{"id":3216,"date":"2023-07-20T17:26:37","date_gmt":"2023-07-20T15:26:37","guid":{"rendered":"https:\/\/dev.konsept.ch\/aivd\/?page_id=3216"},"modified":"2023-08-07T16:35:14","modified_gmt":"2023-08-07T14:35:14","slug":"formulaire-demande-dossier","status":"publish","type":"page","link":"https:\/\/dev.konsept.ch\/aivd\/formulaire-demande-dossier\/","title":{"rendered":"Formulaire &#8211; Demande dossier"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3216\" class=\"elementor elementor-3216\" data-elementor-settings=\"{&quot;element_pack_global_tooltip_width&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true}}\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2cdef74 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2cdef74\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7fabf15\" data-id=\"7fabf15\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3a354f8 bdt-gravity-form-button-custom elementor-widget elementor-widget-bdt-gravity-form\" data-id=\"3a354f8\" data-element_type=\"widget\" data-widget_type=\"bdt-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t<div class=\"bdt-gravity-forms\">\n\t\t\t<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_9' style='display:none'><div id='gf_9' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Demande de dossier<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/aivd\/wp-json\/wp\/v2\/pages\/3216#gf_9' data-formid='9' novalidate>\n        <div id='gf_progressbar_wrapper_9' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>17<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_5' style='width:5%;'><span>5%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_9_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_64\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_64\"><label class='gfield_label gform-field-label' for='input_9_64' >Je suis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_9_64' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='Assur\u00e9' >Assur\u00e9<\/option><option value='Curateur' >Curateur<\/option><option value='Parent (assur\u00e9 mineur)' >Parent (assur\u00e9 mineur)<\/option><option value='Avocat\/Repr\u00e9sentant' >Avocat\/Repr\u00e9sentant<\/option><option value='Assurance sociale, LAA, LPP' >Assurance sociale, LAA, LPP<\/option><option value='Assurance\/Institution\/Association priv\u00e9e' >Assurance\/Institution\/Association priv\u00e9e<\/option><option value='M\u00e9decin' >M\u00e9decin<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_9_72' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"2\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"2\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_2' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_2' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_9_80\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_80\"><legend class='gfield_label gform-field-label'  >A qui est destin\u00e9 le dossier?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_80'>\n\t\t\t<div class='gchoice gchoice_9_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Moi'  id='choice_9_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_0' id='label_9_80_0' class='gform-field-label gform-field-label--type-inline'>Moi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Un tiers'  id='choice_9_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_1' id='label_9_80_1' class='gform-field-label gform-field-label--type-inline'>Un tiers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_71' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"1\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"1\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_71' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"3\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"3\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_3' class='gform_page' data-js='page-field-id-71' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_36\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_36\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_8\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_8\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_8'>\n                            \n                            <span id='input_9_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_8_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_8.3' id='input_9_8_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_8_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_8.6' id='input_9_8_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_401\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_401\"><label class='gfield_label gform-field-label' for='input_9_401' >Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_401' id='input_9_401' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_401_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_401_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_401' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_20\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_20\"><label class='gfield_label gform-field-label' for='input_9_20' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_9_20' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_100\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_100\"><label class='gfield_label gform-field-label' for='input_9_100' >Adresse mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_100' id='input_9_100' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_446\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_446\"><label class='gfield_label gform-field-label' for='input_9_446' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_446'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_446' id='input_9_446' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_446\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_104\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_104\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_104' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_104_1_container' >\n                                        <label for='input_9_104_1' id='input_9_104_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_104.1' id='input_9_104_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_104.4' id='input_9_104_4' value=''\/><input type='hidden' class='gform_hidden' name='input_104.6' id='input_9_104_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_402\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_402\"><label class='gfield_label gform-field-label' for='input_9_402' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_402' id='input_9_402' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_106\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_106\"><label class='gfield_label gform-field-label' for='input_9_106' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_106' id='input_9_106' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_97\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_97\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_97' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_97'>Carte identit\u00e9 ou passport<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_97' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_97&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_97&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_97&quot;,&quot;filelist&quot;:&quot;gform_preview_9_97&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:97},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_97&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_97' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_97' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_97 gfield_description_9_97\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_97'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_97'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_97' class='ginput_preview_list'><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_98' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"2\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"2\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_98' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"4\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"4\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_4' class='gform_page' data-js='page-field-id-98' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_86\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_86\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_84\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_84\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_84'>\n                            \n                            <span id='input_9_84_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_84_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_84.3' id='input_9_84_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_84_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_84_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_84.6' id='input_9_84_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_404\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_404\"><label class='gfield_label gform-field-label' for='input_9_404' >Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_404' id='input_9_404' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_404_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_404_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_404' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_87\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_87\"><label class='gfield_label gform-field-label' for='input_9_87' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_9_87' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_457\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_457\"><label class='gfield_label gform-field-label' for='input_9_457' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_457'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_457' id='input_9_457' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_457\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_89\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_89\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_89' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_89_1_container' >\n                                        <label for='input_9_89_1' id='input_9_89_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_89.1' id='input_9_89_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_89.4' id='input_9_89_4' value=''\/><input type='hidden' class='gform_hidden' name='input_89.6' id='input_9_89_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_405\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_405\"><label class='gfield_label gform-field-label' for='input_9_405' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_405' id='input_9_405' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_91\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_91\"><label class='gfield_label gform-field-label' for='input_9_91' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_9_91' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_112\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_112\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_112' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_112'>Carte identit\u00e9 ou passeport<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_112' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_112&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_112&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_112&quot;,&quot;filelist&quot;:&quot;gform_preview_9_112&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:112},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_112&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_112' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_112' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_112 gfield_description_9_112\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_112'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_112'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_112' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_114\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_114\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_117\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_117\"><label class='gfield_label gform-field-label' for='input_9_117' >Type du tiers<\/label><div class='ginput_container ginput_container_select'><select name='input_117' id='input_9_117' class='large gfield_select'     aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='M\u00e9decin' >M\u00e9decin<\/option><option value='Assurance' >Assurance<\/option><option value='Repr\u00e9sentant' >Repr\u00e9sentant<\/option><\/select><\/div><\/div><div id=\"field_9_371\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_371\"><label class='gfield_label gform-field-label' for='input_9_371' >Nom Organisme\/institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_371' id='input_9_371' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_368\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_368\"><label class='gfield_label gform-field-label' for='input_9_368' >Civilit\u00e9 du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_368' id='input_9_368' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_116\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_116\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_116'>\n                            \n                            <span id='input_9_116_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_116_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_116.3' id='input_9_116_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_116_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_116_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_116.6' id='input_9_116_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_9_118\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_118\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse ou case postale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_118' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_118_1_container' >\n                                        <label for='input_9_118_1' id='input_9_118_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_118.1' id='input_9_118_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_118.4' id='input_9_118_4' value=''\/><input type='hidden' class='gform_hidden' name='input_118.6' id='input_9_118_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_406\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_406\"><label class='gfield_label gform-field-label' for='input_9_406' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_406' id='input_9_406' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_120\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_120\"><label class='gfield_label gform-field-label' for='input_9_120' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_120' id='input_9_120' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_123' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"3\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"3\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_123' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"5\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"5\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_5' class='gform_page' data-js='page-field-id-123' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_5' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_9_128\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_128\"><legend class='gfield_label gform-field-label'  >A qui est destin\u00e9 le dossier?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_128'>\n\t\t\t<div class='gchoice gchoice_9_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='Moi'  id='choice_9_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_128_0' id='label_9_128_0' class='gform-field-label gform-field-label--type-inline'>Moi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='Un tiers'  id='choice_9_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_128_1' id='label_9_128_1' class='gform-field-label gform-field-label--type-inline'>Un tiers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_153' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"4\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"4\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_153' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"6\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"6\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_6' class='gform_page' data-js='page-field-id-153' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_130\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_130\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_124\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_124\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_124'>\n                            \n                            <span id='input_9_124_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_124_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_124.3' id='input_9_124_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_124_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_124_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_124.6' id='input_9_124_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_407\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_407\"><label class='gfield_label gform-field-label' for='input_9_407' >Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_407' id='input_9_407' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_407_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_407_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_407' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_126\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_126\"><label class='gfield_label gform-field-label' for='input_9_126' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_9_126' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_131\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_131\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_131' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_131_1_container' >\n                                        <label for='input_9_131_1' id='input_9_131_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_131.1' id='input_9_131_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_131.4' id='input_9_131_4' value=''\/><input type='hidden' class='gform_hidden' name='input_131.6' id='input_9_131_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_408\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_408\"><label class='gfield_label gform-field-label' for='input_9_408' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_408' id='input_9_408' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_133\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_133\"><label class='gfield_label gform-field-label' for='input_9_133' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_9_133' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_141\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_141\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_141' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_141'>Carte identit\u00e9 ou passeport + Avis de curatelle<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_141' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_141&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_141&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_141&quot;,&quot;filelist&quot;:&quot;gform_preview_9_141&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:141},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_141&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_141' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_141' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_141 gfield_description_9_141\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_141'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_141'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_141' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_142\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_142\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_375\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_375\"><label class='gfield_label gform-field-label' for='input_9_375' >Adresse mail du curateur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_375' id='input_9_375' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_147\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_147\"><label class='gfield_label gform-field-label' for='input_9_147' >Organisme\/institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_9_147' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_376\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_376\"><label class='gfield_label gform-field-label' for='input_9_376' >Civilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_376' id='input_9_376' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_436\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_436\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du curateur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_436'>\n                            \n                            <span id='input_9_436_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_436_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_436.3' id='input_9_436_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_436_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_436_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_436.6' id='input_9_436_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_458\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_458\"><label class='gfield_label gform-field-label' for='input_9_458' >T\u00e9l\u00e9phone du curateur<\/label><div class='gfield_description' id='gfield_description_9_458'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_458' id='input_9_458' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_458\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_149\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_149\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du curateur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_149' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_149_1_container' >\n                                        <label for='input_9_149_1' id='input_9_149_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_149.1' id='input_9_149_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_149.4' id='input_9_149_4' value=''\/><input type='hidden' class='gform_hidden' name='input_149.6' id='input_9_149_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_410\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_410\"><label class='gfield_label gform-field-label' for='input_9_410' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_410' id='input_9_410' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_151\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_151\"><label class='gfield_label gform-field-label' for='input_9_151' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_151' id='input_9_151' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_129' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"5\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"5\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_129' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"7\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"7\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_7' class='gform_page' data-js='page-field-id-129' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_7' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_154\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_154\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_155\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_155\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_155'>\n                            \n                            <span id='input_9_155_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_155_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_155.3' id='input_9_155_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_155_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_155_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_155.6' id='input_9_155_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_388\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_388\"><label class='gfield_label gform-field-label' for='input_9_388' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_388' id='input_9_388' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_388_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_388_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_388' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_157\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_157\"><label class='gfield_label gform-field-label' for='input_9_157' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_9_157' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_161\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_161\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_161' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_161_1_container' >\n                                        <label for='input_9_161_1' id='input_9_161_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_161.1' id='input_9_161_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_161.4' id='input_9_161_4' value=''\/><input type='hidden' class='gform_hidden' name='input_161.6' id='input_9_161_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_411\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_411\"><label class='gfield_label gform-field-label' for='input_9_411' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_411' id='input_9_411' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_163\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_163\"><label class='gfield_label gform-field-label' for='input_9_163' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_9_163' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_168\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_168\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du curateur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_168'>\n                            \n                            <span id='input_9_168_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_168_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_168.3' id='input_9_168_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_168_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_168_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_168.6' id='input_9_168_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_448\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_448\"><label class='gfield_label gform-field-label' for='input_9_448' >T\u00e9l\u00e9phone du curateur<\/label><div class='gfield_description' id='gfield_description_9_448'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_448' id='input_9_448' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_448\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_136\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_136\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du curateur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_136' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_136_1_container' >\n                                        <label for='input_9_136_1' id='input_9_136_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_136.1' id='input_9_136_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_136.4' id='input_9_136_4' value=''\/><input type='hidden' class='gform_hidden' name='input_136.6' id='input_9_136_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_412\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_412\"><label class='gfield_label gform-field-label' for='input_9_412' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_412' id='input_9_412' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_166\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_166\"><label class='gfield_label gform-field-label' for='input_9_166' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_9_166' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_140\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_140\"><label class='gfield_label gform-field-label' for='input_9_140' >Institution du curateur<\/label><div class='ginput_container ginput_container_text'><input name='input_140' id='input_9_140' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_171\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_171\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_171' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_171'>Carte identit\u00e9 ou passeport + Avis de curatelle<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_171' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_171&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_171&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_171&quot;,&quot;filelist&quot;:&quot;gform_preview_9_171&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:171},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_171&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_171' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_171' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_171 gfield_description_9_171\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_171'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_171'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_171' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_170\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_170\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_438\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_438\"><label class='gfield_label gform-field-label' for='input_9_438' >Type de tiers<\/label><div class='ginput_container ginput_container_select'><select name='input_438' id='input_9_438' class='large gfield_select'     aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='M\u00e9decin' >M\u00e9decin<\/option><option value='Assurance' >Assurance<\/option><option value='Repr\u00e9sentant' >Repr\u00e9sentant<\/option><\/select><\/div><\/div><fieldset id=\"field_9_373\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_373\"><legend class='gfield_label gform-field-label'  >Destinataire<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_373'>\n\t\t\t<div class='gchoice gchoice_9_373_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_373' type='radio' value='Organisme\/institution'  id='choice_9_373_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_373_0' id='label_9_373_0' class='gform-field-label gform-field-label--type-inline'>Organisme\/institution<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_373_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_373' type='radio' value='Nom\/Pr\u00e9nom'  id='choice_9_373_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_373_1' id='label_9_373_1' class='gform-field-label gform-field-label--type-inline'>Nom\/Pr\u00e9nom<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_175\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_175\"><label class='gfield_label gform-field-label' for='input_9_175' >Nom Organisme\/institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_175' id='input_9_175' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_379\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_379\"><label class='gfield_label gform-field-label' for='input_9_379' >Civilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_379' id='input_9_379' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_176\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_176\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_176'>\n                            \n                            <span id='input_9_176_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_176_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_176.3' id='input_9_176_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_176_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_176_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_176.6' id='input_9_176_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_9_177\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_177\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_177' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_177_1_container' >\n                                        <label for='input_9_177_1' id='input_9_177_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_177.1' id='input_9_177_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_177.4' id='input_9_177_4' value=''\/><input type='hidden' class='gform_hidden' name='input_177.6' id='input_9_177_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_413\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_413\"><label class='gfield_label gform-field-label' for='input_9_413' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_413' id='input_9_413' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_179\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_179\"><label class='gfield_label gform-field-label' for='input_9_179' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_179' id='input_9_179' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_183' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"6\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"6\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_183' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"8\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"8\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_8' class='gform_page' data-js='page-field-id-183' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_8' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_9_184\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_184\"><legend class='gfield_label gform-field-label'  >A qui est destin\u00e9 le dossier?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_184'>\n\t\t\t<div class='gchoice gchoice_9_184_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_184' type='radio' value='Moi'  id='choice_9_184_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_184_0' id='label_9_184_0' class='gform-field-label gform-field-label--type-inline'>Moi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_184_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_184' type='radio' value='Un tiers'  id='choice_9_184_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_184_1' id='label_9_184_1' class='gform-field-label gform-field-label--type-inline'>Un tiers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_185' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"7\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"7\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_185' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"9\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"9\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_9' class='gform_page' data-js='page-field-id-185' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_9' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_186\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_186\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_187\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_187\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_187'>\n                            \n                            <span id='input_9_187_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_187_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_187.3' id='input_9_187_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_187_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_187_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_187.6' id='input_9_187_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_389\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_389\"><label class='gfield_label gform-field-label' for='input_9_389' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_389' id='input_9_389' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_389_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_389_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_389' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_189\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_189\"><label class='gfield_label gform-field-label' for='input_9_189' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_189' id='input_9_189' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_190\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_190\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_190' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_190_1_container' >\n                                        <label for='input_9_190_1' id='input_9_190_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_190.1' id='input_9_190_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_190.4' id='input_9_190_4' value=''\/><input type='hidden' class='gform_hidden' name='input_190.6' id='input_9_190_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_414\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_414\"><label class='gfield_label gform-field-label' for='input_9_414' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_414' id='input_9_414' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_192\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_192\"><label class='gfield_label gform-field-label' for='input_9_192' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_192' id='input_9_192' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_200\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_200\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_200' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_200'>Carte identit\u00e9 ou passeport de l'assur\u00e9 + Carte identit\u00e9 ou passeport du parent<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_200' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_200&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_200&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_200&quot;,&quot;filelist&quot;:&quot;gform_preview_9_200&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:200},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_200&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_200' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_200' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_200 gfield_description_9_200\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_200'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_200'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_200' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_201\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_201\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_203\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_203\"><label class='gfield_label gform-field-label' for='input_9_203' >Adresse mail du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_203' id='input_9_203' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_382\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_382\"><label class='gfield_label gform-field-label' for='input_9_382' >Civilit\u00e9 du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_382' id='input_9_382' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_204\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_204\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_204'>\n                            \n                            <span id='input_9_204_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_204_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_204.3' id='input_9_204_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_204_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_204_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_204.6' id='input_9_204_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_449\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_449\"><label class='gfield_label gform-field-label' for='input_9_449' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_449'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_449' id='input_9_449' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_449\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_205\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_205\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te ou case postale du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_205' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_205_1_container' >\n                                        <label for='input_9_205_1' id='input_9_205_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_205.1' id='input_9_205_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_205.4' id='input_9_205_4' value=''\/><input type='hidden' class='gform_hidden' name='input_205.6' id='input_9_205_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_416\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_416\"><label class='gfield_label gform-field-label' for='input_9_416' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_416' id='input_9_416' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_207\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_207\"><label class='gfield_label gform-field-label' for='input_9_207' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_207' id='input_9_207' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_209' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"8\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"8\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_209' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"10\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"10\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_10' class='gform_page' data-js='page-field-id-209' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_10' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_210\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_210\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_211\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_211\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_211'>\n                            \n                            <span id='input_9_211_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_211_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_211.3' id='input_9_211_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_211_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_211_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_211.6' id='input_9_211_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_391\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_391\"><label class='gfield_label gform-field-label' for='input_9_391' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_391' id='input_9_391' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_391_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_391_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_391' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_213\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_213\"><label class='gfield_label gform-field-label' for='input_9_213' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_213' id='input_9_213' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_214\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_214\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_214' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_214_1_container' >\n                                        <label for='input_9_214_1' id='input_9_214_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_214.1' id='input_9_214_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_214.4' id='input_9_214_4' value=''\/><input type='hidden' class='gform_hidden' name='input_214.6' id='input_9_214_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_417\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_417\"><label class='gfield_label gform-field-label' for='input_9_417' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_417' id='input_9_417' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_216\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_216\"><label class='gfield_label gform-field-label' for='input_9_216' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_216' id='input_9_216' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_218\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_218\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_218'>\n                            \n                            <span id='input_9_218_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_218_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_218.3' id='input_9_218_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_218_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_218_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_218.6' id='input_9_218_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_392\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_392\"><label class='gfield_label gform-field-label' for='input_9_392' >Date de naissance du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_392' id='input_9_392' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_392_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_392_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_392' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_450\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_450\"><label class='gfield_label gform-field-label' for='input_9_450' >T\u00e9l\u00e9phone du parent<\/label><div class='gfield_description' id='gfield_description_9_450'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_450' id='input_9_450' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_450\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_220\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_220\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du parent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_220' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_220_1_container' >\n                                        <label for='input_9_220_1' id='input_9_220_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_220.1' id='input_9_220_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_220.4' id='input_9_220_4' value=''\/><input type='hidden' class='gform_hidden' name='input_220.6' id='input_9_220_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_418\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_418\"><label class='gfield_label gform-field-label' for='input_9_418' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_418' id='input_9_418' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_222\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_222\"><label class='gfield_label gform-field-label' for='input_9_222' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_222' id='input_9_222' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_224\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_224\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_224' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_224'>Carte identit\u00e9 ou passeport de l'assur\u00e9 + Carte identit\u00e9 ou passeport du parent<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_224' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_224&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_224&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_224&quot;,&quot;filelist&quot;:&quot;gform_preview_9_224&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:224},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_224&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_224' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_224' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_224 gfield_description_9_224\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_224'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_224'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_224' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_225\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_225\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_439\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_439\"><label class='gfield_label gform-field-label' for='input_9_439' >Type de tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_439' id='input_9_439' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='M\u00e9decin' >M\u00e9decin<\/option><option value='Assurance' >Assurance<\/option><option value='Repr\u00e9sentant' >Repr\u00e9sentant<\/option><\/select><\/div><\/div><fieldset id=\"field_9_381\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_381\"><legend class='gfield_label gform-field-label'  >Destinataire<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_381'>\n\t\t\t<div class='gchoice gchoice_9_381_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Organisme\/institution'  id='choice_9_381_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_381_0' id='label_9_381_0' class='gform-field-label gform-field-label--type-inline'>Organisme\/institution<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_381_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Nom\/Pr\u00e9nom'  id='choice_9_381_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_381_1' id='label_9_381_1' class='gform-field-label gform-field-label--type-inline'>Nom\/Pr\u00e9nom<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_233\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_233\"><label class='gfield_label gform-field-label' for='input_9_233' >Organisme\/institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_233' id='input_9_233' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_383\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_383\"><label class='gfield_label gform-field-label' for='input_9_383' >Civilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_383' id='input_9_383' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_227\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_227\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_227'>\n                            \n                            <span id='input_9_227_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_227_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_227.3' id='input_9_227_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_227_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_227_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_227.6' id='input_9_227_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_9_228\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_228\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te ou case postale du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_228' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_228_1_container' >\n                                        <label for='input_9_228_1' id='input_9_228_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_228.1' id='input_9_228_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_228.4' id='input_9_228_4' value=''\/><input type='hidden' class='gform_hidden' name='input_228.6' id='input_9_228_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_419\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_419\"><label class='gfield_label gform-field-label' for='input_9_419' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_419' id='input_9_419' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_230\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_230\"><label class='gfield_label gform-field-label' for='input_9_230' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_230' id='input_9_230' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_235' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"9\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"9\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_235' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"11\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"11\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_11' class='gform_page' data-js='page-field-id-235' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_11' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_9_234\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_234\"><legend class='gfield_label gform-field-label'  >A qui est destin\u00e9 le dossier?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_234'>\n\t\t\t<div class='gchoice gchoice_9_234_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_234' type='radio' value='Moi'  id='choice_9_234_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_234_0' id='label_9_234_0' class='gform-field-label gform-field-label--type-inline'>Moi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_234_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_234' type='radio' value='Un tiers'  id='choice_9_234_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_234_1' id='label_9_234_1' class='gform-field-label gform-field-label--type-inline'>Un tiers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_236' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"10\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"10\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_236' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"12\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"12\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_12' class='gform_page' data-js='page-field-id-236' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_12' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_263\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_263\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_237\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_237\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_237'>\n                            \n                            <span id='input_9_237_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_237_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_237.3' id='input_9_237_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_237_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_237_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_237.6' id='input_9_237_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_393\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_393\"><label class='gfield_label gform-field-label' for='input_9_393' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_393' id='input_9_393' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_393_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_393_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_393' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_239\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_239\"><label class='gfield_label gform-field-label' for='input_9_239' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_239' id='input_9_239' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_240\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_240\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_240' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_240_1_container' >\n                                        <label for='input_9_240_1' id='input_9_240_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_240.1' id='input_9_240_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_240.4' id='input_9_240_4' value=''\/><input type='hidden' class='gform_hidden' name='input_240.6' id='input_9_240_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_420\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_420\"><label class='gfield_label gform-field-label' for='input_9_420' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_420' id='input_9_420' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_242\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_242\"><label class='gfield_label gform-field-label' for='input_9_242' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_242' id='input_9_242' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_266\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_266\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_266' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_266'>Procuration<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_266' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_266&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_266&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_266&quot;,&quot;filelist&quot;:&quot;gform_preview_9_266&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:266},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_266&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_266' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_266' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_266 gfield_description_9_266\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_266'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_266'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_266' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_268\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_268\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_269\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_269\"><label class='gfield_label gform-field-label' for='input_9_269' >Organisme\/Institution\/Raison sociale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_269' id='input_9_269' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_384\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_384\"><label class='gfield_label gform-field-label' for='input_9_384' >Civilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_384' id='input_9_384' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_244\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_244\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du repr\u00e9sentant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_244'>\n                            \n                            <span id='input_9_244_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_244_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_244.3' id='input_9_244_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_244_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_244_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_244.6' id='input_9_244_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_451\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_451\"><label class='gfield_label gform-field-label' for='input_9_451' >T\u00e9l\u00e9phone du repr\u00e9sentant<\/label><div class='gfield_description' id='gfield_description_9_451'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_451' id='input_9_451' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_451\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_271\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_271\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du repr\u00e9sentant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_271' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_271_1_container' >\n                                        <label for='input_9_271_1' id='input_9_271_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_271.1' id='input_9_271_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_271.4' id='input_9_271_4' value=''\/><input type='hidden' class='gform_hidden' name='input_271.6' id='input_9_271_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_422\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_422\"><label class='gfield_label gform-field-label' for='input_9_422' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_422' id='input_9_422' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_273\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_273\"><label class='gfield_label gform-field-label' for='input_9_273' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_273' id='input_9_273' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_282\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_282\"><label class='gfield_label gform-field-label' for='input_9_282' >Adresse mail du repr\u00e9sentant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_282' id='input_9_282' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_249\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_249\"><label class='gfield_label gform-field-label' for='input_9_249' >Etude du repr\u00e9sentant<\/label><div class='ginput_container ginput_container_text'><input name='input_249' id='input_9_249' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_250' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"11\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"11\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_250' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"13\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"13\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_13' class='gform_page' data-js='page-field-id-250' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_13' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_264\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_264\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_270\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_270\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_270'>\n                            \n                            <span id='input_9_270_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_270_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_270.3' id='input_9_270_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_270_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_270_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_270.6' id='input_9_270_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_394\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_394\"><label class='gfield_label gform-field-label' for='input_9_394' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_394' id='input_9_394' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_394_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_394_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_394' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_253\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_253\"><label class='gfield_label gform-field-label' for='input_9_253' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_253' id='input_9_253' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_254\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_254\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_254' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_254_1_container' >\n                                        <label for='input_9_254_1' id='input_9_254_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_254.1' id='input_9_254_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_254.4' id='input_9_254_4' value=''\/><input type='hidden' class='gform_hidden' name='input_254.6' id='input_9_254_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_423\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_423\"><label class='gfield_label gform-field-label' for='input_9_423' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_423' id='input_9_423' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_256\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_256\"><label class='gfield_label gform-field-label' for='input_9_256' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_256' id='input_9_256' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_258\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_258\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du repr\u00e9sentant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_258'>\n                            \n                            <span id='input_9_258_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_258_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_258.3' id='input_9_258_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_258_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_258_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_258.6' id='input_9_258_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_452\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_452\"><label class='gfield_label gform-field-label' for='input_9_452' >T\u00e9l\u00e9phone du repr\u00e9sentant<\/label><div class='gfield_description' id='gfield_description_9_452'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_452' id='input_9_452' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_452\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_259\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_259\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du repr\u00e9sentant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_259' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_259_1_container' >\n                                        <label for='input_9_259_1' id='input_9_259_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_259.1' id='input_9_259_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_259.4' id='input_9_259_4' value=''\/><input type='hidden' class='gform_hidden' name='input_259.6' id='input_9_259_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_424\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_424\"><label class='gfield_label gform-field-label' for='input_9_424' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_424' id='input_9_424' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_261\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_261\"><label class='gfield_label gform-field-label' for='input_9_261' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_261' id='input_9_261' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_265\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_265\"><label class='gfield_label gform-field-label' for='input_9_265' >Etude du repr\u00e9sentant<\/label><div class='ginput_container ginput_container_text'><input name='input_265' id='input_9_265' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_267\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_267\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_267' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_267'>Procuration<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_267' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_267&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_267&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_267&quot;,&quot;filelist&quot;:&quot;gform_preview_9_267&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:267},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_267&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_267' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_267' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_267 gfield_description_9_267\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_267'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_267'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_267' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_275\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_275\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_440\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_440\"><label class='gfield_label gform-field-label' for='input_9_440' >Type du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_440' id='input_9_440' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='M\u00e9decin' >M\u00e9decin<\/option><option value='Assurance' >Assurance<\/option><option value='Repr\u00e9sentant' >Repr\u00e9sentant<\/option><\/select><\/div><\/div><fieldset id=\"field_9_386\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_386\"><legend class='gfield_label gform-field-label'  >Destinataire<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_386'>\n\t\t\t<div class='gchoice gchoice_9_386_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Organisme\/Institution'  id='choice_9_386_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_386_0' id='label_9_386_0' class='gform-field-label gform-field-label--type-inline'>Organisme\/Institution<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_386_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Nom\/Pr\u00e9nom'  id='choice_9_386_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_386_1' id='label_9_386_1' class='gform-field-label gform-field-label--type-inline'>Nom\/Pr\u00e9nom<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_276\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_276\"><label class='gfield_label gform-field-label' for='input_9_276' >Nom Organisme\/Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_276' id='input_9_276' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_387\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_387\"><label class='gfield_label gform-field-label' for='input_9_387' >Civilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_387' id='input_9_387' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' >-- Veuillez s\u00e9lectionner --<\/option><option value='Mme' >Mme<\/option><option value='M.' >M.<\/option><\/select><\/div><\/div><fieldset id=\"field_9_277\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_277\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_277'>\n                            \n                            <span id='input_9_277_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_277_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_277.3' id='input_9_277_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_277_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_277_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_277.6' id='input_9_277_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_9_278\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_278\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_278' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_278_1_container' >\n                                        <label for='input_9_278_1' id='input_9_278_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_278.1' id='input_9_278_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_278.4' id='input_9_278_4' value=''\/><input type='hidden' class='gform_hidden' name='input_278.6' id='input_9_278_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_425\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_425\"><label class='gfield_label gform-field-label' for='input_9_425' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_425' id='input_9_425' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_280\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_280\"><label class='gfield_label gform-field-label' for='input_9_280' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_280' id='input_9_280' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_285' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"12\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"12\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_285' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"14\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"14\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_14' class='gform_page' data-js='page-field-id-285' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_14' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_287\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_287\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_286\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_286\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_286'>\n                            \n                            <span id='input_9_286_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_286_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_286.3' id='input_9_286_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_286_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_286_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_286.6' id='input_9_286_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_396\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_396\"><label class='gfield_label gform-field-label' for='input_9_396' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_396' id='input_9_396' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_396_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_396_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_396' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_293\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_293\"><label class='gfield_label gform-field-label' for='input_9_293' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_293' id='input_9_293' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_297\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_297\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_297' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_297_1_container' >\n                                        <label for='input_9_297_1' id='input_9_297_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_297.1' id='input_9_297_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_297.4' id='input_9_297_4' value=''\/><input type='hidden' class='gform_hidden' name='input_297.6' id='input_9_297_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_426\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_426\"><label class='gfield_label gform-field-label' for='input_9_426' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_426' id='input_9_426' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_303\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_303\"><label class='gfield_label gform-field-label' for='input_9_303' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_303' id='input_9_303' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_335\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_335\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_442\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_442\"><label class='gfield_label gform-field-label' for='input_9_442' >Type de l&#039;assurance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_442' id='input_9_442' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='LPP' >LPP<\/option><option value='LAA' >LAA<\/option><option value='Autre assurance sociale (LAMAL, etc.)' >Autre assurance sociale (LAMAL, etc.)<\/option><\/select><\/div><\/div><div id=\"field_9_337\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_337\"><label class='gfield_label gform-field-label' for='input_9_337' >Adresse mail du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_337' id='input_9_337' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_358\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_358\"><label class='gfield_label gform-field-label' for='input_9_358' >Nom Organisme\/Institution\/Raison sociale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_358' id='input_9_358' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_338\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_338\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_338'>\n                            \n                            <span id='input_9_338_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_338_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_338.3' id='input_9_338_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_338_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_338_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_338.6' id='input_9_338_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_453\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_453\"><label class='gfield_label gform-field-label' for='input_9_453' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_453'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_453' id='input_9_453' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_453\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_339\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_339\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse ou case compl\u00e8te<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_339' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_339_1_container' >\n                                        <label for='input_9_339_1' id='input_9_339_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_339.1' id='input_9_339_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_339.4' id='input_9_339_4' value=''\/><input type='hidden' class='gform_hidden' name='input_339.6' id='input_9_339_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_428\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_428\"><label class='gfield_label gform-field-label' for='input_9_428' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_428' id='input_9_428' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_341\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_341\"><label class='gfield_label gform-field-label' for='input_9_341' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_341' id='input_9_341' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_441\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_441\"><label class='gfield_label gform-field-label' for='input_9_441' >Num\u00e9ro de r\u00e9f\u00e9rence<\/label><div class='ginput_container ginput_container_text'><input name='input_441' id='input_9_441' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_298' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"13\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"13\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_298' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"15\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"15\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_15' class='gform_page' data-js='page-field-id-298' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_15' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_311\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_311\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_289\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_289\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_289'>\n                            \n                            <span id='input_9_289_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_289_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_289.3' id='input_9_289_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_289_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_289_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_289.6' id='input_9_289_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_397\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_397\"><label class='gfield_label gform-field-label' for='input_9_397' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_397' id='input_9_397' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_397_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_397_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_397' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_295\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_295\"><label class='gfield_label gform-field-label' for='input_9_295' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_295' id='input_9_295' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_300\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_300\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_300' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_300_1_container' >\n                                        <label for='input_9_300_1' id='input_9_300_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_300.1' id='input_9_300_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_300.4' id='input_9_300_4' value=''\/><input type='hidden' class='gform_hidden' name='input_300.6' id='input_9_300_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_429\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_429\"><label class='gfield_label gform-field-label' for='input_9_429' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_429' id='input_9_429' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_306\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_306\"><label class='gfield_label gform-field-label' for='input_9_306' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_306' id='input_9_306' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_333\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_333\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_333' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_333'>Procuration<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_333' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_333&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_333&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_333&quot;,&quot;filelist&quot;:&quot;gform_preview_9_333&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:333},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_333&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_333' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_333' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_333 gfield_description_9_333\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_333'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_333'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_333' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_344\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_344\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_444\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_444\"><label class='gfield_label gform-field-label' for='input_9_444' >Type de l&#039;assurance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_444' id='input_9_444' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='-- Veuillez s\u00e9lectionner --' selected='selected'>-- Veuillez s\u00e9lectionner --<\/option><option value='LCA' >LCA<\/option><option value='Assurance Vie' >Assurance Vie<\/option><option value='R\u00e9assurance LPP' >R\u00e9assurance LPP<\/option><\/select><\/div><\/div><div id=\"field_9_345\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_345\"><label class='gfield_label gform-field-label' for='input_9_345' >Adresse mail du destinataire<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_345' id='input_9_345' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_356\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_356\"><label class='gfield_label gform-field-label' for='input_9_356' >Nom Organisme\/Institution\/Raison sociale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_356' id='input_9_356' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_346\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_346\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_346'>\n                            \n                            <span id='input_9_346_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_346_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_346.3' id='input_9_346_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_346_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_346_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_346.6' id='input_9_346_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_454\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_454\"><label class='gfield_label gform-field-label' for='input_9_454' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_454'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_454' id='input_9_454' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_454\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_347\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_347\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse ou case postale compl\u00e8te<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_347' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_347_1_container' >\n                                        <label for='input_9_347_1' id='input_9_347_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_347.1' id='input_9_347_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_347.4' id='input_9_347_4' value=''\/><input type='hidden' class='gform_hidden' name='input_347.6' id='input_9_347_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_431\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_431\"><label class='gfield_label gform-field-label' for='input_9_431' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_431' id='input_9_431' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_349\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_349\"><label class='gfield_label gform-field-label' for='input_9_349' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_349' id='input_9_349' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_443\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_443\"><label class='gfield_label gform-field-label' for='input_9_443' >Num\u00e9ro de r\u00e9f\u00e9rence<\/label><div class='ginput_container ginput_container_text'><input name='input_443' id='input_9_443' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_299' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"14\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"14\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_299' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"16\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"16\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_16' class='gform_page' data-js='page-field-id-299' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_16' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_9_312\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_312\"><h3 class=\"gsection_title\">Assur\u00e9<\/h3><\/div><fieldset id=\"field_9_290\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_290\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_290'>\n                            \n                            <span id='input_9_290_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_290_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_290.3' id='input_9_290_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_290_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_290_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_290.6' id='input_9_290_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_398\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_398\"><label class='gfield_label gform-field-label' for='input_9_398' >Date de naissance de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_398' id='input_9_398' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='jj.mm.aaaa' aria-describedby=\"input_9_398_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_9_398_date_format' class='screen-reader-text'>JJ . MM . AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_398' class='gform_hidden' value='https:\/\/dev.konsept.ch\/aivd\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_9_296\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_296\"><label class='gfield_label gform-field-label' for='input_9_296' >Num\u00e9ro AVS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_296' id='input_9_296' type='text' value='' class='large'    placeholder='756.____.____.__' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_301\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_301\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse compl\u00e8te de l&#039;assur\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_301' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_301_1_container' >\n                                        <label for='input_9_301_1' id='input_9_301_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_301.1' id='input_9_301_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_301.4' id='input_9_301_4' value=''\/><input type='hidden' class='gform_hidden' name='input_301.6' id='input_9_301_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_432\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_432\"><label class='gfield_label gform-field-label' for='input_9_432' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_432' id='input_9_432' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_309\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_309\"><label class='gfield_label gform-field-label' for='input_9_309' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_309' id='input_9_309' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_334\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_334\"><label class='gfield_label gform-field-label' for='gform_browse_button_9_334' >Annexes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_9_334'>Procuration ou d\u00e9charge<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_334' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_334&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_334&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_334&quot;,&quot;filelist&quot;:&quot;gform_preview_9_334&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/?gf_page=22a842b25a0a3bc&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/dev.konsept.ch\\\/aivd\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:334},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_334&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_9_334' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_9_334' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_334 gfield_description_9_334\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_9_334'>Types de fichiers accept\u00e9s\u00a0: jpg, png, pdf, Taille max. des fichiers\u00a0: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_334'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_9_334' class='ginput_preview_list'><\/div><\/div><div id=\"field_9_352\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_352\"><h3 class=\"gsection_title\">Destinataire<\/h3><\/div><div id=\"field_9_445\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_445\"><label class='gfield_label gform-field-label' for='input_9_445' >Type du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_445' id='input_9_445' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Veuillez s\u00e9lectionner' selected='selected'>Veuillez s\u00e9lectionner<\/option><option value='Cabinet' >Cabinet<\/option><option value='H\u00f4pital' >H\u00f4pital<\/option><option value='Service' >Service<\/option><\/select><\/div><\/div><div id=\"field_9_360\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_360\"><label class='gfield_label gform-field-label' for='input_9_360' >Cabinet\/H\u00f4pital\/Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_360' id='input_9_360' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_353\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_353\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nom du tiers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_353'>\n                            \n                            <span id='input_9_353_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_353_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_353.3' id='input_9_353_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_9_353_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_353_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_353.6' id='input_9_353_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_455\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_9_455\"><label class='gfield_label gform-field-label' for='input_9_455' >T\u00e9l\u00e9phone<\/label><div class='gfield_description' id='gfield_description_9_455'>Format international: +41 ...<\/div><div class='ginput_container ginput_container_text'><input name='input_455' id='input_9_455' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_455\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_9_361\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_361\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Adresse ou case postale compl\u00e8te<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street ginput_container_address gform-grid-row' id='input_9_361' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_361_1_container' >\n                                        <label for='input_9_361_1' id='input_9_361_1_label' class='gform-field-label gform-field-label--type-sub '>Rue et n\u00b0<\/label>\n                                        <input type='text' name='input_361.1' id='input_9_361_1' value=''    aria-required='true'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_361.4' id='input_9_361_4' value=''\/><input type='hidden' class='gform_hidden' name='input_361.6' id='input_9_361_6' value='Suisse' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_9_434\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_434\"><label class='gfield_label gform-field-label' for='input_9_434' >Code postal (NPA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_434' id='input_9_434' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_363\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_363\"><label class='gfield_label gform-field-label' for='input_9_363' >Localit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_363' id='input_9_363' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_9_354\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_354\"><label class='gfield_label gform-field-label' for='input_9_354' >Adresse mail du m\u00e9decin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_354' id='input_9_354' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_9_435' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"15\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"15\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_9_435' class='gform_next_button gform-theme-button button' value='Suivant'  onclick='jQuery(\"#gform_target_page_number_9\").val(\"17\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_9\").val(\"17\");  jQuery(\"#gform_9\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_17' class='gform_page' data-js='page-field-id-435' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_17' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_9_400\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_400\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Politique de confidentialit\u00e9<\/legend><div class='ginput_container ginput_container_consent'><input name='input_400.1' id='input_9_400_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_9_400\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_9_400_1' >J\u2019accepte la politique de confidentialit\u00e9.<\/label><input type='hidden' name='input_400.2' value='J\u2019accepte la politique de confidentialit\u00e9.' class='gform_hidden' \/><input type='hidden' name='input_400.3' value='14' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_9_400'>J'accepte le traitement de mes donn\u00e9es personnelles tel que d\u00e9crit dans le document <a href=\"https:\/\/dev.konsept.ch\/aivd\/wp-content\/uploads\/2023\/07\/20230719_lpd_mentions-legales.pdf\" target=\"_blank\">&laquo;D\u00e9claration de protection des donn\u00e9es et mentions l\u00e9gales&raquo;<\/a>.<\/div><\/fieldset><div id=\"field_9_459\"  class=\"gfield gfield--type-turnstile gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_459\"><\/div><div id=\"field_9_460\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_9_460\"><label class='gfield_label gform-field-label' for='input_9_460' >Name<\/label><div class='ginput_container'><input name='input_460' id='input_9_460' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_9_460'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Pr\u00e9c\u00e9dent'  onclick='if(window[\"gf_submitting_9\"]){return false;}  if( !jQuery(\"#gform_9\")[0].checkValidity || jQuery(\"#gform_9\")[0].checkValidity()){window[\"gf_submitting_9\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_9\"]){return false;} if( !jQuery(\"#gform_9\")[0].checkValidity || jQuery(\"#gform_9\")[0].checkValidity()){window[\"gf_submitting_9\"]=true;}  jQuery(\"#gform_9\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Envoyer'  onclick='if(window[\"gf_submitting_9\"]){return false;}  if( !jQuery(\"#gform_9\")[0].checkValidity || jQuery(\"#gform_9\")[0].checkValidity()){window[\"gf_submitting_9\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_9\"]){return false;} if( !jQuery(\"#gform_9\")[0].checkValidity || jQuery(\"#gform_9\")[0].checkValidity()){window[\"gf_submitting_9\"]=true;}  jQuery(\"#gform_9\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' 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