{"id":334,"date":"2025-03-06T10:31:49","date_gmt":"2025-03-06T10:31:49","guid":{"rendered":"https:\/\/www.mcs.co.mz\/en\/?page_id=334"},"modified":"2025-03-24T06:33:08","modified_gmt":"2025-03-24T06:33:08","slug":"seguro-automovel-2","status":"publish","type":"page","link":"https:\/\/www.mcs.co.mz\/en\/seguro-automovel-2\/","title":{"rendered":"Form Seguro automovel"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-325 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-325\" data-uid=\"69f27e2ae2a4a\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-325\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-325 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"325\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\tenctype=\"multipart\/form-data\"\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"69f27e2ae2a4a\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">1. Participant\u2019s Status<\/h2><\/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-69f27e2ae2a4a-label\"><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f27e2ae2a4a\" class=\"forminator-radio\" title=\"Insured\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69f27e2ae2a4a\" 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\">Insured<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f27e2ae2a4a\" class=\"forminator-radio\" title=\"Third Party\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69f27e2ae2a4a\" 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\">Third Party<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69f27e2ae2a4a\" class=\"forminator-radio\" title=\"Broker\"><input type=\"radio\" name=\"radio-2\" value=\"Broker\" id=\"forminator-field-radio-2-3-69f27e2ae2a4a\" 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\">Broker<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p>If you selected <em data-end=\"143\" data-start=\"130\">Third Party<\/em> or <em data-end=\"155\" data-start=\"147\">Broker<\/em>, please fill in the information below<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-42\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-42_69f27e2ae2a4a\" id=\"forminator-field-name-42_69f27e2ae2a4a-label\" class=\"forminator-label\">Full Name<\/label><input type=\"text\" name=\"name-42\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-42_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f27e2ae2a4a\" id=\"forminator-field-text-1_69f27e2ae2a4a-label\" class=\"forminator-label\">Contact<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-1_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-7\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-7_69f27e2ae2a4a\" id=\"forminator-field-phone-7_69f27e2ae2a4a-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-7\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-7_69f27e2ae2a4a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f27e2ae2a4a\" id=\"forminator-field-email-1_69f27e2ae2a4a-label\" class=\"forminator-label\">Email<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69f27e2ae2a4a\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-14\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">2. Insured Person and Policy<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-43\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-43_69f27e2ae2a4a\" id=\"forminator-field-name-43_69f27e2ae2a4a-label\" class=\"forminator-label\">Name<\/label><input type=\"text\" name=\"name-43\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-43_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69f27e2ae2a4a\" id=\"forminator-field-text-2_69f27e2ae2a4a-label\" class=\"forminator-label\">Policy number<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-2_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-15\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3. Date and Time of the Incident<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_69f27e2ae2a4a\" id=\"forminator-field-date-4-picker_69f27e2ae2a4a-label\" class=\"forminator-label\">Date of the Accident<\/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=\"Choose Date\" id=\"forminator-field-date-4-picker_69f27e2ae2a4a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy\/mm\/dd\" 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=\"time-2\" class=\"forminator-field-time forminator-col forminator-col-6 \"><div class=\"forminator-timepicker\" ><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"time-2-hours\" class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-time-2-hours_69f27e2ae2a4a\" id=\"forminator-field-time-2-hours_69f27e2ae2a4a-label\" class=\"forminator-label\">Hours<\/label><input type=\"number\" name=\"time-2-hours\" min=\"0\" max=\"12\" placeholder=\"E.g. 08\" id=\"forminator-field-time-2-hours_69f27e2ae2a4a\" class=\"forminator-input time-hours \" data-field=\"hours\" value=\"\" \/><\/div><\/div><div id=\"time-2-minutes\" class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-time-2-minutes_69f27e2ae2a4a\" id=\"forminator-field-time-2-minutes_69f27e2ae2a4a-label\" class=\"forminator-label\">Minutes<\/label><input type=\"number\" min=\"0\" max=\"59\" name=\"time-2-minutes\" placeholder=\"E.g. 00\" id=\"forminator-field-time-2-minutes_69f27e2ae2a4a\" class=\"forminator-input time-minutes \" data-field=\"minutes\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><select name=\"time-2-ampm\" id=\"forminator-field-325__field--time-2-ampm_69f27e2ae2a4a\" class=\"forminator-select2 time-ampm \" data-field=\"ampm\" data-default-value=\"\"><option value=\"am\" >AM<\/option><option value=\"pm\" >PM<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-35\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">4. LOCATION (Road, locality, and district)<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-9-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-9-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"5. Were there any INJURIES, even minor ones?\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-9-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">5. Were there any INJURIES, even minor ones?<\/span><\/label><label id=\"forminator-field-checkbox-9-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-9-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"6. Were there any Material Damages, other than those caused to vehicles A and B?\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-9-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">6. Were there any Material Damages, other than those caused to vehicles A and B?<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-36\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">7. WITNESSES, Names, addresses, and phone numbers<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><textarea name=\"textarea-8\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-8_69f27e2ae2a4a\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-16\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VEHICLE A<\/h2><\/div><\/div><div id=\"section-18\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VEHICLE B<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-17\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">8. INSURED<\/h2><\/div><\/div><div id=\"section-19\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">8. THIRD<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-44\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-44_69f27e2ae2a4a\" id=\"forminator-field-name-44_69f27e2ae2a4a-label\" class=\"forminator-label\">Surname(s) and First Name(s)<\/label><input type=\"text\" name=\"name-44\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-44_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"name-45\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-45_69f27e2ae2a4a\" id=\"forminator-field-name-45_69f27e2ae2a4a-label\" class=\"forminator-label\">Surname(s) and First Name(s)<\/label><input type=\"text\" name=\"name-45\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-45_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69f27e2ae2a4a\" id=\"forminator-field-address-1-street_address_69f27e2ae2a4a-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_69f27e2ae2a4a\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-2-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-street_address_69f27e2ae2a4a\" id=\"forminator-field-address-2-street_address_69f27e2ae2a4a-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-2-street_address_69f27e2ae2a4a\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-8\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-8_69f27e2ae2a4a\" id=\"forminator-field-phone-8_69f27e2ae2a4a-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-8\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-8_69f27e2ae2a4a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"mz\" data-validation=\"standard\" \/><\/div><\/div><div id=\"phone-9\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-9_69f27e2ae2a4a\" id=\"forminator-field-phone-9_69f27e2ae2a4a-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-9\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-9_69f27e2ae2a4a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69f27e2ae2a4a\" id=\"forminator-field-text-4_69f27e2ae2a4a-label\" class=\"forminator-label\">Occupation<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-4_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69f27e2ae2a4a\" id=\"forminator-field-text-5_69f27e2ae2a4a-label\" class=\"forminator-label\">Occupation<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-5_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-20\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">9. VEHICLE<\/h2><\/div><\/div><div id=\"section-21\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">9. VEHICLE<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69f27e2ae2a4a\" id=\"forminator-field-text-6_69f27e2ae2a4a-label\" class=\"forminator-label\">Make and Model<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-6_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/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_69f27e2ae2a4a\" id=\"forminator-field-text-8_69f27e2ae2a4a-label\" class=\"forminator-label\">Make and Model<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-8_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69f27e2ae2a4a\" id=\"forminator-field-text-7_69f27e2ae2a4a-label\" class=\"forminator-label\">Registration Number (or Engine Number)<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-7_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69f27e2ae2a4a\" id=\"forminator-field-text-9_69f27e2ae2a4a-label\" class=\"forminator-label\">Registration Number (or Engine Number)<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-9_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-22\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">10. Mozambique Insurance Company<\/h2><\/div><\/div><div id=\"section-23\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">10. Other Company<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69f27e2ae2a4a\" id=\"forminator-field-text-10_69f27e2ae2a4a-label\" class=\"forminator-label\">Policy No. (or Temporary Certificate)<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-10_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/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_69f27e2ae2a4a\" id=\"forminator-field-text-11_69f27e2ae2a4a-label\" class=\"forminator-label\">Policy No. (or Temporary Certificate)<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-11_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_69f27e2ae2a4a\" id=\"forminator-field-date-5-picker_69f27e2ae2a4a-label\" class=\"forminator-label\">Policy No. (or Temporary Certificate)<\/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-5\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-5-picker_69f27e2ae2a4a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy\/mm\/dd\" 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=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_69f27e2ae2a4a\" id=\"forminator-field-date-6-picker_69f27e2ae2a4a-label\" class=\"forminator-label\">Policy No. (or Temporary Certificate)<\/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=\"Choose Date\" id=\"forminator-field-date-6-picker_69f27e2ae2a4a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy\/mm\/dd\" 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=\"section-24\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">11. DRIVER<\/h2><\/div><\/div><div id=\"section-25\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">11. DRIVER<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-46\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-46_69f27e2ae2a4a\" id=\"forminator-field-name-46_69f27e2ae2a4a-label\" class=\"forminator-label\">Surname(s) and First Name(s)<\/label><input type=\"text\" name=\"name-46\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-46_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"name-47\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-47_69f27e2ae2a4a\" id=\"forminator-field-name-47_69f27e2ae2a4a-label\" class=\"forminator-label\">Surname(s) and First Name(s)<\/label><input type=\"text\" name=\"name-47\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-47_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-3\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-3-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-street_address_69f27e2ae2a4a\" id=\"forminator-field-address-3-street_address_69f27e2ae2a4a-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"address-3-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-3-street_address_69f27e2ae2a4a\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"address-4\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-4-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-4-street_address_69f27e2ae2a4a\" id=\"forminator-field-address-4-street_address_69f27e2ae2a4a-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"address-4-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-4-street_address_69f27e2ae2a4a\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-10\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-10_69f27e2ae2a4a\" id=\"forminator-field-phone-10_69f27e2ae2a4a-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-10\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-10_69f27e2ae2a4a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"mz\" data-validation=\"standard\" \/><\/div><\/div><div id=\"phone-11\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-11_69f27e2ae2a4a\" id=\"forminator-field-phone-11_69f27e2ae2a4a-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-11\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-11_69f27e2ae2a4a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"mz\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_69f27e2ae2a4a\" id=\"forminator-field-text-12_69f27e2ae2a4a-label\" class=\"forminator-label\">Occupation<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-12_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_69f27e2ae2a4a\" id=\"forminator-field-text-13_69f27e2ae2a4a-label\" class=\"forminator-label\">Occupation<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-13_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_69f27e2ae2a4a\" id=\"forminator-field-number-3_69f27e2ae2a4a-label\" class=\"forminator-label\">Age<\/label><input name=\"number-3\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-3_69f27e2ae2a4a\" 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=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_69f27e2ae2a4a\" id=\"forminator-field-number-4_69f27e2ae2a4a-label\" class=\"forminator-label\">Age<\/label><input name=\"number-4\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-4_69f27e2ae2a4a\" 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=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_69f27e2ae2a4a\" id=\"forminator-field-text-14_69f27e2ae2a4a-label\" class=\"forminator-label\">Driving License No.<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-14_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_69f27e2ae2a4a\" id=\"forminator-field-text-15_69f27e2ae2a4a-label\" class=\"forminator-label\">Driving License No.<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-15_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_69f27e2ae2a4a\" id=\"forminator-field-text-16_69f27e2ae2a4a-label\" class=\"forminator-label\">Category<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-16_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_69f27e2ae2a4a\" id=\"forminator-field-text-17_69f27e2ae2a4a-label\" class=\"forminator-label\">Category<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-17_69f27e2ae2a4a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/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_69f27e2ae2a4a\" id=\"forminator-field-date-7-picker_69f27e2ae2a4a-label\" class=\"forminator-label\">Valid from\/to<\/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=\"Choose Date\" id=\"forminator-field-date-7-picker_69f27e2ae2a4a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy\/mm\/dd\" 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=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_69f27e2ae2a4a\" id=\"forminator-field-date-8-picker_69f27e2ae2a4a-label\" class=\"forminator-label\">Valid from\/to<\/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=\"Choose Date\" id=\"forminator-field-date-8-picker_69f27e2ae2a4a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy\/mm\/dd\" 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=\"section-27\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">12. Indicate, using the options below, the point of initial impact.<\/h2><\/div><\/div><div id=\"section-28\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">12. Indicate, using the options below, the point of initial impact.<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-10-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Front part\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Front part<\/span><\/label><label id=\"forminator-field-checkbox-10-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Rear part\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rear part<\/span><\/label><label id=\"forminator-field-checkbox-10-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Left side\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Left-side\" id=\"forminator-field-checkbox-10-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Left side<\/span><\/label><label id=\"forminator-field-checkbox-10-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Right side\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Right-side\" id=\"forminator-field-checkbox-10-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Right side<\/span><\/label><label id=\"forminator-field-checkbox-10-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Headlight\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Headlight\" id=\"forminator-field-checkbox-10-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Headlight<\/span><\/label><label id=\"forminator-field-checkbox-10-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Mirrors\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Mirrors\" id=\"forminator-field-checkbox-10-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mirrors<\/span><\/label><label id=\"forminator-field-checkbox-10-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"No damage\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"No-damage\" id=\"forminator-field-checkbox-10-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No damage<\/span><\/label><label id=\"forminator-field-checkbox-10-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-10-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Other\" id=\"forminator-field-checkbox-10-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-10-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-11-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Front part\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Front part<\/span><\/label><label id=\"forminator-field-checkbox-11-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Rear part\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"two\" id=\"forminator-field-checkbox-11-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rear part<\/span><\/label><label id=\"forminator-field-checkbox-11-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Left side\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Left-side\" id=\"forminator-field-checkbox-11-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Left side<\/span><\/label><label id=\"forminator-field-checkbox-11-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Right side\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Right-side\" id=\"forminator-field-checkbox-11-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Right side<\/span><\/label><label id=\"forminator-field-checkbox-11-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Headlight\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Headlight\" id=\"forminator-field-checkbox-11-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Headlight<\/span><\/label><label id=\"forminator-field-checkbox-11-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Mirrors\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Mirrors\" id=\"forminator-field-checkbox-11-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mirrors<\/span><\/label><label id=\"forminator-field-checkbox-11-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"No damage\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"No-damage\" id=\"forminator-field-checkbox-11-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No damage<\/span><\/label><label id=\"forminator-field-checkbox-11-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-11-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Other\" id=\"forminator-field-checkbox-11-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-11-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-26\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">13. Visible Damages<\/h2><\/div><\/div><div id=\"section-29\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">13. Visible Damages<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-12-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Front part\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Front part<\/span><\/label><label id=\"forminator-field-checkbox-12-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Rear part\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"two\" id=\"forminator-field-checkbox-12-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rear part<\/span><\/label><label id=\"forminator-field-checkbox-12-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Left side\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Left-side\" id=\"forminator-field-checkbox-12-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Left side<\/span><\/label><label id=\"forminator-field-checkbox-12-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Right side\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Right-side\" id=\"forminator-field-checkbox-12-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Right side<\/span><\/label><label id=\"forminator-field-checkbox-12-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Headlight\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Headlight\" id=\"forminator-field-checkbox-12-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Headlight<\/span><\/label><label id=\"forminator-field-checkbox-12-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Mirrors\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Mirrors\" id=\"forminator-field-checkbox-12-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mirrors<\/span><\/label><label id=\"forminator-field-checkbox-12-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"No damage\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"No-damage\" id=\"forminator-field-checkbox-12-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No damage<\/span><\/label><label id=\"forminator-field-checkbox-12-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-12-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Other\" id=\"forminator-field-checkbox-12-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-12-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-13-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Front part\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Front part<\/span><\/label><label id=\"forminator-field-checkbox-13-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Rear part\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rear part<\/span><\/label><label id=\"forminator-field-checkbox-13-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Left side\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Left-side\" id=\"forminator-field-checkbox-13-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Left side<\/span><\/label><label id=\"forminator-field-checkbox-13-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Right side\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Right-side\" id=\"forminator-field-checkbox-13-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Right side<\/span><\/label><label id=\"forminator-field-checkbox-13-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Headlight\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Headlight\" id=\"forminator-field-checkbox-13-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Headlight<\/span><\/label><label id=\"forminator-field-checkbox-13-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Mirrors\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Mirrors\" id=\"forminator-field-checkbox-13-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mirrors<\/span><\/label><label id=\"forminator-field-checkbox-13-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"No damage\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"No-damage\" id=\"forminator-field-checkbox-13-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No damage<\/span><\/label><label id=\"forminator-field-checkbox-13-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-13-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Other\" id=\"forminator-field-checkbox-13-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-13-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-30\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">14. CIRCUMSTANCES OF THE ACCIDENT<\/h2><\/div><\/div><div id=\"section-31\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">14. CIRCUMSTANCES OF THE ACCIDENT<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-3-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was parked\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was parked<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was leaving the parking lot\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was leaving the parking lot<\/span><\/label><label id=\"forminator-field-checkbox-3-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was about to park\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"la-estacionar\" id=\"forminator-field-checkbox-3-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was about to park<\/span><\/label><label id=\"forminator-field-checkbox-3-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was coming out of a private parking lot or a private driveway\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"saia\" id=\"forminator-field-checkbox-3-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was coming out of a private parking lot or a private driveway<\/span><\/label><label id=\"forminator-field-checkbox-3-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was entering a parking lot, private place or private road\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Saia-de-um-parque-de-estacionamento-de-local-privado-ou-de-um-caminho-particular\" id=\"forminator-field-checkbox-3-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was entering a parking lot, private place or private road<\/span><\/label><label id=\"forminator-field-checkbox-3-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was entering a traffic circle or turning square\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Entrava-numa-rotunda-ou-pra\u00e7a-de-sentido-girat\u00f3rio\" id=\"forminator-field-checkbox-3-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was entering a traffic circle or turning square<\/span><\/label><label id=\"forminator-field-checkbox-3-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving on a traffic circle or turning square\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Circulava-numa-rotunda-ou-pra\u00e7a-de-sentido-girat\u00f3rio\" id=\"forminator-field-checkbox-3-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving on a traffic circle or turning square<\/span><\/label><label id=\"forminator-field-checkbox-3-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It crashed into the back of another vehicle traveling in the same direction and same queue\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Embateu-na-traseira-do-outro-ve\u00edculo-que-circulava-no-mesmo-sentido-e-na-mesma-fila\" id=\"forminator-field-checkbox-3-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It crashed into the back of another vehicle traveling in the same direction and same queue<\/span><\/label><label id=\"forminator-field-checkbox-3-9-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-9-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving in the same direction but in a different queue\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Circulava-no-mesmo-sentido-mas-numa-fila-diferente\" id=\"forminator-field-checkbox-3-9-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-9-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving in the same direction but in a different queue<\/span><\/label><label id=\"forminator-field-checkbox-3-10-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-10-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was changing queue\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Mudava-de-fila\" id=\"forminator-field-checkbox-3-10-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-10-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was changing queue<\/span><\/label><label id=\"forminator-field-checkbox-3-11-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-11-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was overtaking\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Ultrapassava\" id=\"forminator-field-checkbox-3-11-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-11-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was overtaking<\/span><\/label><label id=\"forminator-field-checkbox-3-12-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-12-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was turning left\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Virava-\u00e0-esquerda\" id=\"forminator-field-checkbox-3-12-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-12-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was turning left<\/span><\/label><label id=\"forminator-field-checkbox-3-13-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-13-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was turning right\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Virava-\u00e0-direita\" id=\"forminator-field-checkbox-3-13-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-13-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was turning right<\/span><\/label><label id=\"forminator-field-checkbox-3-14-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-14-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was going backwards\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Recuava\" id=\"forminator-field-checkbox-3-14-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-14-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was going backwards<\/span><\/label><label id=\"forminator-field-checkbox-3-15-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-15-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving on the part of the road reserved for oncoming traffic\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Circulava-na-parte-da-faixa-de-rodagem-reservada-\u00e0-circula\u00e7\u00e3o-em-sentido-contr\u00e1rio\" id=\"forminator-field-checkbox-3-15-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-15-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving on the part of the road reserved for oncoming traffic<\/span><\/label><label id=\"forminator-field-checkbox-3-16-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-16-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was coming from the left (at a crossroads or junction)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Apresentava-se-pela-esquerda-(num-cruzamento-ou-entroncamento)\" id=\"forminator-field-checkbox-3-16-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-16-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was coming from the left (at a crossroads or junction)<\/span><\/label><label id=\"forminator-field-checkbox-3-17-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-3-17-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Didn&#039;t respect a signal to give priority\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"N\u00e3o-respeitou-um-sinal-de-dar-prioridade\" id=\"forminator-field-checkbox-3-17-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-3-17-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Didn't respect a signal to give priority<\/span><\/label><\/div><\/div><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-14-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was parked\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was parked<\/span><\/label><label id=\"forminator-field-checkbox-14-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was leaving the parking lot\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was leaving the parking lot<\/span><\/label><label id=\"forminator-field-checkbox-14-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was about to park\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"la-estacionar\" id=\"forminator-field-checkbox-14-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was about to park<\/span><\/label><label id=\"forminator-field-checkbox-14-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was coming out of a private parking lot or a private driveway\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"saia\" id=\"forminator-field-checkbox-14-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was coming out of a private parking lot or a private driveway<\/span><\/label><label id=\"forminator-field-checkbox-14-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was entering a parking lot, private place or private road\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Saia-de-um-parque-de-estacionamento-de-local-privado-ou-de-um-caminho-particular\" id=\"forminator-field-checkbox-14-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was entering a parking lot, private place or private road<\/span><\/label><label id=\"forminator-field-checkbox-14-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was entering a traffic circle or turning square\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Entrava-numa-rotunda-ou-pra\u00e7a-de-sentido-girat\u00f3rio\" id=\"forminator-field-checkbox-14-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was entering a traffic circle or turning square<\/span><\/label><label id=\"forminator-field-checkbox-14-7-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-7-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving on a traffic circle or turning square\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Circulava-numa-rotunda-ou-pra\u00e7a-de-sentido-girat\u00f3rio\" id=\"forminator-field-checkbox-14-7-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-7-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving on a traffic circle or turning square<\/span><\/label><label id=\"forminator-field-checkbox-14-8-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-8-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It crashed into the back of another vehicle traveling in the same direction and same queue\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Embateu-na-traseira-do-outro-ve\u00edculo-que-circulava-no-mesmo-sentido-e-na-mesma-fila\" id=\"forminator-field-checkbox-14-8-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-8-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It crashed into the back of another vehicle traveling in the same direction and same queue<\/span><\/label><label id=\"forminator-field-checkbox-14-9-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-9-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving in the same direction but in a different queue\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Circulava-no-mesmo-sentido-mas-numa-fila-diferente\" id=\"forminator-field-checkbox-14-9-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-9-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving in the same direction but in a different queue<\/span><\/label><label id=\"forminator-field-checkbox-14-10-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-10-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was changing queue\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Mudava-de-fila\" id=\"forminator-field-checkbox-14-10-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-10-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was changing queue<\/span><\/label><label id=\"forminator-field-checkbox-14-11-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-11-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was overtaking\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Ultrapassava\" id=\"forminator-field-checkbox-14-11-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-11-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was overtaking<\/span><\/label><label id=\"forminator-field-checkbox-14-12-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-12-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was turning left\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Virava-\u00e0-esquerda\" id=\"forminator-field-checkbox-14-12-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-12-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was turning left<\/span><\/label><label id=\"forminator-field-checkbox-14-13-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-13-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was turning right\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Virava-\u00e0-direita\" id=\"forminator-field-checkbox-14-13-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-13-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was turning right<\/span><\/label><label id=\"forminator-field-checkbox-14-14-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-14-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was going backwards\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Recuava\" id=\"forminator-field-checkbox-14-14-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-14-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was going backwards<\/span><\/label><label id=\"forminator-field-checkbox-14-15-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-15-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was driving on the part of the road reserved for oncoming traffic\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Circulava-na-parte-da-faixa-de-rodagem-reservada-\u00e0-circula\u00e7\u00e3o-em-sentido-contr\u00e1rio\" id=\"forminator-field-checkbox-14-15-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-15-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was driving on the part of the road reserved for oncoming traffic<\/span><\/label><label id=\"forminator-field-checkbox-14-16-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-16-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"It was coming from the left (at a crossroads or junction)\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Apresentava-se-pela-esquerda-(num-cruzamento-ou-entroncamento)\" id=\"forminator-field-checkbox-14-16-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-16-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">It was coming from the left (at a crossroads or junction)<\/span><\/label><label id=\"forminator-field-checkbox-14-17-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-14-17-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Didn&#039;t respect a signal to give priority\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"N\u00e3o-respeitou-um-sinal-de-dar-prioridade\" id=\"forminator-field-checkbox-14-17-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-14-17-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Didn't respect a signal to give priority<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-32\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">15. Regular Driver<\/h2><\/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-69f27e2ae2a4a-label\"><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f27e2ae2a4a\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69f27e2ae2a4a\" 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\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f27e2ae2a4a\" class=\"forminator-radio\" title=\"Not\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69f27e2ae2a4a\" 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\">Not<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-33\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">16. Documents Required for Claim Submission:<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-15-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Copy of ID\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Copy of ID<\/span><\/label><label id=\"forminator-field-checkbox-15-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Copy of Driving License\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Copy of Driving License<\/span><\/label><label id=\"forminator-field-checkbox-15-3-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-3-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Copy of Ownership Title\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Copy-of-Ownership-Title\" id=\"forminator-field-checkbox-15-3-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-3-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Copy of Ownership Title<\/span><\/label><label id=\"forminator-field-checkbox-15-4-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-4-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Copy of Vehicle Registration Certificate\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Copy-of-Vehicle-Registration-Certificate\" id=\"forminator-field-checkbox-15-4-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-4-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Copy of Vehicle Registration Certificate<\/span><\/label><label id=\"forminator-field-checkbox-15-5-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-5-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Police Report Number\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Police-Report-Number\" id=\"forminator-field-checkbox-15-5-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-5-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Police Report Number<\/span><\/label><label id=\"forminator-field-checkbox-15-6-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-15-6-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"Two Estimates (quotations)\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Two-Estimates-(quotations)\" id=\"forminator-field-checkbox-15-6-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-15-6-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Two Estimates (quotations)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_69f27e2ae2a4a\" id=\"forminator-field-upload-2_69f27e2ae2a4a-label\" class=\"forminator-label\">Submit Documents<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-2_69f27e2ae2a4a\"><input type=\"file\" name=\"upload-2[]\" id=\"forminator-field-upload-2_69f27e2ae2a4a\" class=\"forminator-input-file forminator-field-upload-2_69f27e2ae2a4a-325\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-2_69f27e2ae2a4a\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-2_69f27e2ae2a4a\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-37\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">17. Detailed Description of the Accident<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><textarea name=\"textarea-9\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-9_69f27e2ae2a4a\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-34\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">18. Declaration<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-16\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27e2ae2a4a-label\"><label id=\"forminator-field-checkbox-16-1-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-16-1-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"The information provided has been given accurately, in good faith, and truthfully, and I assume full responsibility for it.\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"one\" id=\"forminator-field-checkbox-16-1-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-16-1-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">The information provided has been given accurately, in good faith, and truthfully, and I assume full responsibility for it.<\/span><\/label><label id=\"forminator-field-checkbox-16-2-69f27e2ae2a4a-label\" for=\"forminator-field-checkbox-16-2-69f27e2ae2a4a\" class=\"forminator-checkbox\" title=\"I authorize the Insurance Company to collect additional personal data from public authorities, specialized companies, and other economic entities in order to confirm or supplement the information necessary for managing the contractual relationship. Any omissions, inaccuracies, or falsehoods in providing information are the responsibility of the client. Access to the personal data provided will be granted under absolute confidentiality, provided it is compatible with the purpose for which the data was collected.\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"two\" id=\"forminator-field-checkbox-16-2-69f27e2ae2a4a\" aria-labelledby=\"forminator-field-checkbox-16-2-69f27e2ae2a4a-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I authorize the Insurance Company to collect additional personal data from public authorities, specialized companies, and other economic entities in order to confirm or supplement the information necessary for managing the contractual relationship. Any omissions, inaccuracies, or falsehoods in providing information are the responsibility of the client. Access to the personal data provided will be granted under absolute confidentiality, provided it is compatible with the purpose for which the data was collected.<\/span><\/label><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit Accident Report<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"e7309f999c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/334\" \/><input type=\"hidden\" name=\"form_id\" value=\"325\"><input type=\"hidden\" name=\"page_id\" value=\"334\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.mcs.co.mz\/en\/seguro-automovel-2\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-formularios.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-334","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/334","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/comments?post=334"}],"version-history":[{"count":5,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/334\/revisions"}],"predecessor-version":[{"id":468,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/334\/revisions\/468"}],"wp:attachment":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/media?parent=334"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}