{"id":2314,"date":"2021-07-19T10:51:13","date_gmt":"2021-07-19T09:51:13","guid":{"rendered":"https:\/\/intraafrica.co.ke\/?page_id=2314"},"modified":"2021-09-03T09:17:53","modified_gmt":"2021-09-03T08:17:53","slug":"non-motor-quote-form-for-individuals","status":"publish","type":"page","link":"https:\/\/intraafrica.co.ke\/non-motor-quote-form-for-individuals\/","title":{"rendered":"Non-Motor Quote Form (individual)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2314\" class=\"elementor elementor-2314\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-61f6f02 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"61f6f02\" 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-fc94131\" data-id=\"fc94131\" 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-dce8898 elementor-widget elementor-widget-heading\" data-id=\"dce8898\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Non-motor Quote Form (Individual)<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aff68c6 elementor-widget elementor-widget-shortcode\" data-id=\"aff68c6\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><link rel='stylesheet' id='formidable-css' href='https:\/\/intraafrica.co.ke\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=2131346' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_intra-style-on-blue-background\" id=\"frm_form_21_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_personalaccidentf7333b96761050892aea29b4fe188aa06021dacd\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Non Motor Quote Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"21\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_21\" id=\"frm_hide_fields_21\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"personalaccidentf7333b96761050892aea29b4fe188aa06021dacd\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_21\" name=\"frm_submit_entry_21\" value=\"c12ab7d83f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/2314\" \/><input type=\"hidden\" name=\"item_meta[738]\" id=\"field_ddzyi39819a4cfb\" value=\"Mulitiple Quote Form\"  data-frmval=\"Mulitiple Quote Form\" data-invmsg=\"Hidden is invalid\"   \/>\n<div id=\"frm_field_1543_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Please use the form below to get a quote for....<\/h3>\r\n\r\n\r\n<div id=\"frm_field_780_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_jhw1l_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jhw1l_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_780-1543-0\"><label for=\"field_jhw1l-0\">\t\t<input type=\"radio\" name=\"item_meta[780]\" id=\"field_jhw1l-0\" value=\"Personal Accident\"\n\t\t   data-sectionid=\"1543\" data-invmsg=\" is invalid\" aria-invalid=\"false\"  \/> Personal Accident<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_780-1543-1\"><label for=\"field_jhw1l-1\">\t\t<input type=\"radio\" name=\"item_meta[780]\" id=\"field_jhw1l-1\" value=\"Domestic Package\"\n\t\t   data-sectionid=\"1543\" data-invmsg=\" is invalid\" aria-invalid=\"false\"  \/> Domestic Package<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_780-1543-2\"><label for=\"field_jhw1l-2\">\t\t<input type=\"radio\" name=\"item_meta[780]\" id=\"field_jhw1l-2\" value=\"Professional Indemnity\"\n\t\t   data-sectionid=\"1543\" data-invmsg=\" is invalid\" aria-invalid=\"false\"  \/> Professional Indemnity<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_780-1543-3\"><label for=\"field_jhw1l-3\">\t\t<input type=\"radio\" name=\"item_meta[780]\" id=\"field_jhw1l-3\" value=\"All Risk\"\n\t\t   data-sectionid=\"1543\" data-invmsg=\" is invalid\" aria-invalid=\"false\"  \/> All Risk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_780-1543-4\"><label for=\"field_jhw1l-4\">\t\t<input type=\"radio\" name=\"item_meta[780]\" id=\"field_jhw1l-4\" value=\"Golfers\"\n\t\t   data-sectionid=\"1543\" data-invmsg=\" is invalid\" aria-invalid=\"false\"  \/> Golfers<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1666_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n\r\n<div id=\"frm_field_739_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48c\" id=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48c_label\" class=\"frm_primary_label\">Agency Name (if applicable)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48c\" name=\"item_meta[739]\" value=\"\"  data-sectionid=\"1666\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_740_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Proposer's Details (Whether business or individual)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_741_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div  id=\"field_j5axda197cf68480ae8840075d7efcf3d1a_label\" class=\"frm_primary_label\">Full Name of Proposer\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_j5axda197cf68480ae8840075d7efcf3d1a_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tFull Name of Proposer\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_741\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_741-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_j5axda197cf68480ae8840075d7efcf3d1a_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_j5axda197cf68480ae8840075d7efcf3d1a_first\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[741][first]\"  data-sectionid=\"740\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Full Name of Proposer is invalid\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_741_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_741-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_j5axda197cf68480ae8840075d7efcf3d1a_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_j5axda197cf68480ae8840075d7efcf3d1a_last\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[741][last]\"  data-sectionid=\"740\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Full Name of Proposer is invalid\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_741_last_desc\">Last<\/div>\t\t\t<\/div>\n\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_781_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_8j0eb\" id=\"field_8j0eb_label\" class=\"frm_primary_label\">Business Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8j0eb\" name=\"item_meta[781]\" value=\"\"  data-sectionid=\"740\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_743_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contact Details.<\/h3>\r\n\r\n\r\n<div id=\"frm_field_744_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_du0tjaa41e84f6da1f8b8412\" id=\"field_du0tjaa41e84f6da1f8b8412_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_du0tjaa41e84f6da1f8b8412\" name=\"item_meta[744]\" value=\"\"  data-sectionid=\"743\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_745_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_dlef4635cc7318fe1d239426df010c243bf\" id=\"field_dlef4635cc7318fe1d239426df010c243bf_label\" class=\"frm_primary_label\">Nearest Suburb\/Town\/City\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dlef4635cc7318fe1d239426df010c243bf\" name=\"item_meta[745]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_746_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_9560o7c77f166385c4ae5a59a0e245c5074\" id=\"field_9560o7c77f166385c4ae5a59a0e245c5074_label\" class=\"frm_primary_label\">Telephone \/Mobile 1\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_9560o7c77f166385c4ae5a59a0e245c5074\" name=\"item_meta[746]\" value=\"\"  data-sectionid=\"743\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_747_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_uko09b475ec27f4\" id=\"field_uko09b475ec27f4_label\" class=\"frm_primary_label\">Telelphone \/ Mobile 2\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_uko09b475ec27f4\" name=\"item_meta[747]\" value=\"\"  data-sectionid=\"743\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_782_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Please provide the period for which the insurance is required<\/h3>\r\n\r\n\r\n<div id=\"frm_field_784_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_2pkfq\" id=\"field_2pkfq_label\" class=\"frm_primary_label\">Insurance starts from\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2pkfq\" name=\"item_meta[784]\" value=\"\"  data-sectionid=\"782\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_785_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_2dqf8\" id=\"field_2dqf8_label\" class=\"frm_primary_label\">Insurance ends on\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2dqf8\" name=\"item_meta[785]\" value=\"\"  data-sectionid=\"782\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_786_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Personal Accident<\/h3>\r\n\r\n\r\n<div id=\"frm_field_796_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_pihak\" id=\"field_pihak_label\" class=\"frm_primary_label\">Profession or occupation\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pihak\" name=\"item_meta[796]\" value=\"\"  data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_797_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qnjgm\" id=\"field_qnjgm_label\" class=\"frm_primary_label\">Please describe fully\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qnjgm\" name=\"item_meta[797]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_799_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_65opq_label\" class=\"frm_primary_label\">Does your occupation, require you to engage in manual labor?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_65opq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_799-786-0\"><label for=\"field_65opq-0\">\t\t<input type=\"radio\" name=\"item_meta[799]\" id=\"field_65opq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Does your occupation, require you to engage in manual labor? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_799-786-1\"><label for=\"field_65opq-1\">\t\t<input type=\"radio\" name=\"item_meta[799]\" id=\"field_65opq-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Does your occupation, require you to engage in manual labor? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_798_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_z073k\" id=\"field_z073k_label\" class=\"frm_primary_label\">Give Details\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_z073k\" name=\"item_meta[798]\" value=\"\"  data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_803_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Have you suffered from:<\/p>\n<\/div>\n<div id=\"frm_field_801_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_rtiu9_label\" class=\"frm_primary_label\">Rupture(hernia)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_rtiu9_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_801-786-0\"><label for=\"field_rtiu9-0\">\t\t<input type=\"radio\" name=\"item_meta[801]\" id=\"field_rtiu9-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Rupture(hernia) is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_801-786-1\"><label for=\"field_rtiu9-1\">\t\t<input type=\"radio\" name=\"item_meta[801]\" id=\"field_rtiu9-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Rupture(hernia) is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_809_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_nzpha_label\" class=\"frm_primary_label\">Any form of chronic illness\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nzpha_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_809-786-0\"><label for=\"field_nzpha-0\">\t\t<input type=\"radio\" name=\"item_meta[809]\" id=\"field_nzpha-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Any form of chronic illness is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_809-786-1\"><label for=\"field_nzpha-1\">\t\t<input type=\"radio\" name=\"item_meta[809]\" id=\"field_nzpha-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Any form of chronic illness is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_808_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_d6b7i_label\" class=\"frm_primary_label\">Varicose veins\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_d6b7i_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_808-786-0\"><label for=\"field_d6b7i-0\">\t\t<input type=\"radio\" name=\"item_meta[808]\" id=\"field_d6b7i-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Varicose veins is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_808-786-1\"><label for=\"field_d6b7i-1\">\t\t<input type=\"radio\" name=\"item_meta[808]\" id=\"field_d6b7i-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Varicose veins is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_805_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_76aqm_label\" class=\"frm_primary_label\">Back strain\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_76aqm_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_805-786-0\"><label for=\"field_76aqm-0\">\t\t<input type=\"radio\" name=\"item_meta[805]\" id=\"field_76aqm-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Back strain is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_805-786-1\"><label for=\"field_76aqm-1\">\t\t<input type=\"radio\" name=\"item_meta[805]\" id=\"field_76aqm-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Back strain is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_807_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_comu1_label\" class=\"frm_primary_label\">Slipped disc\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_comu1_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_807-786-0\"><label for=\"field_comu1-0\">\t\t<input type=\"radio\" name=\"item_meta[807]\" id=\"field_comu1-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Slipped disc is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_807-786-1\"><label for=\"field_comu1-1\">\t\t<input type=\"radio\" name=\"item_meta[807]\" id=\"field_comu1-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Slipped disc is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_806_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_kl6f8_label\" class=\"frm_primary_label\">Impairment of hearing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_kl6f8_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_806-786-0\"><label for=\"field_kl6f8-0\">\t\t<input type=\"radio\" name=\"item_meta[806]\" id=\"field_kl6f8-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Impairment of hearing is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_806-786-1\"><label for=\"field_kl6f8-1\">\t\t<input type=\"radio\" name=\"item_meta[806]\" id=\"field_kl6f8-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Impairment of hearing is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_804_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_dh9fi_label\" class=\"frm_primary_label\">Impairment of sight\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_dh9fi_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_804-786-0\"><label for=\"field_dh9fi-0\">\t\t<input type=\"radio\" name=\"item_meta[804]\" id=\"field_dh9fi-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Impairment of sight is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_804-786-1\"><label for=\"field_dh9fi-1\">\t\t<input type=\"radio\" name=\"item_meta[804]\" id=\"field_dh9fi-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Impairment of sight is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_810_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_31g23_label\" class=\"frm_primary_label\">Or hearing complaint \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_31g23_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_810-786-0\"><label for=\"field_31g23-0\">\t\t<input type=\"radio\" name=\"item_meta[810]\" id=\"field_31g23-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Or hearing complaint  is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_810-786-1\"><label for=\"field_31g23-1\">\t\t<input type=\"radio\" name=\"item_meta[810]\" id=\"field_31g23-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Or hearing complaint  is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_816_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_k2ral_label\" class=\"frm_primary_label\">Infection of eyes\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_k2ral_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_816-786-0\"><label for=\"field_k2ral-0\">\t\t<input type=\"radio\" name=\"item_meta[816]\" id=\"field_k2ral-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Infection of eyes is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_816-786-1\"><label for=\"field_k2ral-1\">\t\t<input type=\"radio\" name=\"item_meta[816]\" id=\"field_k2ral-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Infection of eyes is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_815_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_v4ohb_label\" class=\"frm_primary_label\">Discharge from the ear\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_v4ohb_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_815-786-0\"><label for=\"field_v4ohb-0\">\t\t<input type=\"radio\" name=\"item_meta[815]\" id=\"field_v4ohb-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Discharge from the ear is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_815-786-1\"><label for=\"field_v4ohb-1\">\t\t<input type=\"radio\" name=\"item_meta[815]\" id=\"field_v4ohb-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Discharge from the ear is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_814_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_5e2od_label\" class=\"frm_primary_label\">Heart disease\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_5e2od_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_814-786-0\"><label for=\"field_5e2od-0\">\t\t<input type=\"radio\" name=\"item_meta[814]\" id=\"field_5e2od-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Heart disease is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_814-786-1\"><label for=\"field_5e2od-1\">\t\t<input type=\"radio\" name=\"item_meta[814]\" id=\"field_5e2od-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Heart disease is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_813_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_tkhmu_label\" class=\"frm_primary_label\">Duodenal or gastric ulcer\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tkhmu_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_813-786-0\"><label for=\"field_tkhmu-0\">\t\t<input type=\"radio\" name=\"item_meta[813]\" id=\"field_tkhmu-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Duodenal or gastric ulcer is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_813-786-1\"><label for=\"field_tkhmu-1\">\t\t<input type=\"radio\" name=\"item_meta[813]\" id=\"field_tkhmu-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Duodenal or gastric ulcer is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_812_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_bk3e8_label\" class=\"frm_primary_label\">Fits or blackouts\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_bk3e8_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_812-786-0\"><label for=\"field_bk3e8-0\">\t\t<input type=\"radio\" name=\"item_meta[812]\" id=\"field_bk3e8-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Fits or blackouts is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_812-786-1\"><label for=\"field_bk3e8-1\">\t\t<input type=\"radio\" name=\"item_meta[812]\" id=\"field_bk3e8-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Fits or blackouts is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_811_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_pndjc_label\" class=\"frm_primary_label\">Any form of paralysis \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_pndjc_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_811-786-0\"><label for=\"field_pndjc-0\">\t\t<input type=\"radio\" name=\"item_meta[811]\" id=\"field_pndjc-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Any form of paralysis  is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_811-786-1\"><label for=\"field_pndjc-1\">\t\t<input type=\"radio\" name=\"item_meta[811]\" id=\"field_pndjc-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Any form of paralysis  is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_818_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_1y8jw_label\" class=\"frm_primary_label\">Have you any physical defect or infirmity?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1y8jw_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_818-786-0\"><label for=\"field_1y8jw-0\">\t\t<input type=\"radio\" name=\"item_meta[818]\" id=\"field_1y8jw-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Have you any physical defect or infirmity? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_818-786-1\"><label for=\"field_1y8jw-1\">\t\t<input type=\"radio\" name=\"item_meta[818]\" id=\"field_1y8jw-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Have you any physical defect or infirmity? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_817_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_97ux0_label\" class=\"frm_primary_label\">Have you sustained any injury by accident(s) during the last five years?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_97ux0_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_817-786-0\"><label for=\"field_97ux0-0\">\t\t<input type=\"radio\" name=\"item_meta[817]\" id=\"field_97ux0-0\" value=\"Yes\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Have you sustained any injury by accident(s) during the last five years? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_817-786-1\"><label for=\"field_97ux0-1\">\t\t<input type=\"radio\" name=\"item_meta[817]\" id=\"field_97ux0-1\" value=\"No\"\n\t\t   data-sectionid=\"786\" data-invmsg=\"Have you sustained any injury by accident(s) during the last five years? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_819_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dqabi\" id=\"field_dqabi_label\" class=\"frm_primary_label\">If so, give dates, nature of injury(ies) and period(s) of disablement\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dqabi\" name=\"item_meta[819]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_820_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_jdj5l\" id=\"field_jdj5l_label\" class=\"frm_primary_label\">Amount of insurance for death or P.D\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jdj5l\" name=\"item_meta[820]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_821_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_20e5t\" id=\"field_20e5t_label\" class=\"frm_primary_label\">Class\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_20e5t\" name=\"item_meta[821]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_822_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_qaxwo\" id=\"field_qaxwo_label\" class=\"frm_primary_label\">Table\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qaxwo\" name=\"item_meta[822]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_823_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_kr6hz\" id=\"field_kr6hz_label\" class=\"frm_primary_label\">Accidental medical expenses\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kr6hz\" name=\"item_meta[823]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_824_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_2peub\" id=\"field_2peub_label\" class=\"frm_primary_label\">Temporary total disablement\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2peub\" name=\"item_meta[824]\" value=\"\"  data-sectionid=\"786\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_2peub\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_2peub\">(per week max 104 weeks)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_825_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_javkj\" id=\"field_javkj_label\" class=\"frm_primary_label\">Beneficiary in the event of death: Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_javkj\" name=\"item_meta[825]\" value=\"\"  data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_826_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_3k7ai\" id=\"field_3k7ai_label\" class=\"frm_primary_label\">Relationship\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3k7ai\" name=\"item_meta[826]\" value=\"\"  data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_827_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_jtuly\" id=\"field_jtuly_label\" class=\"frm_primary_label\">Age\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jtuly\" name=\"item_meta[827]\" value=\"\"  data-sectionid=\"786\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_788_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Domestic Package<\/h3>\r\n\r\n\r\n<div id=\"frm_field_830_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_tsesx\" id=\"field_tsesx_label\" class=\"frm_primary_label\">Of what material is the dwelling constructed?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tsesx\" name=\"item_meta[830]\" value=\"\"  data-sectionid=\"788\" placeholder=\"Walls\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_831_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_unnnp\" id=\"field_unnnp_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_unnnp\" name=\"item_meta[831]\" value=\"\"  data-sectionid=\"788\" placeholder=\"Roof\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_834_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_8cdys_label\" class=\"frm_primary_label\">Is the premises a private dwelling house?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8cdys_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_834-788-0\"><label for=\"field_8cdys-0\">\t\t<input type=\"radio\" name=\"item_meta[834]\" id=\"field_8cdys-0\" value=\"Yes\"\n\t\t   data-sectionid=\"788\" data-invmsg=\"Is the premises a private dwelling house? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_834-788-1\"><label for=\"field_8cdys-1\">\t\t<input type=\"radio\" name=\"item_meta[834]\" id=\"field_8cdys-1\" value=\"No\"\n\t\t   data-sectionid=\"788\" data-invmsg=\"Is the premises a private dwelling house? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_832_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_zluar\" id=\"field_zluar_label\" class=\"frm_primary_label\">If not please explain\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zluar\" name=\"item_meta[832]\" value=\"\"  data-sectionid=\"788\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_835_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_dlia8_label\" class=\"frm_primary_label\">Is the dwelling solely in your occupation? (including your family and servants)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_dlia8_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_835-788-0\"><label for=\"field_dlia8-0\">\t\t<input type=\"radio\" name=\"item_meta[835]\" id=\"field_dlia8-0\" value=\"Yes\"\n\t\t   data-sectionid=\"788\" data-invmsg=\"Is the dwelling solely in your occupation? (including your family and servants) is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_835-788-1\"><label for=\"field_dlia8-1\">\t\t<input type=\"radio\" name=\"item_meta[835]\" id=\"field_dlia8-1\" value=\"No\"\n\t\t   data-sectionid=\"788\" data-invmsg=\"Is the dwelling solely in your occupation? (including your family and servants) is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_836_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2g6r8\" id=\"field_2g6r8_label\" class=\"frm_primary_label\">The Buildings: The proposers residence being a private dwelling or private flat and all domestic offices, stables, garage and outbuildings on the premises and used in connection therewith the wall, gates and fences around and pertaining thereto, including Landlords, fixtures and fittings in the said building all situated as above.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_2g6r8\" name=\"item_meta[836]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_2g6r8\" min=\"1\" max=\"10\" step=\"1\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_2g6r8\">(all the said buildings are brick, stone or concrete built, with tile, concrete or metal roof)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_837_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_8vz6q\" id=\"field_8vz6q_label\" class=\"frm_primary_label\">Total sum insured on buildings Ksh\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_8vz6q\" name=\"item_meta[837]\" value=\"\"  data-sectionid=\"788\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_8vz6q\" min=\"1\" max=\"10\" step=\"1\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_8vz6q\">The sum insured for the buildings should be the reinstatement value. i.e the cost of rebuilding the house including walls and outbuildings, making allowance for architects and surveyors consultancy fees and cost of debris removal.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_838_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><b>Note 1:<\/b> The sum should insure should be the replacement value less depreciation, wear and tear of the property.<\/p>\n<p><b>Note 2:<\/b>No one article (furniture excepted) shall be deemed of greater value than 5% of the total sum insured on the contents, unless such article is   specifically insured.<\/p>\n<p><b>Note 3:<\/b>The value of platinum, gold and silver articles, jewellery will be deemed not to exceed one third of the total sum insured on the said contents unless specifically agreed upon with the insurer. If the said value exceeds the portion, the value of such property should be specified.<\/p>\n<\/p><\/div>\n<div id=\"frm_field_840_container\" class=\"frm_form_field  frm_html_container form-field\"> On furniture, household goods and personal effects of every description the property of the proposer or any member of the proposer's family normally residing with the proposer, and fixtures and fittings the proposer's own or for which the proposer is legally responsible, not being landlord's fixture and fittings, in the building of the proposer's residence.<\/div>\n<div id=\"frm_field_839_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_xtdyl\" id=\"field_xtdyl_label\" class=\"frm_primary_label\">Furniture\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_xtdyl\" name=\"item_meta[839]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_848_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6s0ar\" id=\"field_6s0ar_label\" class=\"frm_primary_label\">Household linen\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_6s0ar\" name=\"item_meta[848]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_847_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_h2lr1\" id=\"field_h2lr1_label\" class=\"frm_primary_label\">Cutlery, Glass, Crockery\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_h2lr1\" name=\"item_meta[847]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_846_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_1aemu\" id=\"field_1aemu_label\" class=\"frm_primary_label\">Pictures and ornaments.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_1aemu\" name=\"item_meta[846]\" value=\"\"  data-sectionid=\"788\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_1aemu\" min=\"1\" max=\"10\" step=\"1\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_1aemu\">KES<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_845_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2c4rj\" id=\"field_2c4rj_label\" class=\"frm_primary_label\">Wines and Spirits\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_2c4rj\" name=\"item_meta[845]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_844_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4u5ef\" id=\"field_4u5ef_label\" class=\"frm_primary_label\">Personal Clothing.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_4u5ef\" name=\"item_meta[844]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_843_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_d1en9\" id=\"field_d1en9_label\" class=\"frm_primary_label\">Photographic Equipment.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_d1en9\" name=\"item_meta[843]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_842_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7kcsd\" id=\"field_7kcsd_label\" class=\"frm_primary_label\">Jewelry and valuables (attach jewelry valuation report for any single item valued in excess of KES (50,000\/-).\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_7kcsd\" name=\"item_meta[842]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_841_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_369lk\" id=\"field_369lk_label\" class=\"frm_primary_label\">Others (Specify)..\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_369lk\" name=\"item_meta[841]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_849_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ufun2\" id=\"field_ufun2_label\" class=\"frm_primary_label\">Total sum insured\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_ufun2\" name=\"item_meta[849]\" value=\"\"  data-sectionid=\"788\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_852_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Specify here any article of greater value than 5% of the total sum insured on the above contents<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[852][form]\" value=\"24\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_852-0\" class=\"frm_repeat_sec frm_repeat_852 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[852][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[852][0][0]\" value=\"\" \/><div id=\"frm_field_854-852-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_854_container\">\r\n    <label for=\"field_344dk-0\" id=\"field_344dk-0_label\" class=\"frm_primary_label\">Item\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_344dk-0\" name=\"item_meta[852][0][854]\" value=\"\"  data-sectionid=\"852\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_856-852-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_856_container\">\r\n    <label for=\"field_ww7lb-0\" id=\"field_ww7lb-0_label\" class=\"frm_primary_label\">Value\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ww7lb-0\" name=\"item_meta[852][0][856]\" value=\"\"  data-sectionid=\"852\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"852\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"852\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_857_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n\r\n<div id=\"frm_field_859_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Complete this option if you wish to insure each item individually. Proposer's estimate of the value of individual items making up the contents Do not include a value for any item which is to be insured under the \"ALL RISKS\u201d\n<\/p>\n<\/div>\n<div id=\"frm_field_860_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Please indicate the security arrangements you have put in place;<\/p>\n<\/div>\n<div id=\"frm_field_863_container\" class=\"frm_form_field form-field  frm_top_container frm_third vertical_radio\">\r\n    <div  id=\"field_brld1_label\" class=\"frm_primary_label\">Own Watchman\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_brld1_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_863-857-0\"><label for=\"field_brld1-0\">\t\t<input type=\"radio\" name=\"item_meta[863]\" id=\"field_brld1-0\" value=\"Yes\"\n\t\t   data-sectionid=\"857\" data-invmsg=\"Own Watchman is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_863-857-1\"><label for=\"field_brld1-1\">\t\t<input type=\"radio\" name=\"item_meta[863]\" id=\"field_brld1-1\" value=\"No\"\n\t\t   data-sectionid=\"857\" data-invmsg=\"Own Watchman is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_864_container\" class=\"frm_form_field form-field  frm_top_container frm_third vertical_radio\">\r\n    <div  id=\"field_8mvgd_label\" class=\"frm_primary_label\">Security Guards\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8mvgd_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_864-857-0\"><label for=\"field_8mvgd-0\">\t\t<input type=\"radio\" name=\"item_meta[864]\" id=\"field_8mvgd-0\" value=\"Yes\"\n\t\t   data-sectionid=\"857\" data-invmsg=\"Security Guards is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_864-857-1\"><label for=\"field_8mvgd-1\">\t\t<input type=\"radio\" name=\"item_meta[864]\" id=\"field_8mvgd-1\" value=\"No\"\n\t\t   data-sectionid=\"857\" data-invmsg=\"Security Guards is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_866_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_2sa5v\" id=\"field_2sa5v_label\" class=\"frm_primary_label\">Any Other (please specify)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2sa5v\" name=\"item_meta[866]\" value=\"\"  data-sectionid=\"857\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_869_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><b><\/b>Note: The sum insured should be the replacement value of the property less a deduction for wear, tear and depreciation Please give a detailed description and state separately the value  of each item as provided below. For any items of jewellery with sum insured up to and in excess of KES:50,000 a valuation report must be submitted.<\/p>\n<\/div>\n<\/div>\n<div id=\"frm_field_867_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[867][form]\" value=\"25\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_867-0\" class=\"frm_repeat_sec frm_repeat_867 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[867][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[867][0][0]\" value=\"\" \/><div id=\"frm_field_870-867-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_870_container\">\r\n    <label for=\"field_cvxyq-0\" id=\"field_cvxyq-0_label\" class=\"frm_primary_label\">Description of article Make\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cvxyq-0\" name=\"item_meta[867][0][870]\" value=\"\"  data-sectionid=\"867\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_874-867-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_874_container\">\r\n    <label for=\"field_5q37x-0\" id=\"field_5q37x-0_label\" class=\"frm_primary_label\">Model\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5q37x-0\" name=\"item_meta[867][0][874]\" value=\"\"  data-sectionid=\"867\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_873-867-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_873_container\">\r\n    <label for=\"field_olzn5-0\" id=\"field_olzn5-0_label\" class=\"frm_primary_label\">S \/ No.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_olzn5-0\" name=\"item_meta[867][0][873]\" value=\"\"  data-sectionid=\"867\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_872-867-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_872_container\">\r\n    <label for=\"field_ui144-0\" id=\"field_ui144-0_label\" class=\"frm_primary_label\">Value\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ui144-0\" name=\"item_meta[867][0][872]\" value=\"\"  data-sectionid=\"867\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"867\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"867\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_877_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n\r\n<div id=\"frm_field_879_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_4aqjs\" id=\"field_4aqjs_label\" class=\"frm_primary_label\">Number of Indoor Workers\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_4aqjs\" name=\"item_meta[879]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_880_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_th74t\" id=\"field_th74t_label\" class=\"frm_primary_label\">Estimated annual wages(indoor workers)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_th74t\" name=\"item_meta[880]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_888_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ha0kv\" id=\"field_ha0kv_label\" class=\"frm_primary_label\">Number of gardeners\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_ha0kv\" name=\"item_meta[888]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_887_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_30eha\" id=\"field_30eha_label\" class=\"frm_primary_label\">Estimated annual wages(gradeners)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_30eha\" name=\"item_meta[887]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_886_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_brzfa\" id=\"field_brzfa_label\" class=\"frm_primary_label\">Number of chauffeurs\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_brzfa\" name=\"item_meta[886]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_885_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_dfu7y\" id=\"field_dfu7y_label\" class=\"frm_primary_label\">Estimated annual wages (chauffeurs)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_dfu7y\" name=\"item_meta[885]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_884_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_rbhph\" id=\"field_rbhph_label\" class=\"frm_primary_label\">Number of watchmen\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_rbhph\" name=\"item_meta[884]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_883_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_wp34l\" id=\"field_wp34l_label\" class=\"frm_primary_label\">Estimated annual wages(watchmen)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_wp34l\" name=\"item_meta[883]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_882_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_nghna\" id=\"field_nghna_label\" class=\"frm_primary_label\">Others(please specify)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_nghna\" name=\"item_meta[882]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_881_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_8h90u\" id=\"field_8h90u_label\" class=\"frm_primary_label\">Estimated annual wages(others)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_8h90u\" name=\"item_meta[881]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_889_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_b9qaa_label\" class=\"frm_primary_label\">Limit of cover required\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_b9qaa_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_889-877-0\"><label for=\"field_b9qaa-0\"><input type=\"checkbox\" name=\"item_meta[889][]\" id=\"field_b9qaa-0\" value=\"Any one person-KES 2,000,000\/=| Any one occurrence-KES 10,000,000\/=| Any one year - KES 20,000,000\/=\"  data-sectionid=\"877\" data-invmsg=\"Limit of cover required is invalid\" aria-invalid=\"false\"   \/> Any one person-KES 2,000,000\/=| Any one occurrence-KES 10,000,000\/=| Any one year - KES 20,000,000\/=<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_889-877-1\"><label for=\"field_b9qaa-1\"><input type=\"checkbox\" name=\"item_meta[889][]\" id=\"field_b9qaa-1\" value=\"Any one person-KES 4,000,000\/=| Any one occurrence-KES 15,000,000\/=| Any one year - KES 30,000,000\/=\"  data-sectionid=\"877\" data-invmsg=\"Limit of cover required is invalid\" aria-invalid=\"false\"   \/> Any one person-KES 4,000,000\/=| Any one occurrence-KES 15,000,000\/=| Any one year - KES 30,000,000\/=<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_b9qaa\">Subject to deductible of KES. 10,000\/= each and every claim.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_890_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_wjo15\" id=\"field_wjo15_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wjo15\" name=\"item_meta[890]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_891_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5x1hg\" id=\"field_5x1hg_label\" class=\"frm_primary_label\">Limit of indemnity required\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5x1hg\" name=\"item_meta[891]\" value=\"\"  data-sectionid=\"877\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_5x1hg\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_5x1hg\">Occupier's & personal liability.<\/div>\r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_790_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Professional Indemnity<\/h3>\r\n\r\n\r\n<div id=\"frm_field_895_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ak7t3\" id=\"field_ak7t3_label\" class=\"frm_primary_label\">Text\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ak7t3\" name=\"item_meta[895]\" value=\"\"  data-sectionid=\"790\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_892_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_t69hw_label\" class=\"frm_primary_label\">Present legal constitution\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_t69hw_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_892-790-0\"><label for=\"field_t69hw-0\"><input type=\"checkbox\" name=\"item_meta[892][]\" id=\"field_t69hw-0\" value=\"Sole practitioner\"  data-sectionid=\"790\" data-frmlimit=\"1\"  data-invmsg=\"Present legal constitution is invalid\" aria-invalid=\"false\"   \/> Sole practitioner<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_892-790-1\"><label for=\"field_t69hw-1\"><input type=\"checkbox\" name=\"item_meta[892][]\" id=\"field_t69hw-1\" value=\"Partnership\"  data-sectionid=\"790\" data-frmlimit=\"1\"  data-invmsg=\"Present legal constitution is invalid\" aria-invalid=\"false\"   \/> Partnership<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_892-790-2\"><label for=\"field_t69hw-2\"><input type=\"checkbox\" name=\"item_meta[892][]\" id=\"field_t69hw-2\" value=\"Incorporated company\"  data-sectionid=\"790\" data-frmlimit=\"1\"  data-invmsg=\"Present legal constitution is invalid\" aria-invalid=\"false\"   \/> Incorporated company<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_892-790-3\"><label for=\"field_t69hw-3\"><input type=\"checkbox\" name=\"item_meta[892][]\" id=\"field_t69hw-3\" value=\"Limited company\"  data-sectionid=\"790\" data-frmlimit=\"1\"  data-invmsg=\"Present legal constitution is invalid\" aria-invalid=\"false\"   \/> Limited company<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_896_container\" class=\"frm_form_field  frm_html_container form-field\">\n<ul>\n<li>In the case of partnerships-partners<\/li>\n<li>In the case of incorporate companies, directors<\/li>\n<li>In the case of limited companies, professionally qualified directors and employees<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"frm_field_893_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[893][form]\" value=\"27\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_893-0\" class=\"frm_repeat_sec frm_repeat_893 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[893][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[893][0][0]\" value=\"\" \/><div id=\"frm_field_897-893-0_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_field_897_container\">\r\n    <label for=\"field_ain7h-0\" id=\"field_ain7h-0_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ain7h-0\" name=\"item_meta[893][0][897]\" value=\"\"  data-sectionid=\"893\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_900-893-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_900_container\">\r\n    <label for=\"field_9yrb6-0\" id=\"field_9yrb6-0_label\" class=\"frm_primary_label\">Qualifications\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9yrb6-0\" name=\"item_meta[893][0][900]\" value=\"\"  data-sectionid=\"893\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_899-893-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_899_container\">\r\n    <label for=\"field_1qhlr-0\" id=\"field_1qhlr-0_label\" class=\"frm_primary_label\">Date qualified \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1qhlr-0\" name=\"item_meta[893][0][899]\" value=\"\"  data-sectionid=\"893\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_898-893-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_898_container\">\r\n    <label for=\"field_l5j3t-0\" id=\"field_l5j3t-0_label\" class=\"frm_primary_label\">How long principal in this practice\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_l5j3t-0\" name=\"item_meta[893][0][898]\" value=\"\"  data-sectionid=\"893\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"893\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"893\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_901_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Total number of partners and staff<\/h3>\r\n\r\n\r\n<div id=\"frm_field_903_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ptec7\" id=\"field_ptec7_label\" class=\"frm_primary_label\">Partners\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_ptec7\" name=\"item_meta[903]\" value=\"\"  data-sectionid=\"901\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_904_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_cxblq\" id=\"field_cxblq_label\" class=\"frm_primary_label\">Staff other than typists, telephonists and messengers\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_cxblq\" name=\"item_meta[904]\" value=\"\"  data-sectionid=\"901\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_905_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3gn6p\" id=\"field_3gn6p_label\" class=\"frm_primary_label\">Annual salaries: KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_3gn6p\" name=\"item_meta[905]\" value=\"\"  data-sectionid=\"901\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_906_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_x3vs7\" id=\"field_x3vs7_label\" class=\"frm_primary_label\">Gross fee income in the last 12 months\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_x3vs7\" name=\"item_meta[906]\" value=\"\"  data-sectionid=\"901\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_907_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_lgnqi\" id=\"field_lgnqi_label\" class=\"frm_primary_label\">Gross fee income in the last 12 months before that.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_lgnqi\" name=\"item_meta[907]\" value=\"\"  data-sectionid=\"901\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_908_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ugu1u\" id=\"field_ugu1u_label\" class=\"frm_primary_label\">Amount of indemnity required: Any one claim:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_ugu1u\" name=\"item_meta[908]\" value=\"\"  data-sectionid=\"901\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_910_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cjzup\" id=\"field_cjzup_label\" class=\"frm_primary_label\">Any one event:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cjzup\" name=\"item_meta[910]\" value=\"\"  data-sectionid=\"901\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_909_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_zbtur\" id=\"field_zbtur_label\" class=\"frm_primary_label\">Any one period:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zbtur\" name=\"item_meta[909]\" value=\"\"  data-sectionid=\"901\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_792_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">All Risk<\/h3>\r\n\r\n\r\n<div id=\"frm_field_922_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_r6lri\" id=\"field_r6lri_label\" class=\"frm_primary_label\">Are you at present insured under a householders, fire, theft or all risks policy in respect for the contents of your residence? If yes please state : The name of company\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r6lri\" name=\"item_meta[922]\" value=\"\"  data-sectionid=\"792\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_923_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3v1h9\" id=\"field_3v1h9_label\" class=\"frm_primary_label\">The type of policy\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3v1h9\" name=\"item_meta[923]\" value=\"\"  data-sectionid=\"792\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_924_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2pbp0\" id=\"field_2pbp0_label\" class=\"frm_primary_label\">Amount insured\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2pbp0\" name=\"item_meta[924]\" value=\"\"  data-sectionid=\"792\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_927_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Evidence of value required for items exceeding Ksh. 10,000<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[927][form]\" value=\"28\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_927-0\" class=\"frm_repeat_sec frm_repeat_927 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[927][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[927][0][0]\" value=\"\" \/><div id=\"frm_field_929-927-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_929_container\">\r\n    <label for=\"field_e8oet-0\" id=\"field_e8oet-0_label\" class=\"frm_primary_label\">Detailed description of property to be insured\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e8oet-0\" name=\"item_meta[927][0][929]\" value=\"\"  data-sectionid=\"927\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_930-927-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_930_container\">\r\n    <label for=\"field_j51co-0\" id=\"field_j51co-0_label\" class=\"frm_primary_label\">Value in Ksh.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_j51co-0\" name=\"item_meta[927][0][930]\" value=\"\"  data-sectionid=\"927\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"927\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"927\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_794_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Golfers Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_917_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_cuv46_label\" class=\"frm_primary_label\">Do you enjoy good health?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cuv46_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_917-794-0\"><label for=\"field_cuv46-0\">\t\t<input type=\"radio\" name=\"item_meta[917]\" id=\"field_cuv46-0\" value=\"Yes\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Do you enjoy good health? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_917-794-1\"><label for=\"field_cuv46-1\">\t\t<input type=\"radio\" name=\"item_meta[917]\" id=\"field_cuv46-1\" value=\"No\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Do you enjoy good health? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_918_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_jfbeq_label\" class=\"frm_primary_label\">Have you ever sustained any accident, loss or breakages?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jfbeq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_918-794-0\"><label for=\"field_jfbeq-0\">\t\t<input type=\"radio\" name=\"item_meta[918]\" id=\"field_jfbeq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Have you ever sustained any accident, loss or breakages? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_918-794-1\"><label for=\"field_jfbeq-1\">\t\t<input type=\"radio\" name=\"item_meta[918]\" id=\"field_jfbeq-1\" value=\"No\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Have you ever sustained any accident, loss or breakages? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_919_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_k9o03_label\" class=\"frm_primary_label\">Do you have any other personal accident insurances?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_k9o03_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_919-794-0\"><label for=\"field_k9o03-0\">\t\t<input type=\"radio\" name=\"item_meta[919]\" id=\"field_k9o03-0\" value=\"Yes\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Do you have any other personal accident insurances? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_919-794-1\"><label for=\"field_k9o03-1\">\t\t<input type=\"radio\" name=\"item_meta[919]\" id=\"field_k9o03-1\" value=\"No\"\n\t\t   data-sectionid=\"794\" data-invmsg=\"Do you have any other personal accident insurances? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_920_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_y054g_label\" class=\"frm_primary_label\">Do you require any of the following benefits?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_y054g_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_920-794-0\"><label for=\"field_y054g-0\"><input type=\"checkbox\" name=\"item_meta[920][]\" id=\"field_y054g-0\" value=\"Hole in one\"  data-sectionid=\"794\" data-invmsg=\"Do you require any of the following benefits? is invalid\" aria-invalid=\"false\"   \/> Hole in one<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_920-794-1\"><label for=\"field_y054g-1\"><input type=\"checkbox\" name=\"item_meta[920][]\" id=\"field_y054g-1\" value=\"Personal effects\"  data-sectionid=\"794\" data-invmsg=\"Do you require any of the following benefits? is invalid\" aria-invalid=\"false\"   \/> Personal effects<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_920-794-2\"><label for=\"field_y054g-2\"><input type=\"checkbox\" name=\"item_meta[920][]\" id=\"field_y054g-2\" value=\"Liability to caddy\/public\"  data-sectionid=\"794\" data-invmsg=\"Do you require any of the following benefits? is invalid\" aria-invalid=\"false\"   \/> Liability to caddy\/public<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_920-794-3\"><label for=\"field_y054g-3\"><input type=\"checkbox\" name=\"item_meta[920][]\" id=\"field_y054g-3\" value=\"Golfing equipment\"  data-sectionid=\"794\" data-invmsg=\"Do you require any of the following benefits? is invalid\" aria-invalid=\"false\"   \/> Golfing equipment<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1551_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_g0o3h_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div id=\"field_g0o3h\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdVVsocAAAAAOgjDivHYkal8o3gpAwv2O-q5PmS\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<input type=\"hidden\" name=\"item_meta[1556]\" id=\"field_2qgw8\" value=\"\" data-frmval=\"\"\/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm_verify\" aria-hidden=\"true\">\n\t\t\t\t<label for=\"frm_email_21\">\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input type=\"text\" class=\"frm_verify\" id=\"frm_email_21\" name=\"frm_verify\" value=\"\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"AoVW2gEuJR0rbSS3wOD8bzrG0BNg1Ry7a5cBXu7Y+Hs=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Non-motor Quote Form (Individual)<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Non-Motor Quote Form (individual) - Intra Africa Assurance<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/intraafrica.co.ke\/non-motor-quote-form-for-individuals\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Non-Motor Quote Form (individual) - Intra Africa Assurance\" \/>\n<meta property=\"og:description\" content=\"Non-motor Quote Form (Individual)\" \/>\n<meta property=\"og:url\" content=\"https:\/\/intraafrica.co.ke\/non-motor-quote-form-for-individuals\/\" \/>\n<meta property=\"og:site_name\" content=\"Intra Africa Assurance\" \/>\n<meta property=\"article:modified_time\" content=\"2021-09-03T08:17:53+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Organization\",\"@id\":\"https:\/\/intraafrica.co.ke\/#organization\",\"name\":\"Intra Africa 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