{"id":516,"date":"2023-12-07T15:20:27","date_gmt":"2023-12-07T15:20:27","guid":{"rendered":"https:\/\/finota.rapiera.com\/?page_id=516"},"modified":"2025-02-23T16:22:49","modified_gmt":"2025-02-23T16:22:49","slug":"assurance-moto","status":"publish","type":"page","link":"https:\/\/mamassur.com\/en\/assurance-moto\/","title":{"rendered":"Motorcycle insurance"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"516\" class=\"elementor elementor-516\">\n\t\t\t\t<div class=\"elementor-element elementor-element-201dce57 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"201dce57\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;curve&quot;,&quot;shape_divider_bottom_negative&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewbox=\"0 0 1000 100\" preserveaspectratio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M500,97C126.7,96.3,0.8,19.8,0,0v100l1000,0V1C1000,19.4,873.3,97.8,500,97z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3c8d559d elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"3c8d559d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><span style=\"color:#FB847B\"><\/span>Assurances Moto<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9c25cfd e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"9c25cfd\" 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-2f44db6 e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-child\" data-id=\"2f44db6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e38d556 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"e38d556\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">The different<span style=\"color:#FB847B\"> advantages<\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-617f1fe elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"617f1fe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-check\" viewbox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M173.898 439.404l-166.4-166.4c-9.997-9.997-9.997-26.206 0-36.204l36.203-36.204c9.997-9.998 26.207-9.998 36.204 0L192 312.69 432.095 72.596c9.997-9.997 26.207-9.997 36.204 0l36.203 36.204c9.997 9.997 9.997 26.206 0 36.204l-294.4 294.401c-9.998 9.997-26.207 9.997-36.204-.001z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Immediate guarantee,<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-check\" viewbox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M173.898 439.404l-166.4-166.4c-9.997-9.997-9.997-26.206 0-36.204l36.203-36.204c9.997-9.998 26.207-9.998 36.204 0L192 312.69 432.095 72.596c9.997-9.997 26.207-9.997 36.204 0l36.203 36.204c9.997 9.997 9.997 26.206 0 36.204l-294.4 294.401c-9.998 9.997-26.207 9.997-36.204-.001z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Contract and a provisional green card online.<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-check\" viewbox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M173.898 439.404l-166.4-166.4c-9.997-9.997-9.997-26.206 0-36.204l36.203-36.204c9.997-9.998 26.207-9.998 36.204 0L192 312.69 432.095 72.596c9.997-9.997 26.207-9.997 36.204 0l36.203 36.204c9.997 9.997 9.997 26.206 0 36.204l-294.4 294.401c-9.998 9.997-26.207 9.997-36.204-.001z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Without history<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-check\" viewbox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M173.898 439.404l-166.4-166.4c-9.997-9.997-9.997-26.206 0-36.204l36.203-36.204c9.997-9.998 26.207-9.998 36.204 0L192 312.69 432.095 72.596c9.997-9.997 26.207-9.997 36.204 0l36.203 36.204c9.997 9.997 9.997 26.206 0 36.204l-294.4 294.401c-9.998 9.997-26.207 9.997-36.204-.001z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">CRM Bonus from 0.50 to 1.56 Penalty<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-check\" viewbox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M173.898 439.404l-166.4-166.4c-9.997-9.997-9.997-26.206 0-36.204l36.203-36.204c9.997-9.998 26.207-9.998 36.204 0L192 312.69 432.095 72.596c9.997-9.997 26.207-9.997 36.204 0l36.203 36.204c9.997 9.997 9.997 26.206 0 36.204l-294.4 294.401c-9.998 9.997-26.207 9.997-36.204-.001z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Suspension or Cancellation for speeding and point failure<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8f41cc2 e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-child\" data-id=\"8f41cc2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bdd61b0 elementor-widget elementor-widget-image\" data-id=\"bdd61b0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1000\" height=\"728\" src=\"https:\/\/mamassur.com\/wp-content\/uploads\/2023\/12\/assurance-moto-auto.png\" class=\"attachment-large size-large wp-image-1398\" alt=\"\" srcset=\"https:\/\/mamassur.com\/wp-content\/uploads\/2023\/12\/assurance-moto-auto.png 1000w, https:\/\/mamassur.com\/wp-content\/uploads\/2023\/12\/assurance-moto-auto-300x218.png 300w, https:\/\/mamassur.com\/wp-content\/uploads\/2023\/12\/assurance-moto-auto-768x559.png 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7523c52b e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"7523c52b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4edcc039 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"4edcc039\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quote<span style=\"color:#FB847B\"> sheet<\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9746008 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"9746008\" 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-6c02c94a elementor-widget elementor-widget-shortcode\" data-id=\"6c02c94a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-834 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-834\" data-uid=\"6a681c326fefc\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-834\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-834 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"834\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a681c326fefc\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-834--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-834--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Information v\u00e9hicule\"\n\t\t\t\tdata-actual-label=\"Vos coordonn\u00e9es\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a681c326fefc\" id=\"forminator-field-name-1_6a681c326fefc-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a681c326fefc\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a681c326fefc\" id=\"forminator-field-name-2_6a681c326fefc-label\" class=\"forminator-label\">First name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6a681c326fefc\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a681c326fefc\" id=\"forminator-field-date-1-picker_6a681c326fefc-label\" class=\"forminator-label\">Date of birth<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a681c326fefc\" id=\"forminator-field-phone-1_6a681c326fefc-label\" class=\"forminator-label\">Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a681c326fefc\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a681c326fefc\" id=\"forminator-field-text-3_6a681c326fefc-label\" class=\"forminator-label\">Postal code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a681c326fefc\" id=\"forminator-field-text-2_6a681c326fefc-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a681c326fefc\" id=\"forminator-field-text-4_6a681c326fefc-label\" class=\"forminator-label\">Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a681c326fefc\" id=\"forminator-field-email-1_6a681c326fefc-label\" class=\"forminator-label\">Your email address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a681c326fefc\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-834--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-834--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"Vos coordonn\u00e9es\"\n\t\t\t\tdata-actual-label=\"Votre situation\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a681c326fefc\" id=\"forminator-field-text-9_6a681c326fefc-label\" class=\"forminator-label\">Motorcycle driving license date:<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a681c326fefc\" id=\"forminator-field-date-2-picker_6a681c326fefc-label\" class=\"forminator-label\">Motorcycle driving license date:<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"\" id=\"forminator-field-date-2-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a681c326fefc\" id=\"forminator-field-text-10_6a681c326fefc-label\" class=\"forminator-label\">Motorcycle Bonus \/ Penalty coefficient<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_6a681c326fefc\" id=\"forminator-field-date-6-picker_6a681c326fefc-label\" class=\"forminator-label\">Date of car license (If obtained):<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"\" id=\"forminator-field-date-6-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6a681c326fefc\" id=\"forminator-field-text-11_6a681c326fefc-label\" class=\"forminator-label\">Auto Bonus \/ Penalty coefficient<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-4_6a681c326fefc\" id=\"forminator-form-834__field--select-4_6a681c326fefc-label\" class=\"forminator-label\">Canceled during the last 36 months?<\/label><select  id=\"forminator-form-834__field--select-4_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-4\" data-default-value=\"non-r\u00e9sili\u00e9-en-derniers-mois\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-4_6a681c326fefc-label\"><option value=\"non-r\u00e9sili\u00e9-en-derniers-mois\" selected=\"selected\" data-calculation=\"0\">No<\/option><option value=\"oui-r\u00e9sili\u00e9-en-derniers-mois\"  data-calculation=\"0\">Yes<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-5_6a681c326fefc\" id=\"forminator-form-834__field--select-5_6a681c326fefc-label\" class=\"forminator-label\">Reason for termination?<\/label><select  id=\"forminator-form-834__field--select-5_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-5_6a681c326fefc-label\"><option value=\"one\"  data-calculation=\"0\">Non-payment<\/option><option value=\"two\"  data-calculation=\"0\">Sinister<\/option><option value=\"Alcool\u00e9mie\"  data-calculation=\"0\">Blood alcohol level<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a681c326fefc\" id=\"forminator-field-number-1_6a681c326fefc-label\" class=\"forminator-label\">Number of claims over the last 36 months:<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6a681c326fefc\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6a681c326fefc\" id=\"forminator-field-date-3-picker_6a681c326fefc-label\" class=\"forminator-label\">Date sinistre<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Choisissez une date\" id=\"forminator-field-date-3-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a681c326fefc-label\"><span id=\"forminator-radiogroup-radio-1-6a681c326fefc-label\" class=\"forminator-label\">Type sinistre<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a681c326fefc\" class=\"forminator-radio\" title=\"Broken glass\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Broken glass<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a681c326fefc\" class=\"forminator-radio\" title=\"Total\/partial fire\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Total\/partial fire<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-1\" value=\"Mat\u00e9riel-responsable-avec-tiers\" id=\"forminator-field-radio-1-3-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a681c326fefc\" class=\"forminator-radio\" title=\"Mat\u00e9riel responsable sans tiers\"><input type=\"radio\" name=\"radio-1\" value=\"Mat\u00e9riel-responsable-sans-tiers\" id=\"forminator-field-radio-1-4-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mat\u00e9riel responsable sans tiers<\/span><\/label><label id=\"forminator-field-radio-1-label-5\" for=\"forminator-field-radio-1-5-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-1\" value=\"Mat\u00e9riel-non-responsable-sans-tiers\" id=\"forminator-field-radio-1-5-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-1-label-6\" for=\"forminator-field-radio-1-6-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-1\" value=\"Mat\u00e9riel-non-responsable-avec-tiers\" id=\"forminator-field-radio-1-6-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-1-label-7\" for=\"forminator-field-radio-1-7-6a681c326fefc\" class=\"forminator-radio\" title=\"Non-responsible body\"><input type=\"radio\" name=\"radio-1\" value=\"Corporel-non-responsable\" id=\"forminator-field-radio-1-7-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non-responsible body<\/span><\/label><label id=\"forminator-field-radio-1-label-8\" for=\"forminator-field-radio-1-8-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible body\"><input type=\"radio\" name=\"radio-1\" value=\"Corporel-responsable\" id=\"forminator-field-radio-1-8-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-1-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible body<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_6a681c326fefc\" id=\"forminator-field-date-8-picker_6a681c326fefc-label\" class=\"forminator-label\">Date sinistre 2<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"Choisissez une date\" id=\"forminator-field-date-8-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a681c326fefc-label\"><span id=\"forminator-radiogroup-radio-3-6a681c326fefc-label\" class=\"forminator-label\">Type sinistre 2<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a681c326fefc\" class=\"forminator-radio\" title=\"Broken glass\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Broken glass<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a681c326fefc\" class=\"forminator-radio\" title=\"Total\/partial fire\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Total\/partial fire<\/span><\/label><label id=\"forminator-field-radio-3-label-3\" for=\"forminator-field-radio-3-3-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-3\" value=\"Mat\u00e9riel-responsable-avec-tiers\" id=\"forminator-field-radio-3-3-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-3-label-4\" for=\"forminator-field-radio-3-4-6a681c326fefc\" class=\"forminator-radio\" title=\"Mat\u00e9riel responsable sans tiers\"><input type=\"radio\" name=\"radio-3\" value=\"Mat\u00e9riel-responsable-sans-tiers\" id=\"forminator-field-radio-3-4-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mat\u00e9riel responsable sans tiers<\/span><\/label><label id=\"forminator-field-radio-3-label-5\" for=\"forminator-field-radio-3-5-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-3\" value=\"Mat\u00e9riel-non-responsable-sans-tiers\" id=\"forminator-field-radio-3-5-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-3-label-6\" for=\"forminator-field-radio-3-6-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-3\" value=\"Mat\u00e9riel-non-responsable-avec-tiers\" id=\"forminator-field-radio-3-6-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-3-label-7\" for=\"forminator-field-radio-3-7-6a681c326fefc\" class=\"forminator-radio\" title=\"Non-responsible body\"><input type=\"radio\" name=\"radio-3\" value=\"Corporel-non-responsable\" id=\"forminator-field-radio-3-7-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non-responsible body<\/span><\/label><label id=\"forminator-field-radio-3-label-8\" for=\"forminator-field-radio-3-8-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible body\"><input type=\"radio\" name=\"radio-3\" value=\"Corporel-responsable\" id=\"forminator-field-radio-3-8-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-3-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible body<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-9\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-picker_6a681c326fefc\" id=\"forminator-field-date-9-picker_6a681c326fefc-label\" class=\"forminator-label\">Date sinistre 3<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-9\" value=\"\" placeholder=\"Choisissez une date\" id=\"forminator-field-date-9-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a681c326fefc-label\"><span id=\"forminator-radiogroup-radio-2-6a681c326fefc-label\" class=\"forminator-label\">Type sinistre 3<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a681c326fefc\" class=\"forminator-radio\" title=\"Broken glass\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Broken glass<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a681c326fefc\" class=\"forminator-radio\" title=\"Total\/partial fire\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Total\/partial fire<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-2\" value=\"Mat\u00e9riel-responsable-avec-tiers\" id=\"forminator-field-radio-2-3-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-6a681c326fefc\" class=\"forminator-radio\" title=\"Mat\u00e9riel responsable sans tiers\"><input type=\"radio\" name=\"radio-2\" value=\"Mat\u00e9riel-responsable-sans-tiers\" id=\"forminator-field-radio-2-4-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mat\u00e9riel responsable sans tiers<\/span><\/label><label id=\"forminator-field-radio-2-label-5\" for=\"forminator-field-radio-2-5-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-2\" value=\"Mat\u00e9riel-non-responsable-sans-tiers\" id=\"forminator-field-radio-2-5-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-2-label-6\" for=\"forminator-field-radio-2-6-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible material with third parties\"><input type=\"radio\" name=\"radio-2\" value=\"Mat\u00e9riel-non-responsable-avec-tiers\" id=\"forminator-field-radio-2-6-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible material with third parties<\/span><\/label><label id=\"forminator-field-radio-2-label-7\" for=\"forminator-field-radio-2-7-6a681c326fefc\" class=\"forminator-radio\" title=\"Non-responsible body\"><input type=\"radio\" name=\"radio-2\" value=\"Corporel-non-responsable\" id=\"forminator-field-radio-2-7-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non-responsible body<\/span><\/label><label id=\"forminator-field-radio-2-label-8\" for=\"forminator-field-radio-2-8-6a681c326fefc\" class=\"forminator-radio\" title=\"Responsible body\"><input type=\"radio\" name=\"radio-2\" value=\"Corporel-responsable\" id=\"forminator-field-radio-2-8-6a681c326fefc\" aria-labelledby=\"forminator-field-radio-2-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Responsible body<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-2_6a681c326fefc\" id=\"forminator-form-834__field--select-2_6a681c326fefc-label\" class=\"forminator-label\">License already suspended?<\/label><select  id=\"forminator-form-834__field--select-2_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"non-permis-suspendu\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-2_6a681c326fefc-label\"><option value=\"non-permis-suspendu\" selected=\"selected\" data-calculation=\"0\">No<\/option><option value=\"oui-permis-suspendu\"  data-calculation=\"0\">Yes<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-3_6a681c326fefc\" id=\"forminator-form-834__field--select-3_6a681c326fefc-label\" class=\"forminator-label\">Reason for suspension?<\/label><select  id=\"forminator-form-834__field--select-3_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-3_6a681c326fefc-label\"><option value=\"alcool\u00e9mie\"  data-calculation=\"0\">Blood alcohol level<\/option><option value=\"stupefiant\"  data-calculation=\"0\">Stunning<\/option><option value=\"sinistre\"  data-calculation=\"0\">Sinister<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a681c326fefc\" id=\"forminator-field-text-1_6a681c326fefc-label\" class=\"forminator-label\">Si suspension pour alcool\u00e9mie ou stup\u00e9fiant ? Indiquez svp Dur\u00e9e suspension<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6a681c326fefc\" id=\"forminator-field-text-12_6a681c326fefc-label\" class=\"forminator-label\">Taux d&#039;alcool g\/l dans le sang<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-834--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-834--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Votre situation\"\n\t\t\t\tdata-actual-label=\"Information v\u00e9hicule\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a681c326fefc\" id=\"forminator-field-text-5_6a681c326fefc-label\" class=\"forminator-label\">Motorcycle brand<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6a681c326fefc\" id=\"forminator-field-text-13_6a681c326fefc-label\" class=\"forminator-label\">Motorcycle Model<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6a681c326fefc\" id=\"forminator-field-date-4-picker_6a681c326fefc-label\" class=\"forminator-label\">Date of circulation ?<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"\" id=\"forminator-field-date-4-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_6a681c326fefc\" id=\"forminator-field-date-7-picker_6a681c326fefc-label\" class=\"forminator-label\">Date of purchase ?<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"\" id=\"forminator-field-date-7-picker_6a681c326fefc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a681c326fefc\" id=\"forminator-field-text-8_6a681c326fefc-label\" class=\"forminator-label\">Mine type (D.2 registration document):<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a681c326fefc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a681c326fefc\" id=\"forminator-field-number-2_6a681c326fefc-label\" class=\"forminator-label\">CV power?<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6a681c326fefc\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-8_6a681c326fefc\" id=\"forminator-form-834__field--select-8_6a681c326fefc-label\" class=\"forminator-label\">Fuel<\/label><select  id=\"forminator-form-834__field--select-8_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-8_6a681c326fefc-label\"><option value=\"one\"  data-calculation=\"0\">Species<\/option><option value=\"two\"  data-calculation=\"0\">Diesel<\/option><option value=\"Electrique\"  data-calculation=\"0\">Electrique<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-834__field--select-9_6a681c326fefc\" id=\"forminator-form-834__field--select-9_6a681c326fefc-label\" class=\"forminator-label\">Desired formula<\/label><select  id=\"forminator-form-834__field--select-9_6a681c326fefc\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-834__field--select-9_6a681c326fefc-label\"><option value=\"one\"  data-calculation=\"0\">(F1): Civil Liability + Driver Guarantee + Breakdown Assistance<\/option><option value=\"two\"  data-calculation=\"0\">(F2): F1 + Theft + Fire + Glass breakage<\/option><option value=\"(F3)-:-F2-+-Tout-Dommage-accident\"  data-calculation=\"0\">(F3): F2 + Any Accident Damage<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a681c326fefc\" id=\"forminator-field-textarea-1_6a681c326fefc-label\" class=\"forminator-label\">Enter additional information if necessary<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a681c326fefc\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a681c326fefc-label\"><label id=\"forminator-field-checkbox-1-1-6a681c326fefc-label\" for=\"forminator-field-checkbox-1-1-6a681c326fefc\" class=\"forminator-checkbox\" title=\"I agree to receive a quote and to be called by an advisor from the MAM ASSUR company.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a681c326fefc\" aria-labelledby=\"forminator-field-checkbox-1-1-6a681c326fefc-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I agree to receive a quote and to be called by an advisor from the MAM ASSUR company.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12\"><div class=\"forminator-captcha-left forminator-g-recaptcha\" data-theme=\"light\"  data-sitekey=\"6LdvdlEpAAAAAFouy8fnxj5-BQAUal1DEN28XXjT\" data-size=\"normal\"><\/div> <\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Send me a quote<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"e38e016831\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/516\" \/><input type=\"hidden\" name=\"form_id\" value=\"834\"><input type=\"hidden\" name=\"page_id\" value=\"516\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/mamassur.com\/en\/assurance-moto\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form><\/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>","protected":false},"excerpt":{"rendered":"<p>Assurances Moto Les diff\u00e9rents Avantages Prise de garantie imm\u00e9diate, Contrat et une carte verte provisoires en ligne. Sans ant\u00e9c\u00e9dents CRM Bonus de 0,50 \u00e0 1,56 de Malus Suspension ou Annulation pour exc\u00e8s de vitesse et d\u00e9faut de point Fiche de Devis<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-516","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/pages\/516","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/comments?post=516"}],"version-history":[{"count":37,"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/pages\/516\/revisions"}],"predecessor-version":[{"id":1975,"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/pages\/516\/revisions\/1975"}],"wp:attachment":[{"href":"https:\/\/mamassur.com\/en\/wp-json\/wp\/v2\/media?parent=516"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}