d3463c4e374f5cf87753e4c1112\",\"4563c57b0905e2709d179cd9d525febd\",\"e3e7d7c6abaebb91b6028b9f5b3e0518\",\"59102b5c45e169a0bc452d3ec31f854e\",\"6a63696049639eaa2acb4d3d877357c0\",\"df3ebdf9b7d314c2a24bf4c632e918a8\",\"9e825c0d93ccafef3dc0bc8062f30ec1\",\"c6eb2aa54f8f8f8fc1df99da0b27cbb1\",\"6de287894849476df4863b97c2bc2dbe\",\"b07e4b00929c69b4c3bb2379c0e1b249\",\"e697e31cde13cf00ec3af284f70c86f0\",\"7cea2c98db7d62ce0a263e857b5fde45\",\"809c21f0683f9deed72809d2e4885262\",\"101d75667da3d915f25f7bd647aa3d7e\",\"e5c72ffea1fb6f181f58baef90656d39\",\"68559641ffbae4fb602582543b1e2ea7\",\"86c8f54ad49364c4874a0433c722ac51\",\"10eb932b1a080c78d47c9a94ab1bba72\",\"0facb2950b4e2f6f9041f1bc4b40290e\",\"f2ba6ac2607cd001540e2ac9cf2fa687\",\"b040d90fafeb1f5552a578c36d79774b\",\"0b4d45d42d2d7d9a69cb06fa5dd2cb0c\",\"35d985bae1fed5c389ed580570174ca5\",\"4b55d44c7b9a2d647bbf6b67b2366e76\"],\"144\":[\"6f77908f0643519dec5815971c269e88\",\"a5ef14892c73bd3cb67b805f22dd9a37\"],\"gform_submission_method\":[\"85321ce35481812df04ce5addaa18954\",\"15395bf035c759c814ba3631f9779edf\"],\"gform_theme\":\"2ca100149c1444a2b51219999e0fe834\",\"gform_style_settings\":\"8bf786b78102f9b7b49b8f4759d53f0b\",\"form_id\":\"3602a244e19a6d9b0ca4b898341f4c76\",\"url\":\"2fec811c799b01264a236f7988a6fbfa\",\"state_timestamp\":\"253a6365561fc98b02e770db35e16983\"}","ad6a386d7287772e035c8e4fa3486f5b",1790731627]' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_7' id='gform_target_page_number_7' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_7' id='gform_source_page_number_7' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>SELECT YOUR LOCATION: Spain Portugal Cyprus Elysium Funeral Plan &#8211; Cyprus CONTRACT\u00a0<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_joinchat":[],"footnotes":""},"class_list":["post-2020","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Application Form - Cyprus - Elysium Funeral Plans<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Application Form - Cyprus - Elysium Funeral Plans\" \/>\n<meta property=\"og:description\" content=\"SELECT YOUR LOCATION: Spain Portugal Cyprus Elysium Funeral Plan &#8211; Cyprus CONTRACT\u00a0\" \/>\n<meta property=\"og:url\" content=\"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/\" \/>\n<meta property=\"og:site_name\" content=\"Elysium Funeral Plans\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/profile.php?id=61559569225257\" \/>\n<meta property=\"article:modified_time\" content=\"2026-09-18T18:11:55+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data1\" content=\"26 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/application-form-cyprus\\\/\",\"url\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/application-form-cyprus\\\/\",\"name\":\"Application Form - Cyprus - Elysium Funeral Plans\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#website\"},\"datePublished\":\"2026-08-28T20:09:20+00:00\",\"dateModified\":\"2026-09-18T18:11:55+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/application-form-cyprus\\\/#breadcrumb\"},\"inLanguage\":\"nl-NL\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/application-form-cyprus\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/application-form-cyprus\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Application Form &#8211; Cyprus\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#website\",\"url\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/\",\"name\":\"Elysium Funeral Plans\",\"description\":\"We are different\",\"publisher\":{\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"nl-NL\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#organization\",\"name\":\"Elysium Funeral Plans\",\"url\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"nl-NL\",\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/elysiumfuneralplans.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/Logo_ELYSIUM.png\",\"contentUrl\":\"https:\\\/\\\/elysiumfuneralplans.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/Logo_ELYSIUM.png\",\"width\":476,\"height\":476,\"caption\":\"Elysium Funeral Plans\"},\"image\":{\"@id\":\"https:\\\/\\\/darkturquoise-dunlin-229635.hostingersite.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/profile.php?id=61559569225257\",\"https:\\\/\\\/instagram.com\\\/elysiumfuneralplans\",\"https:\\\/\\\/www.tiktok.com\\\/@elysiumfuneralplans\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Application Form - Cyprus - Elysium Funeral Plans","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/","og_locale":"nl_NL","og_type":"article","og_title":"Application Form - Cyprus - Elysium Funeral Plans","og_description":"SELECT YOUR LOCATION: Spain Portugal Cyprus Elysium Funeral Plan &#8211; Cyprus CONTRACT\u00a0","og_url":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/","og_site_name":"Elysium Funeral Plans","article_publisher":"https:\/\/www.facebook.com\/profile.php?id=61559569225257","article_modified_time":"2026-09-18T18:11:55+00:00","twitter_card":"summary_large_image","twitter_misc":{"Geschatte leestijd":"26 minuten"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/","url":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/","name":"Application Form - Cyprus - Elysium Funeral Plans","isPartOf":{"@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#website"},"datePublished":"2026-08-28T20:09:20+00:00","dateModified":"2026-09-18T18:11:55+00:00","breadcrumb":{"@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/#breadcrumb"},"inLanguage":"nl-NL","potentialAction":[{"@type":"ReadAction","target":["https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/application-form-cyprus\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/"},{"@type":"ListItem","position":2,"name":"Application Form &#8211; Cyprus"}]},{"@type":"WebSite","@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#website","url":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/","name":"Elysium-uitvaartverzekeringen","description":"Wij zijn anders","publisher":{"@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"nl-NL"},{"@type":"Organization","@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#organization","name":"Elysium-uitvaartverzekeringen","url":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/","logo":{"@type":"ImageObject","inLanguage":"nl-NL","@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#\/schema\/logo\/image\/","url":"https:\/\/elysiumfuneralplans.com\/wp-content\/uploads\/2026\/07\/Logo_ELYSIUM.png","contentUrl":"https:\/\/elysiumfuneralplans.com\/wp-content\/uploads\/2026\/07\/Logo_ELYSIUM.png","width":476,"height":476,"caption":"Elysium Funeral Plans"},"image":{"@id":"https:\/\/darkturquoise-dunlin-229635.hostingersite.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/profile.php?id=61559569225257","https:\/\/instagram.com\/elysiumfuneralplans","https:\/\/www.tiktok.com\/@elysiumfuneralplans"]}]}},"_links":{"self":[{"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/pages\/2020","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/comments?post=2020"}],"version-history":[{"count":22,"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/pages\/2020\/revisions"}],"predecessor-version":[{"id":2634,"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/pages\/2020\/revisions\/2634"}],"wp:attachment":[{"href":"https:\/\/elysiumfuneralplans.com\/nl\/wp-json\/wp\/v2\/media?parent=2020"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}