{"id":593,"date":"2025-09-23T12:20:34","date_gmt":"2025-09-23T12:20:34","guid":{"rendered":"https:\/\/www.mcs.co.mz\/en\/?page_id=593"},"modified":"2025-09-23T12:20:34","modified_gmt":"2025-09-23T12:20:34","slug":"claim-form-industry-and-commerce","status":"publish","type":"page","link":"https:\/\/www.mcs.co.mz\/en\/claim-form-industry-and-commerce\/","title":{"rendered":"Claim Form \u2013 Industry and commerce"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-592 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-592\" data-uid=\"69f2801ed86c8\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-592\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-592 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=\"592\"\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=\"69f2801ed86c8\"\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-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Industry and commerce Multi-risk insurance<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">1. Participant quality<\/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-69f2801ed86c8-label\"><span id=\"forminator-radiogroup-69f2801ed86c8-label\" class=\"forminator-label\">Radio<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f2801ed86c8\" class=\"forminator-radio\" title=\"Policyholder\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69f2801ed86c8\" 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\">Policyholder<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f2801ed86c8\" class=\"forminator-radio\" title=\"Insured\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69f2801ed86c8\" 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\">Insured<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-69f2801ed86c8\" class=\"forminator-radio\" title=\"Legal representative\"><input type=\"radio\" name=\"radio-1\" value=\"Legal-representative\" id=\"forminator-field-radio-1-3-69f2801ed86c8\" 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\">Legal representative<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69f2801ed86c8\" id=\"forminator-field-name-1_69f2801ed86c8-label\" class=\"forminator-label\">Full name<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f2801ed86c8\" id=\"forminator-field-phone-1_69f2801ed86c8-label\" class=\"forminator-label\">Contact<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-1_69f2801ed86c8\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" 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-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69f2801ed86c8\" id=\"forminator-field-name-2_69f2801ed86c8-label\" class=\"forminator-label\">Full name:<\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-2_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/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_69f2801ed86c8\" id=\"forminator-field-number-1_69f2801ed86c8-label\" class=\"forminator-label\">Policy number:<\/label><input name=\"number-1\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-1_69f2801ed86c8\" 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=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><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_69f2801ed86c8\" id=\"forminator-field-address-1-street_address_69f2801ed86c8-label\" class=\"forminator-label\">Address:<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_69f2801ed86c8\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69f2801ed86c8\" id=\"forminator-field-phone-2_69f2801ed86c8-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-2_69f2801ed86c8\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/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_69f2801ed86c8\" id=\"forminator-field-email-1_69f2801ed86c8-label\" class=\"forminator-label\">Email<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69f2801ed86c8\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3. Claim details<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-9\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3.1 Type of claim<\/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-69f2801ed86c8-label\"><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f2801ed86c8\" class=\"forminator-radio\" title=\"In case of fire\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69f2801ed86c8\" 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\">In case of fire<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f2801ed86c8\" class=\"forminator-radio\" title=\"In case od theft\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69f2801ed86c8\" 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\">In case od theft<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69f2801ed86c8\" class=\"forminator-radio\" title=\"In case od glass breakage\"><input type=\"radio\" name=\"radio-2\" value=\"In-case-od-glass-breakage\" id=\"forminator-field-radio-2-3-69f2801ed86c8\" 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\">In case od glass breakage<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-69f2801ed86c8\" class=\"forminator-radio\" title=\"in case of damage caused to third parties (Material\/ bodily)\"><input type=\"radio\" name=\"radio-2\" value=\"in-case-of-damage-caused-to-third-parties-(Material--bodily)\" id=\"forminator-field-radio-2-4-69f2801ed86c8\" 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\">in case of damage caused to third parties (Material\/ bodily)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3.2 In case of fire<\/h2><\/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-69f2801ed86c8-label\"><span id=\"forminator-radiogroup-69f2801ed86c8-label\" class=\"forminator-label\">Were the Firefighters involved?<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69f2801ed86c8\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69f2801ed86c8\" 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\">Yes<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69f2801ed86c8\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69f2801ed86c8\" 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\">No<\/span><\/label><\/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_69f2801ed86c8\" id=\"forminator-field-textarea-1_69f2801ed86c8-label\" class=\"forminator-label\">If the Firefighters did not intervene, what was the reason?<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69f2801ed86c8\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69f2801ed86c8-label\"><span id=\"forminator-radiogroup-69f2801ed86c8-label\" class=\"forminator-label\">Was there any suspicion of arson?<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-69f2801ed86c8\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-69f2801ed86c8\" aria-labelledby=\"forminator-field-radio-4-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-4-label-2\" for=\"forminator-field-radio-4-2-69f2801ed86c8\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-69f2801ed86c8\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69f2801ed86c8-label\"><span id=\"forminator-radiogroup-69f2801ed86c8-label\" class=\"forminator-label\">Was the place uninhabited?<\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-69f2801ed86c8\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-69f2801ed86c8\" aria-labelledby=\"forminator-field-radio-5-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-5-label-2\" for=\"forminator-field-radio-5-2-69f2801ed86c8\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-69f2801ed86c8\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f2801ed86c8\" id=\"forminator-field-text-1_69f2801ed86c8-label\" class=\"forminator-label\">If yes, for how long?<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69f2801ed86c8\" id=\"forminator-field-textarea-2_69f2801ed86c8-label\" class=\"forminator-label\">If there are co-owners of the property, please provide their names:<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69f2801ed86c8\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3.2 In case of theft<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69f2801ed86c8\" id=\"forminator-field-text-2_69f2801ed86c8-label\" class=\"forminator-label\">Authority to which it was reported:<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-12 \"><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_69f2801ed86c8\" id=\"forminator-field-address-2-street_address_69f2801ed86c8-label\" class=\"forminator-label\">Station\/Precinct:<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-2-street_address_69f2801ed86c8\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_69f2801ed86c8\" id=\"forminator-field-name-3_69f2801ed86c8-label\" class=\"forminator-label\">Brigade\/Officer:<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-3_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69f2801ed86c8\" id=\"forminator-field-number-2_69f2801ed86c8-label\" class=\"forminator-label\">Case number:<\/label><input name=\"number-2\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-2_69f2801ed86c8\" 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=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69f2801ed86c8\" id=\"forminator-field-upload-1_69f2801ed86c8-label\" class=\"forminator-label\">Attach proof of the police report.<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_69f2801ed86c8\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_69f2801ed86c8\" class=\"forminator-input-file forminator-field-upload-1_69f2801ed86c8-592\" 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-1_69f2801ed86c8\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-1_69f2801ed86c8\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3.2 In case of glass breakage<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69f2801ed86c8\" id=\"forminator-field-text-3_69f2801ed86c8-label\" class=\"forminator-label\">Location where the glass was installed (shop window, door, showcase, etc.):<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69f2801ed86c8\" id=\"forminator-field-text-4_69f2801ed86c8-label\" class=\"forminator-label\">Glass dimensions<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69f2801ed86c8\" id=\"forminator-field-text-5_69f2801ed86c8-label\" class=\"forminator-label\">Responsible for the damage (Name and address):<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3.2 In case of damages caused to third parties (Material\/ bodily)<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69f2801ed86c8\" id=\"forminator-field-name-4_69f2801ed86c8-label\" class=\"forminator-label\">Name of the Owner\/Victim:<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-4_69f2801ed86c8\" 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-12 \"><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_69f2801ed86c8\" id=\"forminator-field-address-3-street_address_69f2801ed86c8-label\" class=\"forminator-label\">Address<\/label><input type=\"text\" name=\"address-3-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-3-street_address_69f2801ed86c8\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/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_69f2801ed86c8\" id=\"forminator-field-text-6_69f2801ed86c8-label\" class=\"forminator-label\">Occupation<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69f2801ed86c8\" id=\"forminator-field-text-7_69f2801ed86c8-label\" class=\"forminator-label\">Marital Status<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_69f2801ed86c8\" 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-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_69f2801ed86c8\" id=\"forminator-field-number-3_69f2801ed86c8-label\" class=\"forminator-label\">Age<\/label><input name=\"number-3\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-3_69f2801ed86c8\" 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-8\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69f2801ed86c8\" id=\"forminator-field-text-8_69f2801ed86c8-label\" class=\"forminator-label\">Relationship?<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_69f2801ed86c8\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f2801ed86c8\" id=\"forminator-field-textarea-3_69f2801ed86c8-label\" class=\"forminator-label\">Witnesses \u2013 Name\/Address\/Occupation?<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f2801ed86c8\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-10\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">4. Declaration<\/h2><\/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\" aria-labelledby=\"forminator-checkbox-group-69f2801ed86c8-label\"><label id=\"forminator-field-checkbox-1-1-69f2801ed86c8-label\" for=\"forminator-field-checkbox-1-1-69f2801ed86c8\" class=\"forminator-checkbox\" title=\"The information provided is accurate, given in good faith and truthfulness, and I take full responsibility for it.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-69f2801ed86c8\" aria-labelledby=\"forminator-field-checkbox-1-1-69f2801ed86c8-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 is accurate, given in good faith and truthfulness, and I take full responsibility for it.<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69f2801ed86c8-label\" for=\"forminator-field-checkbox-1-2-69f2801ed86c8\" class=\"forminator-checkbox\" title=\"I authorize the Insurer to collect complementary personal data from public organizations, specialized companies and other economic units, with a view to confirming or supplementing the information collected that is necessary for the management of the contractual relationship. Omissions, inaccuracies and false statements in providing information are the responsibility of the client. Consultation of the personal data provided will be carried out under a regime of absolute confidentiality, provided it is compatible with the purpose of its collection.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-69f2801ed86c8\" aria-labelledby=\"forminator-field-checkbox-1-2-69f2801ed86c8-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 Insurer to collect complementary personal data from public organizations, specialized companies and other economic units, with a view to confirming or supplementing the information collected that is necessary for the management of the contractual relationship. Omissions, inaccuracies and false statements in providing information are the responsibility of the client. Consultation of the personal data provided will be carried out under a regime of absolute confidentiality, provided it is compatible with the purpose of its collection.<\/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\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"4d1651c46b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/593\" \/><input type=\"hidden\" name=\"form_id\" value=\"592\"><input type=\"hidden\" name=\"page_id\" value=\"593\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.mcs.co.mz\/en\/claim-form-industry-and-commerce\/\"><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":2,"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-593","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/593","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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/comments?post=593"}],"version-history":[{"count":1,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/593\/revisions"}],"predecessor-version":[{"id":594,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/593\/revisions\/594"}],"wp:attachment":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/media?parent=593"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}