{"id":2553,"date":"2020-11-09T22:54:35","date_gmt":"2020-11-09T21:54:35","guid":{"rendered":"https:\/\/aca-pl.com\/?page_id=2553"},"modified":"2020-11-09T22:54:41","modified_gmt":"2020-11-09T21:54:41","slug":"questionnaire-multirisque-immeuble","status":"publish","type":"page","link":"https:\/\/aca-pl.com\/?page_id=2553","title":{"rendered":"QUESTIONNAIRE MULTIRISQUE IMMEUBLE"},"content":{"rendered":"\n<p class=\"has-background\" style=\"background-color:#f1e830\">L&rsquo;objectif de ce questionnaire est d&rsquo;obtenir les informations destin\u00e9es \u00e0 votre \u00e9tude personnalis\u00e9e. Ces informations ne seront en aucun cas transmis \u00e0 des tiers, hormis les assureurs interrog\u00e9s. Merci de s\u00e9lectionner les propositions ou bien de remplir les informations demand\u00e9es. Si certaines r\u00e9ponses propos\u00e9es, ne correspondent pas, indiquez-le-nous dans votre message d&rsquo;envoi.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-2533 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-2533\" data-uid=\"69f630a4ece43\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2533\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2533 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"2533\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\tenctype=\"multipart\/form-data\"\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"69f630a4ece43\"\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\">QUESTIONNAIRE MULTIRISQUE IMMEUBLE<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-first-name-1_69f630a4ece43-label\">Nom\/soci\u00e9t\u00e9<\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_69f630a4ece43\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-last-name-1_69f630a4ece43-label\">Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_69f630a4ece43\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-1-street_address_69f630a4ece43-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69f630a4ece43\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-1-address_line_69f630a4ece43-label\">Appartement, suite, etc.<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69f630a4ece43\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-1-city_69f630a4ece43-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69f630a4ece43\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-1-zip_69f630a4ece43-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"\" id=\"forminator-field-address-1-zip_69f630a4ece43\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-phone-1_69f630a4ece43-label\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69f630a4ece43\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-validation=\"1\" \/><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-email-1_69f630a4ece43-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"jacques@martin.com\" id=\"forminator-field-email-1_69f630a4ece43\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-13_69f630a4ece43\" id=\"forminator-form-2533__field--select-13_69f630a4ece43-label\" class=\"forminator-label\">Etes vous un syndic  <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2533__field--select-13_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-13\" data-default-value=\"\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-13_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-13_69f630a4ece43-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"professionnel\"  data-calculation=\"0\">Professionnel ?<\/option><option value=\"B\u00e9n\u00e9vole ?\"  data-calculation=\"0\">B\u00e9n\u00e9vole ?<\/option><\/select><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-2-street_address_69f630a4ece43-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"Adresse de l&#039;immeuble \u00e0 garantir\" id=\"forminator-field-address-2-street_address_69f630a4ece43\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-city_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-2-city_69f630a4ece43-label\">Ville<\/label><input type=\"text\" name=\"address-2-city\" placeholder=\"Ville de l&#039;immeuble \u00e0 garantir\" id=\"forminator-field-address-2-city_69f630a4ece43\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-zip_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-address-2-zip_69f630a4ece43-label\">Code postal<\/label><input type=\"text\" name=\"address-2-zip\" placeholder=\"\" id=\"forminator-field-address-2-zip_69f630a4ece43\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-1_69f630a4ece43-label\">Ann\u00e9e de l&#039;immeuble ou p\u00e9riode de construction <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"2\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1900\" max=\"2050\" \/><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-2_69f630a4ece43-label\">Nombre de b\u00e2timents \u00e0 garantir <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"2\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-3_69f630a4ece43-label\">Si plusieurs b\u00e2timents: distance par rapport aux autres <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"2\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"0\" max=\"150\" \/><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-text-1_69f630a4ece43-label\">Surface d\u00e9velopp\u00e9e de l&#039;immeuble  <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f630a4ece43\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"20\" aria-describedby=\"forminator-field-text-1_69f630a4ece43-description\" \/><span id=\"forminator-field-text-1_69f630a4ece43-description\" class=\"forminator-description\">La surface est calcul\u00e9e \u00e9tage par \u00e9tage \u00e0 partir des murs ext\u00e9rieurs<span data-limit=\"20\" data-type=\"characters\">0 \/ 20<\/span><\/span><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-text-2_69f630a4ece43-label\">Dont surfaces garages, sous-sols et d\u00e9pendances <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69f630a4ece43\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-4_69f630a4ece43-label\">Nombre d&#039;\u00e9tages \u00e0 partir du rez de chauss\u00e9e<\/label><input name=\"number-4\" value=\"\" placeholder=\"\" id=\"forminator-field-number-4_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-1_69f630a4ece43\" id=\"forminator-form-2533__field--select-1_69f630a4ece43-label\" class=\"forminator-label\">Pr\u00e9sence d&#039;une v\u00e9randa ?<\/label><select id=\"forminator-form-2533__field--select-1_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-1\" data-default-value=\"non\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-1_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-1_69f630a4ece43-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\" selected=\"selected\" data-calculation=\"0\">NON<\/option><\/select><\/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 required\" aria-labelledby=\"forminator-checkbox-group-69f630a4ece43-label\"><h4 id=\"forminator-checkbox-group-69f630a4ece43-label\" class=\"forminator-label\">Am\u00e9nagements et \u00e9quipements <span class=\"forminator-required\">*<\/span><\/h4><label id=\"forminator-field-checkbox-3-1-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-1-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Aucun am\u00e9nagement ou \u00e9quipement\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"aucun-am\u00e9nagement-ou-quiment\" id=\"forminator-field-checkbox-3-1-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-1-69f630a4ece43-label\" data-calculation=\"0\" checked=\"checked\"  aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Aucun am\u00e9nagement ou \u00e9quipement<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-2-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Ascenseurs\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"ascenseurs\" id=\"forminator-field-checkbox-3-2-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-2-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ascenseurs<\/span><\/label><label id=\"forminator-field-checkbox-3-3-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-3-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Panneaux solaires\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"panneaux-solaires\" id=\"forminator-field-checkbox-3-3-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-3-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Panneaux solaires<\/span><\/label><label id=\"forminator-field-checkbox-3-4-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-4-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Piscine\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"piscine\" id=\"forminator-field-checkbox-3-4-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-4-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Piscine<\/span><\/label><label id=\"forminator-field-checkbox-3-5-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-5-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Jeux pour enfants ext\u00e9rieurs\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"jeux-pour-enfants-extrieurs\" id=\"forminator-field-checkbox-3-5-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-5-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jeux pour enfants ext\u00e9rieurs<\/span><\/label><label id=\"forminator-field-checkbox-3-6-69f630a4ece43-label\" for=\"forminator-field-checkbox-3-6-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Autres (pr\u00e9ciser)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"autres-prciser\" id=\"forminator-field-checkbox-3-6-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-3-6-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-3-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Autres (pr\u00e9ciser)<\/span><\/label><\/div><\/div><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69f630a4ece43\" id=\"forminator-field-textarea-2_69f630a4ece43-label\" class=\"forminator-label\">Si vous avez choisi &quot;Autres&quot; Merci de pr\u00e9ciser<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69f630a4ece43\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-3_69f630a4ece43\" id=\"forminator-form-2533__field--select-3_69f630a4ece43-label\" class=\"forminator-label\">Type de Toiture <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2533__field--select-3_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-3\" data-default-value=\"merci-de-faire-votre-choix\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-3_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-3_69f630a4ece43-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"merci-de-faire-votre-choix\" selected=\"selected\" data-calculation=\"0\">Merci de faire votre choix<\/option><option value=\"terrasse\"  data-calculation=\"0\">Terrasse<\/option><option value=\"traditionnelle-ardoises\"  data-calculation=\"0\">Traditionnelle Ardoises<\/option><option value=\"traditionnelle-tuiles\"  data-calculation=\"0\">Traditionnelle Tuiles<\/option><option value=\"autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-4_69f630a4ece43\" id=\"forminator-form-2533__field--select-4_69f630a4ece43-label\" class=\"forminator-label\">Pr\u00e9sence d&#039;extincteurs ?<\/label><select id=\"forminator-form-2533__field--select-4_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-4\" data-default-value=\"non\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-4_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-4_69f630a4ece43-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\" selected=\"selected\" data-calculation=\"0\">NON<\/option><\/select><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-text-3_69f630a4ece43-label\">Activit\u00e9s exerc\u00e9es dans l&#039;immeuble<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69f630a4ece43\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-5\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-5_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-5_69f630a4ece43-label\">Surface occup\u00e9e par ces activit\u00e9s ?<\/label><input name=\"number-5\" value=\"\" placeholder=\"ex: 30 m\u00b2\" id=\"forminator-field-number-5_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-5_69f630a4ece43\" id=\"forminator-form-2533__field--select-5_69f630a4ece43-label\" class=\"forminator-label\">Le b\u00e2timent est-il class\u00e9 ou inscrit \u00e0 l&#039;inventaire des monuments historiques ?<\/label><select id=\"forminator-form-2533__field--select-5_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-5\" data-default-value=\"non\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-5_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-5_69f630a4ece43-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\" selected=\"selected\" data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-6\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-6_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-number-6_69f630a4ece43-label\">Nombre de sinistres au cours des 36 derniers mois <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-6\" value=\"\" placeholder=\"\" id=\"forminator-field-number-6_69f630a4ece43\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"2\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"0\" max=\"50\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-6_69f630a4ece43\" id=\"forminator-form-2533__field--select-6_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b01<\/label><select id=\"forminator-form-2533__field--select-6_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-6\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-6_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-6_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-6\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-6-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-6-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-6-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-6-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-6-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-6-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-6-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-6-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-6-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-6-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-6-year\" placeholder=\"2000\" id=\"forminator-field-date-6-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-1_69f630a4ece43-label\">Montant du sinistre N\u00b01<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-1_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-8_69f630a4ece43\" id=\"forminator-form-2533__field--select-8_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b02<\/label><select id=\"forminator-form-2533__field--select-8_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-8\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-8_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-8_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-1\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-1-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-1-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-1-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-1-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-1-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-1-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-1-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-1-year\" placeholder=\"2000\" id=\"forminator-field-date-1-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-2_69f630a4ece43-label\">Montant du sinistre N\u00b02<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-2_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-9_69f630a4ece43\" id=\"forminator-form-2533__field--select-9_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b03<\/label><select id=\"forminator-form-2533__field--select-9_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-9\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-9_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-9_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-4\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-4-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-4-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-4-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-4-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-4-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-4-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-4-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-4-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-4-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-4-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-4-year\" placeholder=\"2000\" id=\"forminator-field-date-4-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-3_69f630a4ece43-label\">Montant du sinistre  N\u00b03<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-3_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-7_69f630a4ece43\" id=\"forminator-form-2533__field--select-7_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b04<\/label><select id=\"forminator-form-2533__field--select-7_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-7\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-7_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-7_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-5\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-5-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-5-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-5-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-5-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-5-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-5-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-5-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-5-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-5-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-5-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-5-year\" placeholder=\"2000\" id=\"forminator-field-date-5-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-5\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-5_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-5_69f630a4ece43-label\">Montant du sinistre N\u00b04<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-5\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-5_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-10_69f630a4ece43\" id=\"forminator-form-2533__field--select-10_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b05<\/label><select id=\"forminator-form-2533__field--select-10_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-10\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-10_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-10_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-2\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-2-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-2-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-2-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-2-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-2-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-2-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-2-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-2-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-2-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-2-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-2-year\" placeholder=\"2000\" id=\"forminator-field-date-2-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-4_69f630a4ece43-label\">Montant du sinistre N\u00b05<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-4_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-11_69f630a4ece43\" id=\"forminator-form-2533__field--select-11_69f630a4ece43-label\" class=\"forminator-label\">SINISTRE N\u00b06<\/label><select id=\"forminator-form-2533__field--select-11_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-11\" data-default-value=\"choisir-le-type-de-sinistre\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-11_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-11_69f630a4ece43-description\"><option value=\"bris-de-glaces\"  data-calculation=\"0\">Bris de Glaces<\/option><option value=\"D\u00e9g\u00e2ts des eaux\"  data-calculation=\"0\">D\u00e9g\u00e2ts des eaux<\/option><option value=\"vol\"  data-calculation=\"0\">Vol<\/option><option value=\"vandalisme\"  data-calculation=\"0\">Vandalisme<\/option><option value=\"incendie\"  data-calculation=\"0\">Incendie<\/option><option value=\"Dommages Electriques\"  data-calculation=\"0\">Dommages Electriques<\/option><option value=\"Dommages de fum\u00e9e\"  data-calculation=\"0\">Dommages de fum\u00e9e<\/option><option value=\"Temp\u00eate, Neige, Gr\u00eale\"  data-calculation=\"0\">Temp\u00eate, Neige, Gr\u00eale<\/option><option value=\"Choc de v\u00e9hicule terrestre identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre identifi\u00e9<\/option><option value=\"Choc de v\u00e9hicule terrestre non identifi\u00e9\"  data-calculation=\"0\">Choc de v\u00e9hicule terrestre non identifi\u00e9<\/option><option value=\"Responsabilit\u00e9 civile\"  data-calculation=\"0\">Responsabilit\u00e9 civile<\/option><option value=\"choisir-le-type-de-sinistre\" selected=\"selected\" data-calculation=\"0\">Choisir le type de sinistre<\/option><\/select><\/div><\/div><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-3\" class=\"forminator-label\">Date du sinistre<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-3-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-day_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-3-day_69f630a4ece43-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-3-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-3-day_69f630a4ece43\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-3-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-month_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-3-month_69f630a4ece43-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-3-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-3-month_69f630a4ece43\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69f630a4ece43-description\" \/><\/div><\/div><div id=\"date-3-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-year_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-date-3-year_69f630a4ece43-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-3-year\" placeholder=\"2000\" id=\"forminator-field-date-3-year_69f630a4ece43\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69f630a4ece43-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"currency-6\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-6_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-currency-6_69f630a4ece43-label\">Montant du sinistre N\u00b06<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-6\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-6_69f630a4ece43\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"gdprcheckbox-1\" class=\"forminator-field-gdprcheckbox forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-gdprcheckbox-1_69f630a4ece43\" class=\"forminator-label\">GDPR <span class=\"forminator-required\">*<\/span><\/label><label for=\"forminator-field-gdprcheckbox-1_69f630a4ece43\" class=\"forminator-checkbox\"><input type=\"checkbox\" name=\"gdprcheckbox-1\" value=\"true\" id=\"forminator-field-gdprcheckbox-1_69f630a4ece43\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\"><p>Oui, j\u2019accepte la politique de confidentialit\u00e9.<\/p><\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2533__field--select-12_69f630a4ece43\" id=\"forminator-form-2533__field--select-12_69f630a4ece43-label\" class=\"forminator-label\">Le contrat pr\u00e9c\u00e9dent a-t-il \u00e9t\u00e9 r\u00e9sili\u00e9 ?<\/label><select id=\"forminator-form-2533__field--select-12_69f630a4ece43\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-12\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2533__field--select-12_69f630a4ece43-label\" aria-describedby=\"forminator-form-2533__field--select-12_69f630a4ece43-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f630a4ece43\" id=\"forminator-field-textarea-3_69f630a4ece43-label\" class=\"forminator-label\">Si oui, pour quelles raisons ? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f630a4ece43\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-text-4_69f630a4ece43-label\">Quel est l&#039;assureur actuel ?<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69f630a4ece43\" 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_69f630a4ece43\" class=\"forminator-label\" id=\"forminator-field-text-5_69f630a4ece43-label\">Num\u00e9ro de contrat <\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69f630a4ece43\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-6 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">GARANTIES DE BASE :\t<\/label><ul>\n<li>Incendie et risques annexes<\/li>\n<li>Temp\u00eates, Gr\u00eale, Poids de la neige<\/li>\n<li>D\u00e9g\u00e2ts des eaux<\/li>\n<li>Responsabilit\u00e9 civile propri\u00e9taire d'immeuble<\/li>\n<li>D\u00e9fense p\u00e9nale et recours<\/li>\n<li>Bris de glace<\/li>\n<li>Vol<\/li>\n<li>Dommages \u00e9lectriques aux appareils<\/li>\n<li>Catastrophes naturelles<\/li>\n<li>Attentats<\/li>\n<li>\u00a0Risques technologiques<\/li>\n<\/ul><\/div><\/div><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f630a4ece43-label\"><h4 id=\"forminator-checkbox-group-69f630a4ece43-label\" class=\"forminator-label\">Garanties compl\u00e9mentaires:<\/h4><label id=\"forminator-field-checkbox-2-1-69f630a4ece43-label\" for=\"forminator-field-checkbox-2-1-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Garantie effondrement\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"garantie-effondrement\" id=\"forminator-field-checkbox-2-1-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-2-1-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-2-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Garantie effondrement<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69f630a4ece43-label\" for=\"forminator-field-checkbox-2-2-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Extension panneaux solaires\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"extension-panneaux-solaires\" id=\"forminator-field-checkbox-2-2-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-2-2-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-2-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Extension panneaux solaires<\/span><\/label><label id=\"forminator-field-checkbox-2-3-69f630a4ece43-label\" for=\"forminator-field-checkbox-2-3-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Extension panneaux photovoltaiques\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"extension-panneaux-photovoltaiques\" id=\"forminator-field-checkbox-2-3-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-2-3-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-2-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Extension panneaux photovoltaiques<\/span><\/label><label id=\"forminator-field-checkbox-2-4-69f630a4ece43-label\" for=\"forminator-field-checkbox-2-4-69f630a4ece43\" class=\"forminator-checkbox\" title=\"Bris de machine\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"bris-de-machine\" id=\"forminator-field-checkbox-2-4-69f630a4ece43\" aria-labelledby=\"forminator-field-checkbox-2-4-69f630a4ece43-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-2-69f630a4ece43-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bris de machine<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69f630a4ece43\" id=\"forminator-field-textarea-4_69f630a4ece43-label\" class=\"forminator-label\">Informations compl\u00e9mentaires que vous souhaiteriez nous communiquer:<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69f630a4ece43\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/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_69f630a4ece43\" class=\"forminator-label\">Copie dernier avis \u00e9ch\u00e9ance<\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_69f630a4ece43\" aria-describedby=\"forminator-field-upload-1_69f630a4ece43-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69f630a4ece43\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\"><button id=\"forminator-field-upload-1_69f630a4ece43_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_69f630a4ece43\">Choisissez un fichier<\/button><span data-empty-text=\"Aucun fichier s\u00e9lectionn\u00e9\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9vers\u00e9<\/span><\/button><\/div><\/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_69f630a4ece43\" class=\"forminator-label\">Relev\u00e9 d&#039;informations sinistres<\/label><div class=\"forminator-file-upload \" data-element=\"upload-2_69f630a4ece43\" aria-describedby=\"forminator-field-upload-2_69f630a4ece43-description\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_69f630a4ece43\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\"><button id=\"forminator-field-upload-2_69f630a4ece43_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_69f630a4ece43\">Choisissez un fichier<\/button><span data-empty-text=\"Aucun fichier s\u00e9lectionn\u00e9\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9vers\u00e9<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-3\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-3_69f630a4ece43\" class=\"forminator-label\">Photos immeuble<\/label><div class=\"forminator-file-upload \" data-element=\"upload-3_69f630a4ece43\" aria-describedby=\"forminator-field-upload-3_69f630a4ece43-description\"><input type=\"file\" name=\"upload-3\" id=\"forminator-field-upload-3_69f630a4ece43\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\"><button id=\"forminator-field-upload-3_69f630a4ece43_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-3_69f630a4ece43\">Choisissez un fichier<\/button><span data-empty-text=\"Aucun fichier s\u00e9lectionn\u00e9\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9vers\u00e9<\/span><\/button><\/div><\/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\">Demander un devis<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"997b449928\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2553\" \/><input type=\"hidden\" name=\"form_id\" value=\"2533\"><input type=\"hidden\" name=\"page_id\" value=\"2553\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/aca-pl.com\/?page_id=2553\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\n\n\n<p class=\"has-background\" style=\"background-color:#f1e830\">Des documents compl\u00e9mentaires pourront vous \u00eatre demand\u00e9s dans le cadre de cette \u00e9tude, en compl\u00e9ment de la copie du permis de conduire et de la carte grise qui seront demand\u00e9s obligatoirement en cas de souscription, de m\u00eame que le relev\u00e9 d\u2019information de la ou des compagnies pr\u00e9c\u00e9dentes. Les donn\u00e9es communiqu\u00e9es sont strictement confidentielles et ne seront utilis\u00e9es que dans le cadre de l\u2019\u00e9tude de ce projet.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"125\" height=\"125\" src=\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\" alt=\"LOGO ACA\" class=\"wp-image-33\"\/><\/figure><\/div>\n\n\n\n<p class=\"has-text-align-center\"><strong>Quand la passion est un m\u00e9tier<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>L&rsquo;objectif de ce questionnaire est d&rsquo;obtenir les informations destin\u00e9es \u00e0 votre \u00e9tude personnalis\u00e9e. Ces informations ne seront en aucun cas transmis \u00e0 des tiers, hormis les assureurs interrog\u00e9s. Merci de s\u00e9lectionner les propositions ou bien de remplir les informations demand\u00e9es. Si certaines r\u00e9ponses propos\u00e9es, ne correspondent pas, indiquez-le-nous dans votre message d&rsquo;envoi. Des documents compl\u00e9mentaires &hellip; <a href=\"https:\/\/aca-pl.com\/?page_id=2553\" class=\"more-link\">Continuer la lecture de <span class=\"screen-reader-text\">QUESTIONNAIRE MULTIRISQUE IMMEUBLE<\/span>  <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"class_list":["post-2553","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>QUESTIONNAIRE MULTIRISQUE IMMEUBLE -<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/aca-pl.com\/?page_id=2553\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"QUESTIONNAIRE MULTIRISQUE IMMEUBLE -\" \/>\n<meta property=\"og:description\" content=\"L&rsquo;objectif de ce questionnaire est d&rsquo;obtenir les informations destin\u00e9es \u00e0 votre \u00e9tude personnalis\u00e9e. Ces informations ne seront en aucun cas transmis \u00e0 des tiers, hormis les assureurs interrog\u00e9s. Merci de s\u00e9lectionner les propositions ou bien de remplir les informations demand\u00e9es. Si certaines r\u00e9ponses propos\u00e9es, ne correspondent pas, indiquez-le-nous dans votre message d&rsquo;envoi. Des documents compl\u00e9mentaires &hellip; Continuer la lecture de QUESTIONNAIRE MULTIRISQUE IMMEUBLE &rarr;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/aca-pl.com\/?page_id=2553\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/groups\/1773349446235806\/?ref=bookmarks\" \/>\n<meta property=\"article:modified_time\" content=\"2020-11-09T21:54:41+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@AssistanceAudit\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553\",\"url\":\"https:\/\/aca-pl.com\/?page_id=2553\",\"name\":\"QUESTIONNAIRE MULTIRISQUE IMMEUBLE -\",\"isPartOf\":{\"@id\":\"https:\/\/aca-pl.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553#primaryimage\"},\"image\":{\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553#primaryimage\"},\"thumbnailUrl\":\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\",\"datePublished\":\"2020-11-09T21:54:35+00:00\",\"dateModified\":\"2020-11-09T21:54:41+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/aca-pl.com\/?page_id=2553\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553#primaryimage\",\"url\":\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\",\"contentUrl\":\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\",\"width\":125,\"height\":125,\"caption\":\"LOGO ACA\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/aca-pl.com\/?page_id=2553#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\/\/aca-pl.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"QUESTIONNAIRE MULTIRISQUE IMMEUBLE\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/aca-pl.com\/#website\",\"url\":\"https:\/\/aca-pl.com\/\",\"name\":\"\",\"description\":\"Quand la passion est un m\u00e9tier\",\"publisher\":{\"@id\":\"https:\/\/aca-pl.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/aca-pl.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/aca-pl.com\/#organization\",\"name\":\"AUDIT CONSEIL ASSISTANCE\",\"url\":\"https:\/\/aca-pl.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/aca-pl.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\",\"contentUrl\":\"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png\",\"width\":125,\"height\":125,\"caption\":\"AUDIT CONSEIL ASSISTANCE\"},\"image\":{\"@id\":\"https:\/\/aca-pl.com\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.facebook.com\/groups\/1773349446235806\/?ref=bookmarks\",\"https:\/\/x.com\/AssistanceAudit\",\"http:\/\/www.linkedin.com\/in\/philippe-b-7a43b342\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"QUESTIONNAIRE MULTIRISQUE IMMEUBLE -","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/aca-pl.com\/?page_id=2553","og_locale":"fr_FR","og_type":"article","og_title":"QUESTIONNAIRE MULTIRISQUE IMMEUBLE -","og_description":"L&rsquo;objectif de ce questionnaire est d&rsquo;obtenir les informations destin\u00e9es \u00e0 votre \u00e9tude personnalis\u00e9e. Ces informations ne seront en aucun cas transmis \u00e0 des tiers, hormis les assureurs interrog\u00e9s. Merci de s\u00e9lectionner les propositions ou bien de remplir les informations demand\u00e9es. Si certaines r\u00e9ponses propos\u00e9es, ne correspondent pas, indiquez-le-nous dans votre message d&rsquo;envoi. Des documents compl\u00e9mentaires &hellip; Continuer la lecture de QUESTIONNAIRE MULTIRISQUE IMMEUBLE &rarr;","og_url":"https:\/\/aca-pl.com\/?page_id=2553","article_publisher":"https:\/\/www.facebook.com\/groups\/1773349446235806\/?ref=bookmarks","article_modified_time":"2020-11-09T21:54:41+00:00","og_image":[{"url":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_site":"@AssistanceAudit","twitter_misc":{"Dur\u00e9e de lecture estim\u00e9e":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/aca-pl.com\/?page_id=2553","url":"https:\/\/aca-pl.com\/?page_id=2553","name":"QUESTIONNAIRE MULTIRISQUE IMMEUBLE -","isPartOf":{"@id":"https:\/\/aca-pl.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/aca-pl.com\/?page_id=2553#primaryimage"},"image":{"@id":"https:\/\/aca-pl.com\/?page_id=2553#primaryimage"},"thumbnailUrl":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","datePublished":"2020-11-09T21:54:35+00:00","dateModified":"2020-11-09T21:54:41+00:00","breadcrumb":{"@id":"https:\/\/aca-pl.com\/?page_id=2553#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/aca-pl.com\/?page_id=2553"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/aca-pl.com\/?page_id=2553#primaryimage","url":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","contentUrl":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","width":125,"height":125,"caption":"LOGO ACA"},{"@type":"BreadcrumbList","@id":"https:\/\/aca-pl.com\/?page_id=2553#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"https:\/\/aca-pl.com\/"},{"@type":"ListItem","position":2,"name":"QUESTIONNAIRE MULTIRISQUE IMMEUBLE"}]},{"@type":"WebSite","@id":"https:\/\/aca-pl.com\/#website","url":"https:\/\/aca-pl.com\/","name":"","description":"Quand la passion est un m\u00e9tier","publisher":{"@id":"https:\/\/aca-pl.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/aca-pl.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/aca-pl.com\/#organization","name":"AUDIT CONSEIL ASSISTANCE","url":"https:\/\/aca-pl.com\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/aca-pl.com\/#\/schema\/logo\/image\/","url":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","contentUrl":"https:\/\/aca-pl.com\/wp-content\/uploads\/2019\/11\/ACA-15pxX15px-1.png","width":125,"height":125,"caption":"AUDIT CONSEIL ASSISTANCE"},"image":{"@id":"https:\/\/aca-pl.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/groups\/1773349446235806\/?ref=bookmarks","https:\/\/x.com\/AssistanceAudit","http:\/\/www.linkedin.com\/in\/philippe-b-7a43b342"]}]}},"_links":{"self":[{"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/pages\/2553","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/aca-pl.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2553"}],"version-history":[{"count":5,"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/pages\/2553\/revisions"}],"predecessor-version":[{"id":2558,"href":"https:\/\/aca-pl.com\/index.php?rest_route=\/wp\/v2\/pages\/2553\/revisions\/2558"}],"wp:attachment":[{"href":"https:\/\/aca-pl.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2553"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}