{"id":2581,"date":"2020-11-17T13:39:06","date_gmt":"2020-11-17T12:39:06","guid":{"rendered":"https:\/\/aca-pl.com\/?page_id=2581"},"modified":"2020-11-17T13:47:26","modified_gmt":"2020-11-17T12:47:26","slug":"audit-conseil-assistance-3","status":"publish","type":"page","link":"https:\/\/aca-pl.com\/?page_id=2581","title":{"rendered":"QUESTIONNAIRE PREVOYANCE"},"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-2580 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-2580\" data-uid=\"69e5c7f957229\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2580\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2580 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=\"2580\"\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=\"69e5c7f957229\"\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=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><label class=\"forminator-label\">Questionnaire Pr\u00e9voyance<\/label><p>Afin de pouvoir vous adresser un projet personnalis\u00e9, merci de compl\u00e9ter le questionnaire ci-dessous.<\/p><\/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-form-2580__field--name-1_69e5c7f957229\" id=\"forminator-form-2580__field--name-1_69e5c7f957229-label\" class=\"forminator-label\">Pr\u00e9fixe<\/label><select name=\"name-1-prefix\" id=\"forminator-form-2580__field--name-1_69e5c7f957229\" class=\"forminator-select2\" data-multi=\"1\" aria-labelledby=\"forminator-form-2580__field--name-1_69e5c7f957229-label\" data-default-value=\"\"><option value=\"Mr\" >M.<\/option><option value=\"Mrs\" >Mme<\/option><option value=\"Ms\" >Mme<\/option><option value=\"Mx\" >Mx<\/option><option value=\"Miss\" >Mlle<\/option><option value=\"Dr\" >Dr.<\/option><option value=\"Prof\" >Prof.<\/option><\/select><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-first-name-1_69e5c7f957229-label\">Nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_69e5c7f957229\" class=\"forminator-input\" aria-required=\"true\" 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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-last-name-1_69e5c7f957229-label\">Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_69e5c7f957229\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-3\" class=\"forminator-label\">Date de Naissance<\/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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-3-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-3-day\" value=\"\" placeholder=\"01\" id=\"forminator-field-date-3-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd-mm-yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-3-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-3-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-3-month\" value=\"\" placeholder=\"01\" id=\"forminator-field-date-3-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd-mm-yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-3-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-3-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-3-year\" placeholder=\"2000\" id=\"forminator-field-date-3-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd-mm-yy\" data-parent=\"date-3\" aria-describedby=\"forminator-field-date-3_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"select-14\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-14_69e5c7f957229\" id=\"forminator-form-2580__field--select-14_69e5c7f957229-label\" class=\"forminator-label\">Sexe<\/label><select id=\"forminator-form-2580__field--select-14_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-14\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-14_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-14_69e5c7f957229-description\"><option value=\"masculin\"  data-calculation=\"0\">Masculin<\/option><option value=\"F\u00e9minin\"  data-calculation=\"0\">F\u00e9minin<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-number-2_69e5c7f957229-label\">D\u00e9partement de Naissance <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_69e5c7f957229\" 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=\"\" max=\"110\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-text-3_69e5c7f957229-label\">Ville de Naissance <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"ex: Paris\" id=\"forminator-field-text-3_69e5c7f957229\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-address-1-street_address_69e5c7f957229-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69e5c7f957229\" 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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-address-1-address_line_69e5c7f957229-label\">Appartement, suite, etc.<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69e5c7f957229\" 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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-address-1-city_69e5c7f957229-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69e5c7f957229\" 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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-address-1-zip_69e5c7f957229-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"\" id=\"forminator-field-address-1-zip_69e5c7f957229\" 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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-phone-1_69e5c7f957229-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_69e5c7f957229\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"FX\" data-validation=\"standard\" \/><\/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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-email-1_69e5c7f957229-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_69e5c7f957229\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-2_69e5c7f957229\" id=\"forminator-form-2580__field--select-2_69e5c7f957229-label\" class=\"forminator-label\">Quel est votre statut familial ? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2580__field--select-2_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-2_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-2_69e5c7f957229-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"C\u00e9libataire\"  data-calculation=\"0\">C\u00e9libataire<\/option><option value=\"Mari\u00e9\"  data-calculation=\"0\">Mari\u00e9<\/option><option value=\"Pasc\u00e9\"  data-calculation=\"0\">Pasc\u00e9<\/option><option value=\"concubinage\"  data-calculation=\"0\">Concubinage<\/option><option value=\"Divorc\u00e9\"  data-calculation=\"0\">Divorc\u00e9<\/option><option value=\"veuf\"  data-calculation=\"0\">Veuf<\/option><option value=\"veuve\"  data-calculation=\"0\">Veuve<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-text-1_69e5c7f957229-label\">Quel est votre profession exacte? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69e5c7f957229\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"select-33\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-33_69e5c7f957229\" id=\"forminator-form-2580__field--select-33_69e5c7f957229-label\" class=\"forminator-label\">Cat\u00e9gorie professionnelle<\/label><select id=\"forminator-form-2580__field--select-33_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-33\" data-default-value=\"Choisissez une cat\u00e9gorie professionnelle\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-33_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-33_69e5c7f957229-description\"><option value=\"autre-profession-librale\"  data-calculation=\"0\">Autre profession lib\u00e9rale<\/option><option value=\"M\u00e9tier de la sant\u00e9\/m\u00e9dicaux\"  data-calculation=\"0\">M\u00e9tier de la sant\u00e9\/m\u00e9dicaux<\/option><option value=\"M\u00e9tier de la sant\u00e9\/param\u00e9dicaux\"  data-calculation=\"0\">M\u00e9tier de la sant\u00e9\/param\u00e9dicaux<\/option><option value=\"mtiers-de-la-santinfirmiers\"  data-calculation=\"0\">M\u00e9tiers de la sant\u00e9\/infirmiers<\/option><option value=\"mtier-de-limmobilier-et-du-patrimoine\"  data-calculation=\"0\">M\u00e9tier de l'immobilier et du patrimoine<\/option><option value=\"M\u00e9tier de bouche, h\u00f4tellerie et restauration\"  data-calculation=\"0\">M\u00e9tier de bouche, h\u00f4tellerie et restauration<\/option><option value=\"Autre m\u00e9tier du commerce\"  data-calculation=\"0\">Autre m\u00e9tier du commerce<\/option><option value=\"Autre m\u00e9tier de l&#039;artisanat\"  data-calculation=\"0\">Autre m\u00e9tier de l'artisanat<\/option><option value=\"M\u00e9tier de la beaut\u00e9 et du bien \u00eatre\"  data-calculation=\"0\">M\u00e9tier de la beaut\u00e9 et du bien \u00eatre<\/option><option value=\"M\u00e9tier de l&#039;agriculture et de l&#039;aquaculture\"  data-calculation=\"0\">M\u00e9tier de l'agriculture et de l'aquaculture<\/option><option value=\"M\u00e9tier du transport et de l&#039;automobile\"  data-calculation=\"0\">M\u00e9tier du transport et de l'automobile<\/option><option value=\"M\u00e9tier du b\u00e2timent \/gros \u0153uvre\"  data-calculation=\"0\">M\u00e9tier du b\u00e2timent \/gros \u0153uvre<\/option><option value=\"M\u00e9tier du droit r\u00e9glement\u00e9\"  data-calculation=\"0\">M\u00e9tier du droit r\u00e9glement\u00e9<\/option><option value=\"Choisissez une cat\u00e9gorie professionnelle\" selected=\"selected\" data-calculation=\"0\">Choisissez une cat\u00e9gorie professionnelle<\/option><\/select><\/div><\/div><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-number-3_69e5c7f957229-label\">Num\u00e9ro de Siret <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_69e5c7f957229\" 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=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-3_69e5c7f957229\" id=\"forminator-form-2580__field--select-3_69e5c7f957229-label\" class=\"forminator-label\">Etes vous salari\u00e9 ou travailleur non salari\u00e9 ? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2580__field--select-3_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-3_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-3_69e5c7f957229-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"Salari\u00e9\"  data-calculation=\"0\">Salari\u00e9<\/option><option value=\"Travailleur non salari\u00e9\"  data-calculation=\"0\">Travailleur non salari\u00e9<\/option><\/select><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-text-4_69e5c7f957229-label\">Caisse de retraite obligatoire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"Ex: CNAV\" id=\"forminator-field-text-4_69e5c7f957229\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/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_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-number-1_69e5c7f957229-label\">Nombre d&#039;enfants fiscalement \u00e0 charge <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_69e5c7f957229\" 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=\"15\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-25\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-25_69e5c7f957229\" id=\"forminator-form-2580__field--select-25_69e5c7f957229-label\" class=\"forminator-label\">Etes vous cr\u00e9ateur ou repreneur depuis moins d&#039;un an ?<\/label><select id=\"forminator-form-2580__field--select-25_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-25\" data-default-value=\"non\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-25_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-25_69e5c7f957229-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\" selected=\"selected\" data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><div id=\"select-24\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-24_69e5c7f957229\" id=\"forminator-form-2580__field--select-24_69e5c7f957229-label\" class=\"forminator-label\">Etes vous conjoint collaborateur ?<\/label><select id=\"forminator-form-2580__field--select-24_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-24\" data-default-value=\"non\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-24_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-24_69e5c7f957229-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=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-1_69e5c7f957229-label\">Dernier revenu annuel d\u00e9clar\u00e9 hors dividende <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-1_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-2_69e5c7f957229-label\">Derniers dividendes annuels d\u00e9clar\u00e9s <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-2_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-12 \"><label for=\"forminator-field-date-4\" class=\"forminator-label\">Date de cl\u00f4ture du bilan<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-4-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-4-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-4-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-4-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-4-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-4-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-4-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-4-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-4-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-4-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-4-year\" placeholder=\"\" id=\"forminator-field-date-4-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-4\" aria-describedby=\"forminator-field-date-4_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-26\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-26_69e5c7f957229\" id=\"forminator-form-2580__field--select-26_69e5c7f957229-label\" class=\"forminator-label\">Etes vous une personne politiquement expos\u00e9e ou proche d&#039;une personne politiquement expos\u00e9e ? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2580__field--select-26_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-26\" data-default-value=\"non\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-26_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-26_69e5c7f957229-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"OUI\"  data-calculation=\"0\">Option 1<\/option><option value=\"non\" selected=\"selected\" data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-27\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-27_69e5c7f957229\" id=\"forminator-form-2580__field--select-27_69e5c7f957229-label\" class=\"forminator-label\">Souhaitez vous b\u00e9n\u00e9ficier de la fiscalit\u00e9 Madelin ?<\/label><select id=\"forminator-form-2580__field--select-27_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-27\" data-default-value=\"oui\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-27_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-27_69e5c7f957229-description\"><option value=\"oui\" selected=\"selected\" data-calculation=\"0\">OUI<\/option><option value=\"non\"  data-calculation=\"0\">NON<\/option><\/select><\/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\">Personnes \u00e0 garantir<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-4 \"><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-2_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-first-name-2_69e5c7f957229-label\">Nom Souscripteur <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-first-name\" placeholder=\"\" id=\"forminator-field-first-name-2_69e5c7f957229\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-2_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-last-name-2_69e5c7f957229-label\">Pr\u00e9nom Souscripteur <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-last-name\" placeholder=\"\" id=\"forminator-field-last-name-2_69e5c7f957229\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/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 de Naissance <span class=\"forminator-required\">*<\/span><\/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_69e5c7f957229\" class=\"forminator-label\">Jour <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-2-day\" value=\"\" placeholder=\"01\" id=\"forminator-field-date-2-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd-mm-yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-2-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-month_69e5c7f957229\" class=\"forminator-label\">Mois <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-2-month\" value=\"\" placeholder=\"01\" id=\"forminator-field-date-2-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd-mm-yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-2-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-year_69e5c7f957229\" class=\"forminator-label\">Ann\u00e9e <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" name=\"date-2-year\" placeholder=\"2000\" id=\"forminator-field-date-2-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd-mm-yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-4_69e5c7f957229\" id=\"forminator-form-2580__field--select-4_69e5c7f957229-label\" class=\"forminator-label\">R\u00e9gime obligatoire  <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-2580__field--select-4_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-4\" data-default-value=\"slectionner-votre-rponse\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-4_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-4_69e5c7f957229-description\"><option value=\"\">Merci de choisir une option<\/option><option value=\"cpam\"  data-calculation=\"0\">CPAM<\/option><option value=\"S\u00e9curit\u00e9 sociale des ind\u00e9pendants\"  data-calculation=\"0\">S\u00e9curit\u00e9 sociale des ind\u00e9pendants<\/option><option value=\"R\u00e9gime agricole\"  data-calculation=\"0\">R\u00e9gime agricole<\/option><option value=\"Alsace\/Moselle\"  data-calculation=\"0\">Alsace\/Moselle<\/option><option value=\"slectionner-votre-rponse\" selected=\"selected\" data-calculation=\"0\">S\u00e9lectionner votre r\u00e9ponse<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-4 \"><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-3_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-first-name-3_69e5c7f957229-label\">Nom Conjoint<\/label><input type=\"text\" name=\"name-3-first-name\" placeholder=\"\" id=\"forminator-field-first-name-3_69e5c7f957229\" 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-3_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-last-name-3_69e5c7f957229-label\">Pr\u00e9nom Conjoint<\/label><input type=\"text\" name=\"name-3-last-name\" placeholder=\"\" id=\"forminator-field-last-name-3_69e5c7f957229\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-6_69e5c7f957229\" id=\"forminator-form-2580__field--select-6_69e5c7f957229-label\" class=\"forminator-label\">Sexe<\/label><select id=\"forminator-form-2580__field--select-6_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-6\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-6_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-6_69e5c7f957229-description\"><option value=\"masculin\"  data-calculation=\"0\">Masculin<\/option><option value=\"F\u00e9minin\"  data-calculation=\"0\">F\u00e9minin<\/option><\/select><\/div><\/div><div id=\"select-15\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-15_69e5c7f957229\" id=\"forminator-form-2580__field--select-15_69e5c7f957229-label\" class=\"forminator-label\">R\u00e9gime obligatoire <\/label><select id=\"forminator-form-2580__field--select-15_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-15\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-15_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-15_69e5c7f957229-description\"><option value=\"cpam\"  data-calculation=\"0\">CPAM<\/option><option value=\"S\u00e9curit\u00e9 sociale des ind\u00e9pendants\"  data-calculation=\"0\">S\u00e9curit\u00e9 sociale des ind\u00e9pendants<\/option><option value=\"R\u00e9gime agricole\"  data-calculation=\"0\">R\u00e9gime agricole<\/option><option value=\"Alsace\/Moselle\"  data-calculation=\"0\">Alsace\/Moselle<\/option><\/select><\/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\">Garanties propos\u00e9es<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-28\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-28_69e5c7f957229\" id=\"forminator-form-2580__field--select-28_69e5c7f957229-label\" class=\"forminator-label\">Incapacit\u00e9 temporaire totale de travail jusqu&#039;au 90\u00e8me jour d&#039;arr\u00eat<\/label><select id=\"forminator-form-2580__field--select-28_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-28\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-28_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-28_69e5c7f957229-description\"><option value=\"10\"  data-calculation=\"0\">10 \u20ac<\/option><option value=\"20\"  data-calculation=\"0\">20 \u20ac<\/option><option value=\"30\"  data-calculation=\"0\">30 \u20ac<\/option><option value=\"40\"  data-calculation=\"0\">40 \u20ac<\/option><option value=\"50\"  data-calculation=\"0\">50 \u20ac<\/option><option value=\"60\"  data-calculation=\"0\">60 \u20ac<\/option><option value=\"70\"  data-calculation=\"0\">70 \u20ac<\/option><option value=\"80\"  data-calculation=\"0\">80 \u20ac<\/option><option value=\"90\"  data-calculation=\"0\">90 \u20ac<\/option><option value=\"100\"  data-calculation=\"0\">100 \u20ac<\/option><option value=\"110\"  data-calculation=\"0\">110 \u20ac<\/option><option value=\"120\"  data-calculation=\"0\">120 \u20ac<\/option><option value=\"130\"  data-calculation=\"0\">130 \u20ac<\/option><option value=\"140\"  data-calculation=\"0\">140 \u20ac<\/option><option value=\"150\"  data-calculation=\"0\">150 \u20ac<\/option><option value=\"160\"  data-calculation=\"0\">160 \u20ac<\/option><option value=\"170\"  data-calculation=\"0\">170 \u20ac<\/option><option value=\"180\"  data-calculation=\"0\">180 \u20ac<\/option><option value=\"190\"  data-calculation=\"0\">190 \u20ac<\/option><option value=\"200\"  data-calculation=\"0\">200 \u20ac<\/option><option value=\"210\"  data-calculation=\"0\">210 \u20ac<\/option><option value=\"220\"  data-calculation=\"0\">220 \u20ac<\/option><option value=\"autre-montant\"  data-calculation=\"0\">AUTRE MONTANT<\/option><\/select><\/div><\/div><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-3_69e5c7f957229-label\">AUTRE MONTANT<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-3_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-29\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-29_69e5c7f957229\" id=\"forminator-form-2580__field--select-29_69e5c7f957229-label\" class=\"forminator-label\">Incapacit\u00e9 temporaire totale de travail jusqu&#039;au 90\u00e8me jour d&#039;arr\u00eat dividendes<\/label><select id=\"forminator-form-2580__field--select-29_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-29\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-29_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-29_69e5c7f957229-description\"><option value=\"10\"  data-calculation=\"0\">10 \u20ac<\/option><option value=\"20\"  data-calculation=\"0\">20 \u20ac<\/option><option value=\"30\"  data-calculation=\"0\">30 \u20ac<\/option><option value=\"40\"  data-calculation=\"0\">40 \u20ac<\/option><option value=\"50\"  data-calculation=\"0\">50 \u20ac<\/option><option value=\"60\"  data-calculation=\"0\">60 \u20ac<\/option><option value=\"70\"  data-calculation=\"0\">70 \u20ac<\/option><option value=\"80\"  data-calculation=\"0\">80 \u20ac<\/option><option value=\"90\"  data-calculation=\"0\">90 \u20ac<\/option><option value=\"100\"  data-calculation=\"0\">100 \u20ac<\/option><option value=\"110\"  data-calculation=\"0\">110 \u20ac<\/option><option value=\"120\"  data-calculation=\"0\">120 \u20ac<\/option><option value=\"130\"  data-calculation=\"0\">130 \u20ac<\/option><option value=\"140\"  data-calculation=\"0\">140 \u20ac<\/option><option value=\"150\"  data-calculation=\"0\">150 \u20ac<\/option><option value=\"160\"  data-calculation=\"0\">160 \u20ac<\/option><option value=\"170\"  data-calculation=\"0\">170 \u20ac<\/option><option value=\"180\"  data-calculation=\"0\">180 \u20ac<\/option><option value=\"190\"  data-calculation=\"0\">190 \u20ac<\/option><option value=\"200\"  data-calculation=\"0\">200 \u20ac<\/option><option value=\"210\"  data-calculation=\"0\">210 \u20ac<\/option><option value=\"220\"  data-calculation=\"0\">220 \u20ac<\/option><option value=\"autre-montant\"  data-calculation=\"0\">AUTRE MONTANT<\/option><\/select><\/div><\/div><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-4_69e5c7f957229-label\">AUTRE MONTANT<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-4_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-30\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-30_69e5c7f957229\" id=\"forminator-form-2580__field--select-30_69e5c7f957229-label\" class=\"forminator-label\">Franchise: maladie, accident, hospitalisation<\/label><select id=\"forminator-form-2580__field--select-30_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-30\" data-default-value=\"choisir-une-franchise\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-30_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-30_69e5c7f957229-description\"><option value=\"franchise-1530\"  data-calculation=\"0\">Franchise 15\/3\/0<\/option><option value=\"Franchise 15\/3\/0\"  data-calculation=\"0\">Franchise 15\/3\/0<\/option><option value=\"franchise-3033\"  data-calculation=\"0\">Franchise 30\/3\/3<\/option><option value=\"franchise-303030\"  data-calculation=\"0\">Franchise 30\/30\/30<\/option><option value=\"franchise-733-professions-mdicales\"  data-calculation=\"0\">Franchise 7\/3\/3 (professions m\u00e9dicales)<\/option><option value=\"franchise-730-professions-mdicales\"  data-calculation=\"0\">Franchise 7\/3\/0 (professions m\u00e9dicales)<\/option><option value=\"franchise-606060-avocats\"  data-calculation=\"0\">Franchise 60\/60\/60 (avocats)<\/option><option value=\"choisir-une-franchise\" selected=\"selected\" data-calculation=\"0\">Choisir une Franchise<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-31\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-31_69e5c7f957229\" id=\"forminator-form-2580__field--select-31_69e5c7f957229-label\" class=\"forminator-label\">Incapacit\u00e9 temporaire totale de travail \u00e0 partir du 91 \u00e8me jour d&#039;arr\u00eat<\/label><select id=\"forminator-form-2580__field--select-31_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-31\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-31_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-31_69e5c7f957229-description\"><option value=\"10\"  data-calculation=\"10\">10 \u20ac<\/option><option value=\"20\"  data-calculation=\"20\">20 \u20ac<\/option><option value=\"30\"  data-calculation=\"30\">30 \u20ac<\/option><option value=\"40\"  data-calculation=\"40\">40 \u20ac<\/option><option value=\"50\"  data-calculation=\"50\">50 \u20ac<\/option><option value=\"60\"  data-calculation=\"60\">60 \u20ac<\/option><option value=\"70\"  data-calculation=\"70\">70 \u20ac<\/option><option value=\"80\"  data-calculation=\"78\">80 \u20ac<\/option><option value=\"90\"  data-calculation=\"90\">90 \u20ac<\/option><option value=\"100\"  data-calculation=\"100\">100 \u20ac<\/option><option value=\"110\"  data-calculation=\"110\">110 \u20ac<\/option><option value=\"120\"  data-calculation=\"120\">120 \u20ac<\/option><option value=\"130\"  data-calculation=\"129\">130 \u20ac<\/option><option value=\"140\"  data-calculation=\"140\">140 \u20ac<\/option><option value=\"150\"  data-calculation=\"150\">150 \u20ac<\/option><option value=\"160\"  data-calculation=\"160\">160 \u20ac<\/option><option value=\"170\"  data-calculation=\"170\">170 \u20ac<\/option><option value=\"180\"  data-calculation=\"180\">180 \u20ac<\/option><option value=\"190\"  data-calculation=\"190\">190 \u20ac<\/option><option value=\"200\"  data-calculation=\"200\">200 \u20ac<\/option><option value=\"210\"  data-calculation=\"210\">210 \u20ac<\/option><option value=\"220\"  data-calculation=\"220\">220 \u20ac<\/option><option value=\"autre-montant\"  data-calculation=\"0\">AUTRE MONTANT<\/option><\/select><\/div><\/div><div id=\"currency-5\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-5_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-5_69e5c7f957229-label\">AUTRE MONTANT<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-5\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-5_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-32\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-32_69e5c7f957229\" id=\"forminator-form-2580__field--select-32_69e5c7f957229-label\" class=\"forminator-label\">Incapacit\u00e9 temporaire totale de travail  \u00e0 partir du 91\u00e8me jour d&#039;arr\u00eat dividendes<\/label><select id=\"forminator-form-2580__field--select-32_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-32\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-32_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-32_69e5c7f957229-description\"><option value=\"10\"  data-calculation=\"0\">10 \u20ac<\/option><option value=\"20\"  data-calculation=\"0\">20 \u20ac<\/option><option value=\"30\"  data-calculation=\"0\">30 \u20ac<\/option><option value=\"40\"  data-calculation=\"0\">40 \u20ac<\/option><option value=\"50\"  data-calculation=\"0\">50 \u20ac<\/option><option value=\"60\"  data-calculation=\"0\">60 \u20ac<\/option><option value=\"70\"  data-calculation=\"0\">70 \u20ac<\/option><option value=\"80\"  data-calculation=\"0\">80 \u20ac<\/option><option value=\"90\"  data-calculation=\"0\">90 \u20ac<\/option><option value=\"100\"  data-calculation=\"0\">100 \u20ac<\/option><option value=\"110\"  data-calculation=\"0\">110 \u20ac<\/option><option value=\"120\"  data-calculation=\"0\">120 \u20ac<\/option><option value=\"130\"  data-calculation=\"0\">130 \u20ac<\/option><option value=\"140\"  data-calculation=\"0\">140 \u20ac<\/option><option value=\"150\"  data-calculation=\"0\">150 \u20ac<\/option><option value=\"160\"  data-calculation=\"0\">160 \u20ac<\/option><option value=\"170\"  data-calculation=\"0\">170 \u20ac<\/option><option value=\"180\"  data-calculation=\"0\">180 \u20ac<\/option><option value=\"190\"  data-calculation=\"0\">190 \u20ac<\/option><option value=\"200\"  data-calculation=\"0\">200 \u20ac<\/option><option value=\"210\"  data-calculation=\"0\">210 \u20ac<\/option><option value=\"220\"  data-calculation=\"0\">220 \u20ac<\/option><option value=\"autre-montant\"  data-calculation=\"0\">AUTRE MONTANT<\/option><\/select><\/div><\/div><div id=\"currency-6\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-6_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-6_69e5c7f957229-label\">AUTRE MONTANT<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-6\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-6_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-34\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-34_69e5c7f957229\" id=\"forminator-form-2580__field--select-34_69e5c7f957229-label\" class=\"forminator-label\">Invalidit\u00e9 Permanente Partielle\/Invalidit\u00e9 Permanente Totale (IPT\/ IPP) d\u00e8s 33% (revenus)<\/label><select id=\"forminator-form-2580__field--select-34_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-34\" data-default-value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-34_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-34_69e5c7f957229-description\"><option value=\"300\"  data-calculation=\"0\">300 \u20ac<\/option><option value=\"600\"  data-calculation=\"0\">600 \u20ac<\/option><option value=\"900\"  data-calculation=\"0\">900 \u20ac<\/option><option value=\"1-200\"  data-calculation=\"0\">1 200 \u20ac<\/option><option value=\"1-500\"  data-calculation=\"0\">1 500 \u20ac<\/option><option value=\"1-800\"  data-calculation=\"0\">1 800 \u20ac<\/option><option value=\"2-100\"  data-calculation=\"0\">2 100 \u20ac<\/option><option value=\"2-400\"  data-calculation=\"0\">2 400 \u20ac<\/option><option value=\"2-700\"  data-calculation=\"0\">2 700 \u20ac<\/option><option value=\"3-000\"  data-calculation=\"0\">3 000 \u20ac<\/option><option value=\"3-300\"  data-calculation=\"0\">3 300 \u20ac<\/option><option value=\"3-600\"  data-calculation=\"0\">3 600 \u20ac<\/option><option value=\"3-900\"  data-calculation=\"0\">3 900 \u20ac<\/option><option value=\"4-200\"  data-calculation=\"0\">4 200 \u20ac<\/option><option value=\"4-500\"  data-calculation=\"0\">4 500 \u20ac<\/option><option value=\"4-800\"  data-calculation=\"0\">4 800 \u20ac<\/option><option value=\"5-100\"  data-calculation=\"0\">5 100 \u20ac<\/option><option value=\"5-400\"  data-calculation=\"0\">5 400 \u20ac<\/option><option value=\"5-700\"  data-calculation=\"0\">5 700 \u20ac<\/option><option value=\"6-000\"  data-calculation=\"0\">6 000 \u20ac<\/option><option value=\"6-300\"  data-calculation=\"0\">6 300 \u20ac<\/option><option value=\"6-600\"  data-calculation=\"0\">6 600 \u20ac<\/option><option value=\"6-900\"  data-calculation=\"0\">6 900 \u20ac<\/option><option value=\"7-200\"  data-calculation=\"0\">7 200 \u20ac<\/option><option value=\"7-500\"  data-calculation=\"0\">7 500 \u20ac<\/option><option value=\"7-800\"  data-calculation=\"0\">7 800 \u20ac<\/option><option value=\"8-100\"  data-calculation=\"0\">8 100 \u20ac<\/option><option value=\"8-400\"  data-calculation=\"0\">8 400 \u20ac<\/option><option value=\"8-700\"  data-calculation=\"0\">8 700 \u20ac<\/option><option value=\"9-000\"  data-calculation=\"0\">9 000 \u20ac<\/option><option value=\"9-300\"  data-calculation=\"0\">9 300 \u20ac<\/option><option value=\"9-600\"  data-calculation=\"0\">9 600 \u20ac<\/option><option value=\"9-900\"  data-calculation=\"0\">9 900 \u20ac<\/option><option value=\"10-200\"  data-calculation=\"0\">10 200 \u20ac<\/option><option value=\"10-500\"  data-calculation=\"0\">10 500 \u20ac<\/option><option value=\"10-800\"  data-calculation=\"0\">10 800 \u20ac<\/option><option value=\"11-100\"  data-calculation=\"0\">11 100 \u20ac<\/option><option value=\"11-400\"  data-calculation=\"0\">11 400 \u20ac<\/option><option value=\"11-700\"  data-calculation=\"0\">11 700 \u20ac<\/option><option value=\"12-000\"  data-calculation=\"0\">12 000 \u20ac<\/option><option value=\"12-300\"  data-calculation=\"0\">12 300 \u20ac<\/option><option value=\"12-600\"  data-calculation=\"0\">12 600  \u20ac<\/option><option value=\"12-900\"  data-calculation=\"0\">12 900 \u20ac<\/option><option value=\"13-200\"  data-calculation=\"0\">13 200 \u20ac<\/option><option value=\"13-500\"  data-calculation=\"0\">13 500 \u20ac<\/option><option value=\"13-800\"  data-calculation=\"0\">13 800 \u20ac<\/option><option value=\"14-100\"  data-calculation=\"0\">14 100 \u20ac<\/option><option value=\"14-400\"  data-calculation=\"0\">14 400 \u20ac<\/option><option value=\"14-700\"  data-calculation=\"0\">14 700 \u20ac<\/option><option value=\"15-000\"  data-calculation=\"0\">15 000 \u20ac<\/option><option value=\"15-300\"  data-calculation=\"0\">15 300 \u20ac<\/option><option value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" selected=\"selected\" data-calculation=\"0\">Choisir la rente mensuelle d\u00e9sir\u00e9e<\/option><\/select><span id=\"forminator-form-2580__field--select-34_69e5c7f957229-description\" class=\"forminator-description\">Minimum : 300 \u20ac\/mois par tranche de 300 \u20ac (Rente revenu)<\/span><\/div><\/div><div id=\"select-36\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-36_69e5c7f957229\" id=\"forminator-form-2580__field--select-36_69e5c7f957229-label\" class=\"forminator-label\">Invalidit\u00e9 Permanente Partielle\/Invalidit\u00e9 Permanente Totale (IPT\/ IPP) d\u00e8s 33% (dividendes)<\/label><select id=\"forminator-form-2580__field--select-36_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-36\" data-default-value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-36_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-36_69e5c7f957229-description\"><option value=\"300\"  data-calculation=\"0\">300 \u20ac<\/option><option value=\"600\"  data-calculation=\"0\">600 \u20ac<\/option><option value=\"900\"  data-calculation=\"0\">900 \u20ac<\/option><option value=\"1-200\"  data-calculation=\"0\">1 200 \u20ac<\/option><option value=\"1-500\"  data-calculation=\"0\">1 500 \u20ac<\/option><option value=\"1-800\"  data-calculation=\"0\">1 800 \u20ac<\/option><option value=\"2-100\"  data-calculation=\"0\">2 100 \u20ac<\/option><option value=\"2-400\"  data-calculation=\"0\">2 400 \u20ac<\/option><option value=\"2-700\"  data-calculation=\"0\">2 700 \u20ac<\/option><option value=\"3-000\"  data-calculation=\"0\">3 000 \u20ac<\/option><option value=\"3-300\"  data-calculation=\"0\">3 300 \u20ac<\/option><option value=\"3-600\"  data-calculation=\"0\">3 600 \u20ac<\/option><option value=\"3-900\"  data-calculation=\"0\">3 900 \u20ac<\/option><option value=\"4-200\"  data-calculation=\"0\">4 200 \u20ac<\/option><option value=\"4-500\"  data-calculation=\"0\">4 500 \u20ac<\/option><option value=\"4-800\"  data-calculation=\"0\">4 800 \u20ac<\/option><option value=\"5-100\"  data-calculation=\"0\">5 100 \u20ac<\/option><option value=\"5-400\"  data-calculation=\"0\">5 400 \u20ac<\/option><option value=\"5-700\"  data-calculation=\"0\">5 700 \u20ac<\/option><option value=\"6-000\"  data-calculation=\"0\">6 000 \u20ac<\/option><option value=\"6-300\"  data-calculation=\"0\">6 300 \u20ac<\/option><option value=\"6-600\"  data-calculation=\"0\">6 600 \u20ac<\/option><option value=\"6-900\"  data-calculation=\"0\">6 900 \u20ac<\/option><option value=\"7-200\"  data-calculation=\"0\">7 200 \u20ac<\/option><option value=\"7-500\"  data-calculation=\"0\">7 500 \u20ac<\/option><option value=\"7-800\"  data-calculation=\"0\">7 800 \u20ac<\/option><option value=\"8-100\"  data-calculation=\"0\">8 100 \u20ac<\/option><option value=\"8-400\"  data-calculation=\"0\">8 400 \u20ac<\/option><option value=\"8-700\"  data-calculation=\"0\">8 700 \u20ac<\/option><option value=\"9-000\"  data-calculation=\"0\">9 000 \u20ac<\/option><option value=\"9-300\"  data-calculation=\"0\">9 300 \u20ac<\/option><option value=\"9-600\"  data-calculation=\"0\">9 600 \u20ac<\/option><option value=\"9-900\"  data-calculation=\"0\">9 900 \u20ac<\/option><option value=\"10-200\"  data-calculation=\"0\">10 200 \u20ac<\/option><option value=\"10-500\"  data-calculation=\"0\">10 500 \u20ac<\/option><option value=\"10-800\"  data-calculation=\"0\">10 800 \u20ac<\/option><option value=\"11-100\"  data-calculation=\"0\">11 100 \u20ac<\/option><option value=\"11-400\"  data-calculation=\"0\">11 400 \u20ac<\/option><option value=\"11-700\"  data-calculation=\"0\">11 700 \u20ac<\/option><option value=\"12-000\"  data-calculation=\"0\">12 000 \u20ac<\/option><option value=\"12-300\"  data-calculation=\"0\">12 300 \u20ac<\/option><option value=\"12-600\"  data-calculation=\"0\">12 600  \u20ac<\/option><option value=\"12-900\"  data-calculation=\"0\">12 900 \u20ac<\/option><option value=\"13-200\"  data-calculation=\"0\">13 200 \u20ac<\/option><option value=\"13-500\"  data-calculation=\"0\">13 500 \u20ac<\/option><option value=\"13-800\"  data-calculation=\"0\">13 800 \u20ac<\/option><option value=\"14-100\"  data-calculation=\"0\">14 100 \u20ac<\/option><option value=\"14-400\"  data-calculation=\"0\">14 400 \u20ac<\/option><option value=\"14-700\"  data-calculation=\"0\">14 700 \u20ac<\/option><option value=\"15-000\"  data-calculation=\"0\">15 000 \u20ac<\/option><option value=\"15-300\"  data-calculation=\"0\">15 300 \u20ac<\/option><option value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" selected=\"selected\" data-calculation=\"0\">Choisir la rente mensuelle d\u00e9sir\u00e9e<\/option><\/select><span id=\"forminator-form-2580__field--select-36_69e5c7f957229-description\" class=\"forminator-description\">Minimum : 300 \u20ac\/mois par tranche de 300 \u20ac (Rente revenu)<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-35\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-35_69e5c7f957229\" id=\"forminator-form-2580__field--select-35_69e5c7f957229-label\" class=\"forminator-label\">Invalidit\u00e9 Permanente Partielle\/Invalidit\u00e9 Permanente Totale (IPT\/ IPP) d\u00e8s 15%(dividendes)<\/label><select id=\"forminator-form-2580__field--select-35_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-35\" data-default-value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" data-placeholder=\"(hors m\u00e9tiers du b\u00e2timent\/gros oeuvre et m\u00e9tiers de l&#039;agriculture et aquaculture)\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-35_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-35_69e5c7f957229-description\"><option value=\"\">(hors m\u00e9tiers du b\u00e2timent\/gros oeuvre et m\u00e9tiers de l&#039;agriculture et aquaculture)<\/option><option value=\"300\"  data-calculation=\"0\">300 \u20ac<\/option><option value=\"600\"  data-calculation=\"0\">600 \u20ac<\/option><option value=\"900\"  data-calculation=\"0\">900 \u20ac<\/option><option value=\"1-200\"  data-calculation=\"0\">1 200 \u20ac<\/option><option value=\"1-500\"  data-calculation=\"0\">1 500 \u20ac<\/option><option value=\"1-800\"  data-calculation=\"0\">1 800 \u20ac<\/option><option value=\"2-100\"  data-calculation=\"0\">2 100 \u20ac<\/option><option value=\"2-400\"  data-calculation=\"0\">2 400 \u20ac<\/option><option value=\"2-700\"  data-calculation=\"0\">2 700 \u20ac<\/option><option value=\"3-000\"  data-calculation=\"0\">3 000 \u20ac<\/option><option value=\"3-300\"  data-calculation=\"0\">3 300 \u20ac<\/option><option value=\"3-600\"  data-calculation=\"0\">3 600 \u20ac<\/option><option value=\"3-900\"  data-calculation=\"0\">3 900 \u20ac<\/option><option value=\"4-200\"  data-calculation=\"0\">4 200 \u20ac<\/option><option value=\"4-500\"  data-calculation=\"0\">4 500 \u20ac<\/option><option value=\"4-800\"  data-calculation=\"0\">4 800 \u20ac<\/option><option value=\"5-100\"  data-calculation=\"0\">5 100 \u20ac<\/option><option value=\"5-400\"  data-calculation=\"0\">5 400 \u20ac<\/option><option value=\"5-700\"  data-calculation=\"0\">5 700 \u20ac<\/option><option value=\"6-000\"  data-calculation=\"0\">6 000 \u20ac<\/option><option value=\"6-300\"  data-calculation=\"0\">6 300 \u20ac<\/option><option value=\"6-600\"  data-calculation=\"0\">6 600 \u20ac<\/option><option value=\"6-900\"  data-calculation=\"0\">6 900 \u20ac<\/option><option value=\"7-200\"  data-calculation=\"0\">7 200 \u20ac<\/option><option value=\"7-500\"  data-calculation=\"0\">7 500 \u20ac<\/option><option value=\"7-800\"  data-calculation=\"0\">7 800 \u20ac<\/option><option value=\"8-100\"  data-calculation=\"0\">8 100 \u20ac<\/option><option value=\"8-400\"  data-calculation=\"0\">8 400 \u20ac<\/option><option value=\"8-700\"  data-calculation=\"0\">8 700 \u20ac<\/option><option value=\"9-000\"  data-calculation=\"0\">9 000 \u20ac<\/option><option value=\"9-300\"  data-calculation=\"0\">9 300 \u20ac<\/option><option value=\"9-600\"  data-calculation=\"0\">9 600 \u20ac<\/option><option value=\"9-900\"  data-calculation=\"0\">9 900 \u20ac<\/option><option value=\"10-200\"  data-calculation=\"0\">10 200 \u20ac<\/option><option value=\"10-500\"  data-calculation=\"0\">10 500 \u20ac<\/option><option value=\"10-800\"  data-calculation=\"0\">10 800 \u20ac<\/option><option value=\"11-100\"  data-calculation=\"0\">11 100 \u20ac<\/option><option value=\"11-400\"  data-calculation=\"0\">11 400 \u20ac<\/option><option value=\"11-700\"  data-calculation=\"0\">11 700 \u20ac<\/option><option value=\"12-000\"  data-calculation=\"0\">12 000 \u20ac<\/option><option value=\"12-300\"  data-calculation=\"0\">12 300 \u20ac<\/option><option value=\"12-600\"  data-calculation=\"0\">12 600  \u20ac<\/option><option value=\"12-900\"  data-calculation=\"0\">12 900 \u20ac<\/option><option value=\"13-200\"  data-calculation=\"0\">13 200 \u20ac<\/option><option value=\"13-500\"  data-calculation=\"0\">13 500 \u20ac<\/option><option value=\"13-800\"  data-calculation=\"0\">13 800 \u20ac<\/option><option value=\"14-100\"  data-calculation=\"0\">14 100 \u20ac<\/option><option value=\"14-400\"  data-calculation=\"0\">14 400 \u20ac<\/option><option value=\"14-700\"  data-calculation=\"0\">14 700 \u20ac<\/option><option value=\"15-000\"  data-calculation=\"0\">15 000 \u20ac<\/option><option value=\"15-300\"  data-calculation=\"0\">15 300 \u20ac<\/option><option value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" selected=\"selected\" data-calculation=\"0\">Choisir la rente mensuelle d\u00e9sir\u00e9e<\/option><\/select><span id=\"forminator-form-2580__field--select-35_69e5c7f957229-description\" class=\"forminator-description\">Minimum : 300 \u20ac\/mois par tranche de 300 \u20ac<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><label class=\"forminator-label\">RENTE INVALIDITE PERMANENTE<\/label><p>Le minimum est de 300 \u20ac. Les tranches suivantes s'\u00e9l\u00e8vent par fraction de 300 \u20ac.<\/p>\n<p>\u00a0<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-7\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-7_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-7_69e5c7f957229-label\">CAPITAL RECONVERSION<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-7\" value=\"\" placeholder=\"Minimum 10 000 \u20ac maximum 150 000 \" id=\"forminator-field-currency-7_69e5c7f957229\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-field-calculation forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"calculation-1-field_69e5c7f957229\" class=\"forminator-label\" id=\"calculation-1-field_69e5c7f957229-label\">CAPITAL DECES \/INVALIDITE ABSOLUE ET DEFINITIVE<\/label><input name=\"calculation-1\" value=\"\" id=\"calculation-1-field_69e5c7f957229\" class=\"forminator-calculation forminator-input\" data-formula=\"{select-31}*500\" data-required=\"\" data-decimal-point=\"\" data-precision=\"0\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" \/><\/div><\/div><div id=\"currency-8\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-8_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-currency-8_69e5c7f957229-label\">CAPITAL DECES \/INVALIDITE ABSOLUE ET DEFINITIVE COMPLEMENTAIRE<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-8\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-8_69e5c7f957229\" 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\" aria-describedby=\"forminator-field-currency-8_69e5c7f957229-description\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><span id=\"forminator-field-currency-8_69e5c7f957229-description\" class=\"forminator-description\">Capital compl\u00e9mentaire souhait\u00e9 <\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-37\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-37_69e5c7f957229\" id=\"forminator-form-2580__field--select-37_69e5c7f957229-label\" class=\"forminator-label\">Invalidit\u00e9 Permanente Partielle\/Invalidit\u00e9 Permanente Totale (IPT\/ IPP) d\u00e8s 15% (revenus)<\/label><select id=\"forminator-form-2580__field--select-37_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-37\" data-default-value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" data-placeholder=\"(hors m\u00e9tiers du b\u00e2timent\/gros oeuvre et m\u00e9tiers de l&#039;agriculture et aquaculture)\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-37_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-37_69e5c7f957229-description\"><option value=\"\">(hors m\u00e9tiers du b\u00e2timent\/gros oeuvre et m\u00e9tiers de l&#039;agriculture et aquaculture)<\/option><option value=\"300\"  data-calculation=\"0\">300 \u20ac<\/option><option value=\"600\"  data-calculation=\"0\">600 \u20ac<\/option><option value=\"900\"  data-calculation=\"0\">900 \u20ac<\/option><option value=\"1-200\"  data-calculation=\"0\">1 200 \u20ac<\/option><option value=\"1-500\"  data-calculation=\"0\">1 500 \u20ac<\/option><option value=\"1-800\"  data-calculation=\"0\">1 800 \u20ac<\/option><option value=\"2-100\"  data-calculation=\"0\">2 100 \u20ac<\/option><option value=\"2-400\"  data-calculation=\"0\">2 400 \u20ac<\/option><option value=\"2-700\"  data-calculation=\"0\">2 700 \u20ac<\/option><option value=\"3-000\"  data-calculation=\"0\">3 000 \u20ac<\/option><option value=\"3-300\"  data-calculation=\"0\">3 300 \u20ac<\/option><option value=\"3-600\"  data-calculation=\"0\">3 600 \u20ac<\/option><option value=\"3-900\"  data-calculation=\"0\">3 900 \u20ac<\/option><option value=\"4-200\"  data-calculation=\"0\">4 200 \u20ac<\/option><option value=\"4-500\"  data-calculation=\"0\">4 500 \u20ac<\/option><option value=\"4-800\"  data-calculation=\"0\">4 800 \u20ac<\/option><option value=\"5-100\"  data-calculation=\"0\">5 100 \u20ac<\/option><option value=\"5-400\"  data-calculation=\"0\">5 400 \u20ac<\/option><option value=\"5-700\"  data-calculation=\"0\">5 700 \u20ac<\/option><option value=\"6-000\"  data-calculation=\"0\">6 000 \u20ac<\/option><option value=\"6-300\"  data-calculation=\"0\">6 300 \u20ac<\/option><option value=\"6-600\"  data-calculation=\"0\">6 600 \u20ac<\/option><option value=\"6-900\"  data-calculation=\"0\">6 900 \u20ac<\/option><option value=\"7-200\"  data-calculation=\"0\">7 200 \u20ac<\/option><option value=\"7-500\"  data-calculation=\"0\">7 500 \u20ac<\/option><option value=\"7-800\"  data-calculation=\"0\">7 800 \u20ac<\/option><option value=\"8-100\"  data-calculation=\"0\">8 100 \u20ac<\/option><option value=\"8-400\"  data-calculation=\"0\">8 400 \u20ac<\/option><option value=\"8-700\"  data-calculation=\"0\">8 700 \u20ac<\/option><option value=\"9-000\"  data-calculation=\"0\">9 000 \u20ac<\/option><option value=\"9-300\"  data-calculation=\"0\">9 300 \u20ac<\/option><option value=\"9-600\"  data-calculation=\"0\">9 600 \u20ac<\/option><option value=\"9-900\"  data-calculation=\"0\">9 900 \u20ac<\/option><option value=\"10-200\"  data-calculation=\"0\">10 200 \u20ac<\/option><option value=\"10-500\"  data-calculation=\"0\">10 500 \u20ac<\/option><option value=\"10-800\"  data-calculation=\"0\">10 800 \u20ac<\/option><option value=\"11-100\"  data-calculation=\"0\">11 100 \u20ac<\/option><option value=\"11-400\"  data-calculation=\"0\">11 400 \u20ac<\/option><option value=\"11-700\"  data-calculation=\"0\">11 700 \u20ac<\/option><option value=\"12-000\"  data-calculation=\"0\">12 000 \u20ac<\/option><option value=\"12-300\"  data-calculation=\"0\">12 300 \u20ac<\/option><option value=\"12-600\"  data-calculation=\"0\">12 600  \u20ac<\/option><option value=\"12-900\"  data-calculation=\"0\">12 900 \u20ac<\/option><option value=\"13-200\"  data-calculation=\"0\">13 200 \u20ac<\/option><option value=\"13-500\"  data-calculation=\"0\">13 500 \u20ac<\/option><option value=\"13-800\"  data-calculation=\"0\">13 800 \u20ac<\/option><option value=\"14-100\"  data-calculation=\"0\">14 100 \u20ac<\/option><option value=\"14-400\"  data-calculation=\"0\">14 400 \u20ac<\/option><option value=\"14-700\"  data-calculation=\"0\">14 700 \u20ac<\/option><option value=\"15-000\"  data-calculation=\"0\">15 000 \u20ac<\/option><option value=\"15-300\"  data-calculation=\"0\">15 300 \u20ac<\/option><option value=\"Choisir la rente mensuelle d\u00e9sir\u00e9e\" selected=\"selected\" data-calculation=\"0\">Choisir la rente mensuelle d\u00e9sir\u00e9e<\/option><\/select><span id=\"forminator-form-2580__field--select-37_69e5c7f957229-description\" class=\"forminator-description\">Minimum : 300 \u20ac\/mois par tranche de 300 \u20ac (Rente revenu)<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-38\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2580__field--select-38_69e5c7f957229\" id=\"forminator-form-2580__field--select-38_69e5c7f957229-label\" class=\"forminator-label\">RENTE EDUCATION<\/label><select id=\"forminator-form-2580__field--select-38_69e5c7f957229\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-38\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-labelledby=\"forminator-form-2580__field--select-38_69e5c7f957229-label\" aria-describedby=\"forminator-form-2580__field--select-38_69e5c7f957229-description\"><option value=\"oui\"  data-calculation=\"0\">OUI<\/option><option value=\"non\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-4_69e5c7f957229-label\">Nom et pr\u00e9nom 1er Enfant<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-4_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-5\" class=\"forminator-label\">Date de naissance 1er enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-5-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-5-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-5-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-5-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-5-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-5-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-5-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-5-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-5-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-5-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-5-year\" placeholder=\"\" id=\"forminator-field-date-5-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-5\" aria-describedby=\"forminator-field-date-5_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-5_69e5c7f957229-label\">Nom et pr\u00e9nom 2\u00e8me Enfant<\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-5_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-6\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-6\" class=\"forminator-label\">Date de naissance 2\u00e8me enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-6-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-6-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-6-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-6-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-6-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-6-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-6-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-6-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-6-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-6-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-6-year\" placeholder=\"\" id=\"forminator-field-date-6-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-6\" aria-describedby=\"forminator-field-date-6_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-6_69e5c7f957229-label\">Nom et pr\u00e9nom 3\u00e8me Enfant<\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-6_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-10\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-10\" class=\"forminator-label\">Date de naissance 3\u00e8me enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-10-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-10-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-10-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-10-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-10-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-10\" aria-describedby=\"forminator-field-date-10_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-10-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-10-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-10-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-10-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-10-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-10\" aria-describedby=\"forminator-field-date-10_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-10-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-10-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-10-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-10-year\" placeholder=\"\" id=\"forminator-field-date-10-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-10\" aria-describedby=\"forminator-field-date-10_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-7\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-7_69e5c7f957229-label\">Nom et pr\u00e9nom 4 \u00e8me Enfant<\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-7_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-7\" class=\"forminator-label\">Date de naissance 4\u00e8me enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-7-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-7-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-7-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-7-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-7-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-7-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-7-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-7-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-7-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-7-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-7-year\" placeholder=\"\" id=\"forminator-field-date-7-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-8\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-8_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-8_69e5c7f957229-label\">Nom et pr\u00e9nom 5\u00e8me Enfant<\/label><input type=\"text\" name=\"name-8\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-8_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-8\" class=\"forminator-label\">Date de naissance 1er enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-8-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-8-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-8-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-8-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-8\" aria-describedby=\"forminator-field-date-8_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-8-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-8-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-8-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-8-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-8\" aria-describedby=\"forminator-field-date-8_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-8-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-8-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-8-year\" placeholder=\"\" id=\"forminator-field-date-8-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-8\" aria-describedby=\"forminator-field-date-8_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-9\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-9_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-name-9_69e5c7f957229-label\">Nom et pr\u00e9nom 6\u00e8me Enfant<\/label><input type=\"text\" name=\"name-9\" value=\"\" placeholder=\"Jacques Martin\u00a0\" id=\"forminator-field-name-9_69e5c7f957229\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-9\" class=\"forminator-field-date forminator-col forminator-col-6 \"><label for=\"forminator-field-date-9\" class=\"forminator-label\">Date de naissance 6\u00e8me enfant<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-9-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-month_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-9-month_69e5c7f957229-label\">Mois<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-9-month\" value=\"\" placeholder=\"\" id=\"forminator-field-date-9-month_69e5c7f957229\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-9\" aria-describedby=\"forminator-field-date-9_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-9-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-day_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-9-day_69e5c7f957229-label\">Jour<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-9-day\" value=\"\" placeholder=\"\" id=\"forminator-field-date-9-day_69e5c7f957229\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-9\" aria-describedby=\"forminator-field-date-9_69e5c7f957229-description\" \/><\/div><\/div><div id=\"date-9-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-year_69e5c7f957229\" class=\"forminator-label\" id=\"forminator-field-date-9-year_69e5c7f957229-label\">Ann\u00e9e<\/label><input type=\"number\" min=\"1\" name=\"date-9-year\" placeholder=\"\" id=\"forminator-field-date-9-year_69e5c7f957229\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-9\" aria-describedby=\"forminator-field-date-9_69e5c7f957229-description\" \/><\/div><\/div><\/div><\/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_69e5c7f957229\" id=\"forminator-field-textarea-2_69e5c7f957229-label\" class=\"forminator-label\">Informations compl\u00e9mentaires<\/label><textarea name=\"textarea-2\" placeholder=\"Vous souhaitez apporter des pr\u00e9cisions ? \n\u00c9crivez les ici\" id=\"forminator-field-textarea-2_69e5c7f957229\" 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_69e5c7f957229\" class=\"forminator-label\">T\u00e9l\u00e9chargez ici tout document que vous jugeriez utile<\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_69e5c7f957229\" aria-describedby=\"forminator-field-upload-1_69e5c7f957229-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69e5c7f957229\" class=\"forminator-input-file\" 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value=\"https:\/\/aca-pl.com\/?page_id=2581\"><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=2581\" class=\"more-link\">Continuer la lecture de <span class=\"screen-reader-text\">QUESTIONNAIRE PREVOYANCE<\/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-2581","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 PREVOYANCE -<\/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=2581\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"QUESTIONNAIRE PREVOYANCE -\" \/>\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. 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