{"id":2324,"date":"2021-07-19T10:57:39","date_gmt":"2021-07-19T09:57:39","guid":{"rendered":"https:\/\/intraafrica.co.ke\/?page_id=2324"},"modified":"2021-09-03T10:35:27","modified_gmt":"2021-09-03T09:35:27","slug":"non-motor-quote-form-for-businesses","status":"publish","type":"page","link":"https:\/\/intraafrica.co.ke\/non-motor-quote-form-for-businesses\/","title":{"rendered":"Non-Motor Quote Form (Business)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2324\" class=\"elementor elementor-2324\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-86fc2e3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"86fc2e3\" 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-39f10bf\" data-id=\"39f10bf\" 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-433b3b4 elementor-widget elementor-widget-heading\" data-id=\"433b3b4\" 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 (Business)<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-061df77 elementor-widget elementor-widget-shortcode\" data-id=\"061df77\" 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_29_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form  frm_ajax_submit \" id=\"form_personalaccidentf7333b96761050892aea29b4fe188aa06021dacd3e858cd2e7\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Non Motor Quote Form (business)<\/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=\"29\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_29\" id=\"frm_hide_fields_29\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"personalaccidentf7333b96761050892aea29b4fe188aa06021dacd3e858cd2e7\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_29\" name=\"frm_submit_entry_29\" value=\"ec82eb2f0e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/2324\" \/><input type=\"hidden\" name=\"item_meta[933]\" id=\"field_ddzyi39819a4cfbbcb196c11c\" value=\"Mulitiple Quote Form\"  data-frmval=\"Mulitiple Quote Form\" data-invmsg=\"Hidden is invalid\"   \/>\n<div id=\"frm_field_1361_container\" class=\"frm_form_field frm_section_heading form-field \">\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_945_container\" class=\"frm_form_field form-field  frm_top_container frm_color_block vertical_radio\">\r\n    <div  id=\"field_jhw1l2f0ee654be_label\" class=\"frm_primary_label\">Choose the insurance cover you require a quote for\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jhw1l2f0ee654be_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-0\"><label for=\"field_jhw1l2f0ee654be-0\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-0\" value=\"Work Injury Benefits Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Work Injury Benefits Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-1\"><label for=\"field_jhw1l2f0ee654be-1\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-1\" value=\"Employers Liability Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Employers Liability Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-2\"><label for=\"field_jhw1l2f0ee654be-2\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-2\" value=\"Group Personal Accident Proposal\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Group Personal Accident Proposal<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-3\"><label for=\"field_jhw1l2f0ee654be-3\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-3\" value=\"Public Liability\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Public Liability<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-4\"><label for=\"field_jhw1l2f0ee654be-4\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-4\" value=\"Marine cargo Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Marine cargo Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-5\"><label for=\"field_jhw1l2f0ee654be-5\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-5\" value=\"Plate Glass Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Plate Glass Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-6\"><label for=\"field_jhw1l2f0ee654be-6\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-6\" value=\"Fire &amp; Peril Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Fire &amp; Peril Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-7\"><label for=\"field_jhw1l2f0ee654be-7\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-7\" value=\"Money Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Money Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-8\"><label for=\"field_jhw1l2f0ee654be-8\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-8\" value=\"Fidelity Guarantee\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Fidelity Guarantee<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-9\"><label for=\"field_jhw1l2f0ee654be-9\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-9\" value=\"Goods in Transit\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Goods in Transit<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-10\"><label for=\"field_jhw1l2f0ee654be-10\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-10\" value=\"Burglary Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Burglary Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-11\"><label for=\"field_jhw1l2f0ee654be-11\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-11\" value=\"Industrial All Risk Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Industrial All Risk Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-12\"><label for=\"field_jhw1l2f0ee654be-12\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-12\" value=\"Machinery Breakdown Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Machinery Breakdown Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-13\"><label for=\"field_jhw1l2f0ee654be-13\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-13\" value=\"Fire Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Fire Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-14\"><label for=\"field_jhw1l2f0ee654be-14\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-14\" value=\"Terrorism &amp; Political Risks Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Terrorism &amp; Political Risks Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-15\"><label for=\"field_jhw1l2f0ee654be-15\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-15\" value=\"Products Liability Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Products Liability Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-16\"><label for=\"field_jhw1l2f0ee654be-16\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-16\" value=\"Contractors Plant &amp; Machinery nsurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Contractors Plant &amp; Machinery nsurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-17\"><label for=\"field_jhw1l2f0ee654be-17\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-17\" value=\"Electronic Equipment Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Electronic Equipment Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-18\"><label for=\"field_jhw1l2f0ee654be-18\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-18\" value=\"Carriers Legal Liability Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Carriers Legal Liability Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-19\"><label for=\"field_jhw1l2f0ee654be-19\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-19\" value=\"Contractors All Risk Insurance\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Contractors All Risk Insurance<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_945-1361-20\"><label for=\"field_jhw1l2f0ee654be-20\">\t\t<input type=\"radio\" name=\"item_meta[945]\" id=\"field_jhw1l2f0ee654be-20\" value=\"Contractual Legal Liability\"\n\t\t   data-sectionid=\"1361\" data-invmsg=\"Choose the insurance cover you require a quote for is invalid\" aria-invalid=\"false\"  \/> Contractual Legal Liability<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1546_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_934_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48cffea5dc1af\" id=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48cffea5dc1af_label\" class=\"frm_primary_label\">Agency Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ozy2v2e0a90abd132e523cc4bd99f66e48cffea5dc1af\" name=\"item_meta[934]\" value=\"\"  data-sectionid=\"1546\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_935_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_936_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div  id=\"field_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_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_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_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_936\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_936-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_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_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_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_first\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[936][first]\"  data-sectionid=\"935\" 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_936_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_936-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_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_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_j5axda197cf68480ae8840075d7efcf3d1af7d47e683e_last\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[936][last]\"  data-sectionid=\"935\" 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_936_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_937_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_8j0ebf788fc4aa7\" id=\"field_8j0ebf788fc4aa7_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_8j0ebf788fc4aa7\" name=\"item_meta[937]\" value=\"\"  data-sectionid=\"935\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_939_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_940_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_du0tjaa41e84f6da1f8b841\" id=\"field_du0tjaa41e84f6da1f8b841_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_du0tjaa41e84f6da1f8b841\" name=\"item_meta[940]\" value=\"\"  data-sectionid=\"939\" 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_941_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_dlef4635cc7318fe1d239426df010c243bf04c89c60e9\" id=\"field_dlef4635cc7318fe1d239426df010c243bf04c89c60e9_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_dlef4635cc7318fe1d239426df010c243bf04c89c60e9\" name=\"item_meta[941]\" 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_942_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_9560o7c77f166385c4ae5a59a0e245c5074d93d23d438\" id=\"field_9560o7c77f166385c4ae5a59a0e245c5074d93d23d438_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_9560o7c77f166385c4ae5a59a0e245c5074d93d23d438\" name=\"item_meta[942]\" value=\"\"  data-sectionid=\"939\" 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}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_943_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_uko09b475ec27f4081c1d3661\" id=\"field_uko09b475ec27f4081c1d3661_label\" class=\"frm_primary_label\">Telelphone \/ Mobile 2\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_uko09b475ec27f4081c1d3661\" name=\"item_meta[943]\" value=\"\"  data-sectionid=\"939\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_946_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_947_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_2pkfqea035fc35f\" id=\"field_2pkfqea035fc35f_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_2pkfqea035fc35f\" name=\"item_meta[947]\" value=\"\"  data-sectionid=\"946\" 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_948_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_2dqf8d5e3bc659c\" id=\"field_2dqf8d5e3bc659c_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_2dqf8d5e3bc659c\" name=\"item_meta[948]\" value=\"\"  data-sectionid=\"946\" 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_1093_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">WIBA<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1095_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_9me65_label\" class=\"frm_primary_label\">Does any law or regulation governing the conduct or maintenance of premises apply to your premises?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_9me65_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1095-1093-0\"><label for=\"field_9me65-0\">\t\t<input type=\"radio\" name=\"item_meta[1095]\" id=\"field_9me65-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Does any law or regulation governing the conduct or maintenance of premises apply to your premises? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1095-1093-1\"><label for=\"field_9me65-1\">\t\t<input type=\"radio\" name=\"item_meta[1095]\" id=\"field_9me65-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Does any law or regulation governing the conduct or maintenance of premises apply to your premises? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1096_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k6qg5\" id=\"field_k6qg5_label\" class=\"frm_primary_label\">If so, name such laws and regulations\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k6qg5\" name=\"item_meta[1096]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1097_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_u5uwk_label\" class=\"frm_primary_label\">Have you carried out all obligations imposed on you by such laws and regulations?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_u5uwk_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1097-1093-0\"><label for=\"field_u5uwk-0\">\t\t<input type=\"radio\" name=\"item_meta[1097]\" id=\"field_u5uwk-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have you carried out all obligations imposed on you by such laws and regulations? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1097-1093-1\"><label for=\"field_u5uwk-1\">\t\t<input type=\"radio\" name=\"item_meta[1097]\" id=\"field_u5uwk-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have you carried out all obligations imposed on you by such laws and regulations? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1098_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_bsel5_label\" class=\"frm_primary_label\">Have you carried out all obligations imposed on you by such laws and regulations?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_bsel5_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1098-1093-0\"><label for=\"field_bsel5-0\">\t\t<input type=\"radio\" name=\"item_meta[1098]\" id=\"field_bsel5-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have you carried out all obligations imposed on you by such laws and regulations? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1098-1093-1\"><label for=\"field_bsel5-1\">\t\t<input type=\"radio\" name=\"item_meta[1098]\" id=\"field_bsel5-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have you carried out all obligations imposed on you by such laws and regulations? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1099_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_agc10\" id=\"field_agc10_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_agc10\" name=\"item_meta[1099]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1100_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_wo120_label\" class=\"frm_primary_label\">Do you have any boilers?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wo120_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1100-1093-0\"><label for=\"field_wo120-0\">\t\t<input type=\"radio\" name=\"item_meta[1100]\" id=\"field_wo120-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any boilers? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1100-1093-1\"><label for=\"field_wo120-1\">\t\t<input type=\"radio\" name=\"item_meta[1100]\" id=\"field_wo120-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any boilers? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1101_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vrjgy\" id=\"field_vrjgy_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vrjgy\" name=\"item_meta[1101]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1102_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_yr22s_label\" class=\"frm_primary_label\">Are your ways, works and plant properly fenced and guarded and otherwise in good order and condition?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_yr22s_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1102-1093-0\"><label for=\"field_yr22s-0\">\t\t<input type=\"radio\" name=\"item_meta[1102]\" id=\"field_yr22s-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Are your ways, works and plant properly fenced and guarded and otherwise in good order and condition? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1102-1093-1\"><label for=\"field_yr22s-1\">\t\t<input type=\"radio\" name=\"item_meta[1102]\" id=\"field_yr22s-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Are your ways, works and plant properly fenced and guarded and otherwise in good order and condition? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1103_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_34qcr_label\" class=\"frm_primary_label\">Do you use acids, gases, chemicals or explosives?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_34qcr_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1103-1093-0\"><label for=\"field_34qcr-0\">\t\t<input type=\"radio\" name=\"item_meta[1103]\" id=\"field_34qcr-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you use acids, gases, chemicals or explosives? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1103-1093-1\"><label for=\"field_34qcr-1\">\t\t<input type=\"radio\" name=\"item_meta[1103]\" id=\"field_34qcr-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you use acids, gases, chemicals or explosives? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1104_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gofm1\" id=\"field_gofm1_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gofm1\" name=\"item_meta[1104]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1105_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_kxlj2_label\" class=\"frm_primary_label\">Do you handle or use radio isotopes radioactive substances or other sources of ionizing radiations? \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_kxlj2_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1105-1093-0\"><label for=\"field_kxlj2-0\">\t\t<input type=\"radio\" name=\"item_meta[1105]\" id=\"field_kxlj2-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you handle or use radio isotopes radioactive substances or other sources of ionizing radiations?  is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1105-1093-1\"><label for=\"field_kxlj2-1\">\t\t<input type=\"radio\" name=\"item_meta[1105]\" id=\"field_kxlj2-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you handle or use radio isotopes radioactive substances or other sources of ionizing radiations?  is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1106_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mnj3x\" id=\"field_mnj3x_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mnj3x\" name=\"item_meta[1106]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1107_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_4ojq0_label\" class=\"frm_primary_label\">Are you at present insured or have you ever proposed for a Workmen's Compensation Policy or a Work Injury Benefits Policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4ojq0_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1107-1093-0\"><label for=\"field_4ojq0-0\">\t\t<input type=\"radio\" name=\"item_meta[1107]\" id=\"field_4ojq0-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Are you at present insured or have you ever proposed for a Workmen&#039;s Compensation Policy or a Work Injury Benefits Policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1107-1093-1\"><label for=\"field_4ojq0-1\">\t\t<input type=\"radio\" name=\"item_meta[1107]\" id=\"field_4ojq0-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Are you at present insured or have you ever proposed for a Workmen&#039;s Compensation Policy or a Work Injury Benefits Policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1108_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rj86f\" id=\"field_rj86f_label\" class=\"frm_primary_label\">If so, please state policy number and name of insurer\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rj86f\" name=\"item_meta[1108]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1109_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_buc28_label\" class=\"frm_primary_label\">Have such proposals or renewals ever been declined or withdrawn?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_buc28_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1109-1093-0\"><label for=\"field_buc28-0\">\t\t<input type=\"radio\" name=\"item_meta[1109]\" id=\"field_buc28-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have such proposals or renewals ever been declined or withdrawn? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1109-1093-1\"><label for=\"field_buc28-1\">\t\t<input type=\"radio\" name=\"item_meta[1109]\" id=\"field_buc28-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have such proposals or renewals ever been declined or withdrawn? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1110_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dvont\" id=\"field_dvont_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dvont\" name=\"item_meta[1110]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1111_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_scuhm_label\" class=\"frm_primary_label\">Have increased rates been required for such proposals or renewals?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_scuhm_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1111-1093-0\"><label for=\"field_scuhm-0\">\t\t<input type=\"radio\" name=\"item_meta[1111]\" id=\"field_scuhm-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have increased rates been required for such proposals or renewals? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1111-1093-1\"><label for=\"field_scuhm-1\">\t\t<input type=\"radio\" name=\"item_meta[1111]\" id=\"field_scuhm-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Have increased rates been required for such proposals or renewals? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1112_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_l30qv\" id=\"field_l30qv_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_l30qv\" name=\"item_meta[1112]\" value=\"\"  data-sectionid=\"1093\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1113_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_6f8q3_label\" class=\"frm_primary_label\">Do you have any employee with pre-existing medical condition?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6f8q3_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1113-1093-0\"><label for=\"field_6f8q3-0\">\t\t<input type=\"radio\" name=\"item_meta[1113]\" id=\"field_6f8q3-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any employee with pre-existing medical condition? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1113-1093-1\"><label for=\"field_6f8q3-1\">\t\t<input type=\"radio\" name=\"item_meta[1113]\" id=\"field_6f8q3-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any employee with pre-existing medical condition? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1114_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_tippv_label\" class=\"frm_primary_label\">Do you have any employees who are apprentices or trainees in your organization?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tippv_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1114-1093-0\"><label for=\"field_tippv-0\">\t\t<input type=\"radio\" name=\"item_meta[1114]\" id=\"field_tippv-0\" value=\"yes\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any employees who are apprentices or trainees in your organization? is invalid\" aria-invalid=\"false\"  \/> yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1114-1093-1\"><label for=\"field_tippv-1\">\t\t<input type=\"radio\" name=\"item_meta[1114]\" id=\"field_tippv-1\" value=\"No\"\n\t\t   data-sectionid=\"1093\" data-invmsg=\"Do you have any employees who are apprentices or trainees in your organization? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1115_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_eg70k\" id=\"field_eg70k_label\" class=\"frm_primary_label\">If yes, state how many  and give estimated annual wages payable to a similar person(s) with five years experience\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eg70k\" name=\"item_meta[1115]\" value=\"\"  data-sectionid=\"1093\" 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_1116_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Employers Liability Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1118_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_5jg3w_label\" class=\"frm_primary_label\">Do have any circular saw or other machinery driven by steam, gas water, electricity or other mechanical power?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_5jg3w_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1118-1116-0\"><label for=\"field_5jg3w-0\">\t\t<input type=\"radio\" name=\"item_meta[1118]\" id=\"field_5jg3w-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Do have any circular saw or other machinery driven by steam, gas water, electricity or other mechanical power? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1118-1116-1\"><label for=\"field_5jg3w-1\">\t\t<input type=\"radio\" name=\"item_meta[1118]\" id=\"field_5jg3w-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Do have any circular saw or other machinery driven by steam, gas water, electricity or other mechanical power? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1119_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yp0k6\" id=\"field_yp0k6_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yp0k6\" name=\"item_meta[1119]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1120_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ho8k7_label\" class=\"frm_primary_label\">Have you any boilers?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ho8k7_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1120-1116-0\"><label for=\"field_ho8k7-0\">\t\t<input type=\"radio\" name=\"item_meta[1120]\" id=\"field_ho8k7-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have you any boilers? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1120-1116-1\"><label for=\"field_ho8k7-1\">\t\t<input type=\"radio\" name=\"item_meta[1120]\" id=\"field_ho8k7-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have you any boilers? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1121_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_wfota\" id=\"field_wfota_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wfota\" name=\"item_meta[1121]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1122_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_lad62_label\" class=\"frm_primary_label\">Are your ways, works and plant properly fenced and guarder and in good order and condition?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lad62_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1122-1116-0\"><label for=\"field_lad62-0\">\t\t<input type=\"radio\" name=\"item_meta[1122]\" id=\"field_lad62-0\" value=\"Option 1\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are your ways, works and plant properly fenced and guarder and in good order and condition? is invalid\" aria-invalid=\"false\"  \/> Option 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1122-1116-1\"><label for=\"field_lad62-1\">\t\t<input type=\"radio\" name=\"item_meta[1122]\" id=\"field_lad62-1\" value=\"Option 2\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are your ways, works and plant properly fenced and guarder and in good order and condition? is invalid\" aria-invalid=\"false\"  \/> Option 2<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1123_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ughq7\" id=\"field_ughq7_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ughq7\" name=\"item_meta[1123]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1124_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ftrbz_label\" class=\"frm_primary_label\">Are you at present insured or have you ever proposed for work injury benefits policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ftrbz_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1124-1116-0\"><label for=\"field_ftrbz-0\">\t\t<input type=\"radio\" name=\"item_meta[1124]\" id=\"field_ftrbz-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are you at present insured or have you ever proposed for work injury benefits policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1124-1116-1\"><label for=\"field_ftrbz-1\">\t\t<input type=\"radio\" name=\"item_meta[1124]\" id=\"field_ftrbz-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are you at present insured or have you ever proposed for work injury benefits policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1125_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_in1x3\" id=\"field_in1x3_label\" class=\"frm_primary_label\">If yes, please state number of policy and name(s) of insurer(s)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_in1x3\" name=\"item_meta[1125]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1126_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ey1li_label\" class=\"frm_primary_label\">Are you at present insured or have you ever proposed for any insurance in respect of your legal liability under common low to your employees?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ey1li_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1126-1116-0\"><label for=\"field_ey1li-0\">\t\t<input type=\"radio\" name=\"item_meta[1126]\" id=\"field_ey1li-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are you at present insured or have you ever proposed for any insurance in respect of your legal liability under common low to your employees? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1126-1116-1\"><label for=\"field_ey1li-1\">\t\t<input type=\"radio\" name=\"item_meta[1126]\" id=\"field_ey1li-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Are you at present insured or have you ever proposed for any insurance in respect of your legal liability under common low to your employees? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1127_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hxhsf\" id=\"field_hxhsf_label\" class=\"frm_primary_label\">If yes, please state number of policy and name(s) of insurer(s)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hxhsf\" name=\"item_meta[1127]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1129_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_n50hh_label\" class=\"frm_primary_label\">Have such proposals or renewals ever been declined or withdrawn?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_n50hh_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1129-1116-0\"><label for=\"field_n50hh-0\">\t\t<input type=\"radio\" name=\"item_meta[1129]\" id=\"field_n50hh-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have such proposals or renewals ever been declined or withdrawn? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1129-1116-1\"><label for=\"field_n50hh-1\">\t\t<input type=\"radio\" name=\"item_meta[1129]\" id=\"field_n50hh-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have such proposals or renewals ever been declined or withdrawn? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1130_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_fw0zt\" id=\"field_fw0zt_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fw0zt\" name=\"item_meta[1130]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1128_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_sxdc3_label\" class=\"frm_primary_label\">Have increased rated been required for such proposals or renewals?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_sxdc3_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1128-1116-0\"><label for=\"field_sxdc3-0\">\t\t<input type=\"radio\" name=\"item_meta[1128]\" id=\"field_sxdc3-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have increased rated been required for such proposals or renewals? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1128-1116-1\"><label for=\"field_sxdc3-1\">\t\t<input type=\"radio\" name=\"item_meta[1128]\" id=\"field_sxdc3-1\" value=\"No\"\n\t\t   data-sectionid=\"1116\" data-invmsg=\"Have increased rated been required for such proposals or renewals? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1131_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_lnt0s\" id=\"field_lnt0s_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lnt0s\" name=\"item_meta[1131]\" value=\"\"  data-sectionid=\"1116\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1132_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top\">Estimated Annual Wages Salaries and other Earnings<\/h3>\r\n<div id=\"frm_desc_field_zj8i4\" class=\"frm_description frm_section_spacing\">Please note that it is a condition of this policy that the estimated annual wages, salaries and other earnings is required to be certified by your auditors within three months of the expiry date of the period of insurance.<\/div>\r\n<input type=\"hidden\" name=\"item_meta[1132][form]\" value=\"34\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1132-0\" class=\"frm_repeat_sec frm_repeat_1132 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1132][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1132][0][0]\" value=\"\" \/><div id=\"frm_field_1134-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1134_container\">\r\n    <label for=\"field_3opwb-0\" id=\"field_3opwb-0_label\" class=\"frm_primary_label\">Description of employees(list each type separately)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3opwb-0\" name=\"item_meta[1132][0][1134]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1135-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1135_container\">\r\n    <label for=\"field_ddc7o-0\" id=\"field_ddc7o-0_label\" class=\"frm_primary_label\">Estimated no. of employees\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ddc7o-0\" name=\"item_meta[1132][0][1135]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1137-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1137_container\">\r\n    <label for=\"field_7eyv-0\" id=\"field_7eyv-0_label\" class=\"frm_primary_label\">Cash\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7eyv-0\" name=\"item_meta[1132][0][1137]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1138-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1138_container\">\r\n    <label for=\"field_cul92-0\" id=\"field_cul92-0_label\" class=\"frm_primary_label\">Value of food, fuel quarters & other consideration\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cul92-0\" name=\"item_meta[1132][0][1138]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1136-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1136_container\">\r\n    <label for=\"field_jimy2-0\" id=\"field_jimy2-0_label\" class=\"frm_primary_label\">Total\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jimy2-0\" name=\"item_meta[1132][0][1136]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1141-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1141_container\">\r\n    <label for=\"field_y75qg-0\" id=\"field_y75qg-0_label\" class=\"frm_primary_label\">Rate per mile\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_y75qg-0\" name=\"item_meta[1132][0][1141]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1140-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1140_container\">\r\n    <label for=\"field_odegx-0\" id=\"field_odegx-0_label\" class=\"frm_primary_label\">Prem\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_odegx-0\" name=\"item_meta[1132][0][1140]\" value=\"\"  data-sectionid=\"1132\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1139-1132-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1139_container\">\r\n    <label for=\"field_abce1-0\" id=\"field_abce1-0_label\" class=\"frm_primary_label\">Classification number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_abce1-0\" name=\"item_meta[1132][0][1139]\" value=\"\"  data-sectionid=\"1132\" 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=\"1132\" 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=\"1132\" 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_1142_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Give the following information in respect of the past three years.<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[1142][form]\" value=\"35\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1142-0\" class=\"frm_repeat_sec frm_repeat_1142 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1142][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1142][0][0]\" value=\"\" \/><div id=\"frm_field_1144-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1144_container\">\r\n    <label for=\"field_v9rr5-0\" id=\"field_v9rr5-0_label\" class=\"frm_primary_label\">Year\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_v9rr5-0\" name=\"item_meta[1142][0][1144]\" value=\"\"  data-sectionid=\"1142\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1145-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1145_container\">\r\n    <label for=\"field_395jv-0\" id=\"field_395jv-0_label\" class=\"frm_primary_label\">Wages, salaries & other earnings\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_395jv-0\" name=\"item_meta[1142][0][1145]\" value=\"\"  data-sectionid=\"1142\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1146-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1146_container\">\r\n    <label for=\"field_275sb-0\" id=\"field_275sb-0_label\" class=\"frm_primary_label\">No. of accidents to your employees (whether or not involving claims)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_275sb-0\" name=\"item_meta[1142][0][1146]\" value=\"\"  data-sectionid=\"1142\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1149-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1149_container\">\r\n    <label for=\"field_clhvv-0\" id=\"field_clhvv-0_label\" class=\"frm_primary_label\">Settled claims\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_clhvv-0\" name=\"item_meta[1142][0][1149]\" value=\"\"  data-sectionid=\"1142\" placeholder=\"Number\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1148-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1148_container\">\r\n    <label for=\"field_ypw0v-0\" id=\"field_ypw0v-0_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_ypw0v-0\" name=\"item_meta[1142][0][1148]\" value=\"\"  data-sectionid=\"1142\" placeholder=\"Cost\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1151-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1151_container\">\r\n    <label for=\"field_ber1y-0\" id=\"field_ber1y-0_label\" class=\"frm_primary_label\">O\/standing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ber1y-0\" name=\"item_meta[1142][0][1151]\" value=\"\"  data-sectionid=\"1142\" placeholder=\"Number\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1150-1142-0_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_field_1150_container\">\r\n    <label for=\"field_c11ee-0\" id=\"field_c11ee-0_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_c11ee-0\" name=\"item_meta[1142][0][1150]\" value=\"\"  data-sectionid=\"1142\" placeholder=\"Cost\" 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=\"1142\" 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=\"1142\" 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_1162_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Limits of liability select any one of the following options below<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1200_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_tn3ml_label\" class=\"frm_primary_label\">Any one person\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tn3ml_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1200-1162-0\"><label for=\"field_tn3ml-0\">\t\t<input type=\"radio\" name=\"item_meta[1200]\" id=\"field_tn3ml-0\" value=\"Option A - 2M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one person is invalid\" aria-invalid=\"false\"  \/> Option A - 2M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1200-1162-1\"><label for=\"field_tn3ml-1\">\t\t<input type=\"radio\" name=\"item_meta[1200]\" id=\"field_tn3ml-1\" value=\"Option B - 4M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one person is invalid\" aria-invalid=\"false\"  \/> Option B - 4M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1200-1162-2\"><label for=\"field_tn3ml-2\">\t\t<input type=\"radio\" name=\"item_meta[1200]\" id=\"field_tn3ml-2\" value=\"Option C - 6M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one person is invalid\" aria-invalid=\"false\"  \/> Option C - 6M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1200-1162-3\"><label for=\"field_tn3ml-3\">\t\t<input type=\"radio\" name=\"item_meta[1200]\" id=\"field_tn3ml-3\" value=\"Option D - 8M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one person is invalid\" aria-invalid=\"false\"  \/> Option D - 8M<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1201_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_w2x5g_label\" class=\"frm_primary_label\">Any one occurrence\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w2x5g_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1201-1162-0\"><label for=\"field_w2x5g-0\">\t\t<input type=\"radio\" name=\"item_meta[1201]\" id=\"field_w2x5g-0\" value=\"Option A - 10M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one occurrence is invalid\" aria-invalid=\"false\"  \/> Option A - 10M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1201-1162-1\"><label for=\"field_w2x5g-1\">\t\t<input type=\"radio\" name=\"item_meta[1201]\" id=\"field_w2x5g-1\" value=\"Option B - 15M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one occurrence is invalid\" aria-invalid=\"false\"  \/> Option B - 15M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1201-1162-2\"><label for=\"field_w2x5g-2\">\t\t<input type=\"radio\" name=\"item_meta[1201]\" id=\"field_w2x5g-2\" value=\"Option C - 20M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one occurrence is invalid\" aria-invalid=\"false\"  \/> Option C - 20M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1201-1162-3\"><label for=\"field_w2x5g-3\">\t\t<input type=\"radio\" name=\"item_meta[1201]\" id=\"field_w2x5g-3\" value=\"Option D - 25M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one occurrence is invalid\" aria-invalid=\"false\"  \/> Option D - 25M<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1202_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_vu7b4_label\" class=\"frm_primary_label\">Any one year\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_vu7b4_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1202-1162-0\"><label for=\"field_vu7b4-0\">\t\t<input type=\"radio\" name=\"item_meta[1202]\" id=\"field_vu7b4-0\" value=\"Option A - 20M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one year is invalid\" aria-invalid=\"false\"  \/> Option A - 20M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1202-1162-1\"><label for=\"field_vu7b4-1\">\t\t<input type=\"radio\" name=\"item_meta[1202]\" id=\"field_vu7b4-1\" value=\"Option B - 30M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one year is invalid\" aria-invalid=\"false\"  \/> Option B - 30M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1202-1162-2\"><label for=\"field_vu7b4-2\">\t\t<input type=\"radio\" name=\"item_meta[1202]\" id=\"field_vu7b4-2\" value=\"Option C - 40M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one year is invalid\" aria-invalid=\"false\"  \/> Option C - 40M<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1202-1162-3\"><label for=\"field_vu7b4-3\">\t\t<input type=\"radio\" name=\"item_meta[1202]\" id=\"field_vu7b4-3\" value=\"Option D - 50M\"\n\t\t   data-sectionid=\"1162\" data-invmsg=\"Any one year is invalid\" aria-invalid=\"false\"  \/> Option D - 50M<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1159_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top\">Group Personal Accident<\/h3>\r\n<div id=\"frm_desc_field_mwxo4\" class=\"frm_description frm_section_spacing\">Benefit Required (capital benefits)<\/div>\r\n\r\n<div id=\"frm_field_1161_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_h4vhy\" id=\"field_h4vhy_label\" class=\"frm_primary_label\">Death: \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_h4vhy\" name=\"item_meta[1161]\" value=\"\"  data-sectionid=\"1159\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1166_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_fopqe\" id=\"field_fopqe_label\" class=\"frm_primary_label\">PTD\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fopqe\" name=\"item_meta[1166]\" value=\"\"  data-sectionid=\"1159\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1165_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_a6n9r\" id=\"field_a6n9r_label\" class=\"frm_primary_label\">TTD\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_a6n9r\" name=\"item_meta[1165]\" value=\"\"  data-sectionid=\"1159\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1164_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_e6qex\" id=\"field_e6qex_label\" class=\"frm_primary_label\">MEDICAL\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e6qex\" name=\"item_meta[1164]\" value=\"\"  data-sectionid=\"1159\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1167_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3nyzk\" id=\"field_3nyzk_label\" class=\"frm_primary_label\">Limits of cover (Based on annual earnings)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3nyzk\" name=\"item_meta[1167]\" value=\"\"  data-sectionid=\"1159\" placeholder=\"Years earnings\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1169_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_bb3w9\" id=\"field_bb3w9_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_bb3w9\" name=\"item_meta[1169]\" value=\"\"  data-sectionid=\"1159\" placeholder=\"Years earnings\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1168_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_an0ch\" id=\"field_an0ch_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_an0ch\" name=\"item_meta[1168]\" value=\"\"  data-sectionid=\"1159\" placeholder=\"Years earnings\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1172_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Public Liability<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1174_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dq5lv\" id=\"field_dq5lv_label\" class=\"frm_primary_label\">Limits of liability required. (Any one claim KES)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dq5lv\" name=\"item_meta[1174]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1176_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ba7n2\" id=\"field_ba7n2_label\" class=\"frm_primary_label\">All claims arising out of one event KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ba7n2\" name=\"item_meta[1176]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1175_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uckk\" id=\"field_uckk_label\" class=\"frm_primary_label\">All claims arising during the period insurance KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uckk\" name=\"item_meta[1175]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1177_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_83mty\" id=\"field_83mty_label\" class=\"frm_primary_label\">Business\/Trade\/Occupation(full description)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1177]\" id=\"field_83mty\" rows=\"5\"  data-sectionid=\"1172\" data-invmsg=\"Business\/Trade\/Occupation(full description) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1178_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4bp0o\" id=\"field_4bp0o_label\" class=\"frm_primary_label\">If the business is a hotel or an entertainment club, state\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4bp0o\" name=\"item_meta[1178]\" value=\"\"  data-sectionid=\"1172\" placeholder=\"Seating Capacity or membership\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1182_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_6zbjp_label\" class=\"frm_primary_label\">Whether accommodation facilities are offered\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6zbjp_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1182-1172-0\"><label for=\"field_6zbjp-0\">\t\t<input type=\"radio\" name=\"item_meta[1182]\" id=\"field_6zbjp-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Whether accommodation facilities are offered is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1182-1172-1\"><label for=\"field_6zbjp-1\">\t\t<input type=\"radio\" name=\"item_meta[1182]\" id=\"field_6zbjp-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Whether accommodation facilities are offered is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1181_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_v39jy_label\" class=\"frm_primary_label\">Whether car park facilities are provided\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_v39jy_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1181-1172-0\"><label for=\"field_v39jy-0\">\t\t<input type=\"radio\" name=\"item_meta[1181]\" id=\"field_v39jy-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Whether car park facilities are provided is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1181-1172-1\"><label for=\"field_v39jy-1\">\t\t<input type=\"radio\" name=\"item_meta[1181]\" id=\"field_v39jy-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Whether car park facilities are provided is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1183_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_m286\" id=\"field_m286_label\" class=\"frm_primary_label\">Premises to be insured description and physical address \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_m286\" name=\"item_meta[1183]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1186_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_4c25j_label\" class=\"frm_primary_label\">Do you own the premises?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4c25j_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1186-1172-0\"><label for=\"field_4c25j-0\">\t\t<input type=\"radio\" name=\"item_meta[1186]\" id=\"field_4c25j-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you own the premises? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1186-1172-1\"><label for=\"field_4c25j-1\">\t\t<input type=\"radio\" name=\"item_meta[1186]\" id=\"field_4c25j-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you own the premises? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1185_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_dznde_label\" class=\"frm_primary_label\">Are you the sole occupier?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_dznde_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1185-1172-0\"><label for=\"field_dznde-0\">\t\t<input type=\"radio\" name=\"item_meta[1185]\" id=\"field_dznde-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Are you the sole occupier? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1185-1172-1\"><label for=\"field_dznde-1\">\t\t<input type=\"radio\" name=\"item_meta[1185]\" id=\"field_dznde-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Are you the sole occupier? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1188_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_vcic4_label\" class=\"frm_primary_label\">Do you wish to cover your liability in connection with your car park?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_vcic4_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1188-1172-0\"><label for=\"field_vcic4-0\">\t\t<input type=\"radio\" name=\"item_meta[1188]\" id=\"field_vcic4-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you wish to cover your liability in connection with your car park? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1188-1172-1\"><label for=\"field_vcic4-1\">\t\t<input type=\"radio\" name=\"item_meta[1188]\" id=\"field_vcic4-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you wish to cover your liability in connection with your car park? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1189_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_r9ghg\" id=\"field_r9ghg_label\" class=\"frm_primary_label\">If so, give details of the area of parking\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r9ghg\" name=\"item_meta[1189]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1190_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3sn3l\" id=\"field_3sn3l_label\" class=\"frm_primary_label\">Maximum number of cars parked at any one time\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_3sn3l\" name=\"item_meta[1190]\" value=\"\"  data-sectionid=\"1172\" 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_1191_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dma5f\" id=\"field_dma5f_label\" class=\"frm_primary_label\">Security Provisions\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dma5f\" name=\"item_meta[1191]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1194_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gc304\" id=\"field_gc304_label\" class=\"frm_primary_label\">limit of indemnity required for car park extension.  (Any one claim KES)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gc304\" name=\"item_meta[1194]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1193_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_op4k4\" id=\"field_op4k4_label\" class=\"frm_primary_label\">All claims arising out of one event KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_op4k4\" name=\"item_meta[1193]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1192_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_kp6zw\" id=\"field_kp6zw_label\" class=\"frm_primary_label\">All claims arising during the period of insurance KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kp6zw\" name=\"item_meta[1192]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1195_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_cyy9f_label\" class=\"frm_primary_label\">Do you wish to cover liability in respect of guests personal effects rising from fire, theft or accidental damage\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cyy9f_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1195-1172-0\"><label for=\"field_cyy9f-0\">\t\t<input type=\"radio\" name=\"item_meta[1195]\" id=\"field_cyy9f-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you wish to cover liability in respect of guests personal effects rising from fire, theft or accidental damage is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1195-1172-1\"><label for=\"field_cyy9f-1\">\t\t<input type=\"radio\" name=\"item_meta[1195]\" id=\"field_cyy9f-1\" value=\"No\"\n\t\t   data-sectionid=\"1172\" data-invmsg=\"Do you wish to cover liability in respect of guests personal effects rising from fire, theft or accidental damage is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1196_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ee9nk\" id=\"field_ee9nk_label\" class=\"frm_primary_label\">If yes, state indemnity limit required (Any one person)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ee9nk\" name=\"item_meta[1196]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1197_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qhyco\" id=\"field_qhyco_label\" class=\"frm_primary_label\">All claims arising out of one event KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qhyco\" name=\"item_meta[1197]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1198_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_zto20\" id=\"field_zto20_label\" class=\"frm_primary_label\">All claims arising during the period of insurance KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zto20\" name=\"item_meta[1198]\" value=\"\"  data-sectionid=\"1172\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1203_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Marine Cargo Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1205_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_hpo94\" id=\"field_hpo94_label\" class=\"frm_primary_label\">Name of Craft\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hpo94\" name=\"item_meta[1205]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1207_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_8qsk\" id=\"field_8qsk_label\" class=\"frm_primary_label\">Registration No.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8qsk\" name=\"item_meta[1207]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1206_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_cm2rq\" id=\"field_cm2rq_label\" class=\"frm_primary_label\">Type\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cm2rq\" name=\"item_meta[1206]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1208_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_of1iq\" id=\"field_of1iq_label\" class=\"frm_primary_label\">Where is the craft laid up\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_of1iq\" name=\"item_meta[1208]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1211_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6rj8h\" id=\"field_6rj8h_label\" class=\"frm_primary_label\">Limit of indemnity any one accident\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6rj8h\" name=\"item_meta[1211]\" value=\"\"  data-sectionid=\"1203\" placeholder=\"Third party other than passengers\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1210_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3l304\" id=\"field_3l304_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_3l304\" name=\"item_meta[1210]\" value=\"\"  data-sectionid=\"1203\" placeholder=\"Per passenger\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1209_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_gkuy2\" id=\"field_gkuy2_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_gkuy2\" name=\"item_meta[1209]\" value=\"\"  data-sectionid=\"1203\" placeholder=\"Number of passengers\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1222_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_bkf8u\" id=\"field_bkf8u_label\" class=\"frm_primary_label\">Hull, engine and equipment\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bkf8u\" name=\"item_meta[1222]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1213_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_o40ik\" id=\"field_o40ik_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_o40ik\" name=\"item_meta[1213]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1212_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_zuimn\" id=\"field_zuimn_label\" class=\"frm_primary_label\">Outboard motors\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zuimn\" name=\"item_meta[1212]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1220_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_myz9k\" id=\"field_myz9k_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=\"number\" id=\"field_myz9k\" name=\"item_meta[1220]\" value=\"\"  data-sectionid=\"1203\" 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_1219_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ekm70\" id=\"field_ekm70_label\" class=\"frm_primary_label\">Dinghy\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ekm70\" name=\"item_meta[1219]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1218_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_y0j0\" id=\"field_y0j0_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=\"number\" id=\"field_y0j0\" name=\"item_meta[1218]\" value=\"\"  data-sectionid=\"1203\" 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_1217_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_76ux9\" id=\"field_76ux9_label\" class=\"frm_primary_label\">Special Equipment\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_76ux9\" name=\"item_meta[1217]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1216_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_rq4y0\" id=\"field_rq4y0_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=\"number\" id=\"field_rq4y0\" name=\"item_meta[1216]\" value=\"\"  data-sectionid=\"1203\" 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_1215_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_2qw7d\" id=\"field_2qw7d_label\" class=\"frm_primary_label\">Trailer\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2qw7d\" name=\"item_meta[1215]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1214_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_iiu1s\" id=\"field_iiu1s_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=\"number\" id=\"field_iiu1s\" name=\"item_meta[1214]\" value=\"\"  data-sectionid=\"1203\" 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_1221_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_6x1gg\" id=\"field_6x1gg_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_6x1gg\" name=\"item_meta[1221]\" value=\"\"  data-sectionid=\"1203\" 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_1223_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gzc3q\" id=\"field_gzc3q_label\" class=\"frm_primary_label\">State purpose of which craft is used\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gzc3q\" name=\"item_meta[1223]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1225_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2w3px\" id=\"field_2w3px_label\" class=\"frm_primary_label\">What crew is carried?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2w3px\" name=\"item_meta[1225]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1224_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vidvp\" id=\"field_vidvp_label\" class=\"frm_primary_label\">Are any of them experienced?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vidvp\" name=\"item_meta[1224]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1226_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_a5919\" id=\"field_a5919_label\" class=\"frm_primary_label\">Material of hull\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_a5919\" name=\"item_meta[1226]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1236_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_u0zlp\" id=\"field_u0zlp_label\" class=\"frm_primary_label\">Dimensions\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u0zlp\" name=\"item_meta[1236]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1235_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_e3zid\" id=\"field_e3zid_label\" class=\"frm_primary_label\">Type of construction\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e3zid\" name=\"item_meta[1235]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1234_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_1o25p\" id=\"field_1o25p_label\" class=\"frm_primary_label\">Type of engine, H.P and no. of cylinders\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1o25p\" name=\"item_meta[1234]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1233_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_3apjm\" id=\"field_3apjm_label\" class=\"frm_primary_label\">Date built and builders name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3apjm\" name=\"item_meta[1233]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1232_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_k9x11\" id=\"field_k9x11_label\" class=\"frm_primary_label\">Maximum designed speed of vessel\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k9x11\" name=\"item_meta[1232]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1231_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ctl38\" id=\"field_ctl38_label\" class=\"frm_primary_label\">Amateur or professional built\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ctl38\" name=\"item_meta[1231]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1230_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_vovub\" id=\"field_vovub_label\" class=\"frm_primary_label\">Date built and makers name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vovub\" name=\"item_meta[1230]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1229_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_il1vv\" id=\"field_il1vv_label\" class=\"frm_primary_label\">Give particulars of lighting and heating appliances\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_il1vv\" name=\"item_meta[1229]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1228_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_n4cr5\" id=\"field_n4cr5_label\" class=\"frm_primary_label\">State what fuel is used. Petrol, paraffin or heavy oil\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_n4cr5\" name=\"item_meta[1228]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1227_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_qh9lm\" id=\"field_qh9lm_label\" class=\"frm_primary_label\">Is copper tubing used throughout? \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh9lm\" name=\"item_meta[1227]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1237_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_4pmrn\" id=\"field_4pmrn_label\" class=\"frm_primary_label\">Type of fire extinguishers and numbers carried\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4pmrn\" name=\"item_meta[1237]\" value=\"\"  data-sectionid=\"1203\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1238_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Plate Glass Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1240_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_47uu2\" id=\"field_47uu2_label\" class=\"frm_primary_label\">Is the glass mentioned below free from cracks and other defects?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_47uu2\" name=\"item_meta[1240]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1241_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_wbnyy\" id=\"field_wbnyy_label\" class=\"frm_primary_label\">Do you desire to insure damage to woodwork of showcases or window frame?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wbnyy\" name=\"item_meta[1241]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_wbnyy\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_wbnyy\">This additional cover can be obtained at a premium of 5% on the declared value of the wood work<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1242_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yhqkb\" id=\"field_yhqkb_label\" class=\"frm_primary_label\">Are the premises at the corner of a street or subject to any extra risk?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yhqkb\" name=\"item_meta[1242]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1244_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vzqw6\" id=\"field_vzqw6_label\" class=\"frm_primary_label\">Does this proposal include all the insurable glass at the premises?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vzqw6\" name=\"item_meta[1244]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1243_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cg0xm\" id=\"field_cg0xm_label\" class=\"frm_primary_label\">Have the premises been erected or altered during the last twelve months\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cg0xm\" name=\"item_meta[1243]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1246_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_n46if\" id=\"field_n46if_label\" class=\"frm_primary_label\">What breakages (if any) have occurred during the last twelve months?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_n46if\" name=\"item_meta[1246]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1245_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ubzpr_label\" class=\"frm_primary_label\">Is the glass insured at preset?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ubzpr_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1245-1238-0\"><label for=\"field_ubzpr-0\">\t\t<input type=\"radio\" name=\"item_meta[1245]\" id=\"field_ubzpr-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Is the glass insured at preset? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1245-1238-1\"><label for=\"field_ubzpr-1\">\t\t<input type=\"radio\" name=\"item_meta[1245]\" id=\"field_ubzpr-1\" value=\"No\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Is the glass insured at preset? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1247_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5tk85\" id=\"field_5tk85_label\" class=\"frm_primary_label\">If so what company?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5tk85\" name=\"item_meta[1247]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1248_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_2z7qv_label\" class=\"frm_primary_label\">Has any company declined to acceptor renew the insurance\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_2z7qv_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1248-1238-0\"><label for=\"field_2z7qv-0\">\t\t<input type=\"radio\" name=\"item_meta[1248]\" id=\"field_2z7qv-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Has any company declined to acceptor renew the insurance is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1248-1238-1\"><label for=\"field_2z7qv-1\">\t\t<input type=\"radio\" name=\"item_meta[1248]\" id=\"field_2z7qv-1\" value=\"No\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Has any company declined to acceptor renew the insurance is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1249_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_jon7p_label\" class=\"frm_primary_label\">Has any company imposed a special condition?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jon7p_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1249-1238-0\"><label for=\"field_jon7p-0\">\t\t<input type=\"radio\" name=\"item_meta[1249]\" id=\"field_jon7p-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Has any company imposed a special condition? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1249-1238-1\"><label for=\"field_jon7p-1\">\t\t<input type=\"radio\" name=\"item_meta[1249]\" id=\"field_jon7p-1\" value=\"No\"\n\t\t   data-sectionid=\"1238\" data-invmsg=\"Has any company imposed a special condition? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1251_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cvv5o\" id=\"field_cvv5o_label\" class=\"frm_primary_label\">If yes, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cvv5o\" name=\"item_meta[1251]\" value=\"\"  data-sectionid=\"1238\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1252_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Fire & Peril Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1254_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4d1vx\" id=\"field_4d1vx_label\" class=\"frm_primary_label\">Name of Building\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4d1vx\" name=\"item_meta[1254]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1255_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_724h\" id=\"field_724h_label\" class=\"frm_primary_label\">Height in Stories \/ meters\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_724h\" name=\"item_meta[1255]\" value=\"\"  data-sectionid=\"1252\" 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_1257_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_zcnwf\" id=\"field_zcnwf_label\" class=\"frm_primary_label\">Materials used in construction of the walls?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zcnwf\" name=\"item_meta[1257]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1259_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_b383j\" id=\"field_b383j_label\" class=\"frm_primary_label\">Materials used in construction of the roof?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_b383j\" name=\"item_meta[1259]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1258_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3g31f\" id=\"field_3g31f_label\" class=\"frm_primary_label\">Materials used in construction of the partitions?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3g31f\" name=\"item_meta[1258]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1261_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ysphz\" id=\"field_ysphz_label\" class=\"frm_primary_label\">Situate LR \/ PlotNo:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ysphz\" name=\"item_meta[1261]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1260_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_ef4zl\" id=\"field_ef4zl_label\" class=\"frm_primary_label\">Street:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ef4zl\" name=\"item_meta[1260]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1262_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_82m47\" id=\"field_82m47_label\" class=\"frm_primary_label\">Township \/ County\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_82m47\" name=\"item_meta[1262]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1264_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6riav\" id=\"field_6riav_label\" class=\"frm_primary_label\">The building is occupied by the insured as:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6riav\" name=\"item_meta[1264]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1263_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_znuc3\" id=\"field_znuc3_label\" class=\"frm_primary_label\">(If more than one location prepare a list)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_znuc3\" name=\"item_meta[1263]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1265_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mafa3\" id=\"field_mafa3_label\" class=\"frm_primary_label\">Who is\/are the owner of the building(s)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mafa3\" name=\"item_meta[1265]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1266_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_s89xb\" id=\"field_s89xb_label\" class=\"frm_primary_label\">Who is\/are the occupant(s) of the building(s)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_s89xb\" name=\"item_meta[1266]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1267_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ebeja\" id=\"field_ebeja_label\" class=\"frm_primary_label\">Amount to be insured Gross Profit\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ebeja\" name=\"item_meta[1267]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ebeja\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ebeja\">Representing the annual NET TRADING PROFIT added to the annual amount of the following STANDING CHARGES OF THE BUSINESS<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1269_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vskwr\" id=\"field_vskwr_label\" class=\"frm_primary_label\">Kshs:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vskwr\" name=\"item_meta[1269]\" value=\"\"  data-sectionid=\"1252\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_vskwr\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_vskwr\">Deleted charges not to be covered.\r\nInterest on debentures, Mortgages, Loans, Bank overdrafts and other borrowed capital, Rent Rates and taxes, Director's fees, Auditors fees, insurance premiums, advertising charges, travelling expenses, Salaries to permanent staff, wages to skilled Employees.<\/div>\r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1270_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Money Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1272_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6oj4m\" id=\"field_6oj4m_label\" class=\"frm_primary_label\">State the type of premises where the business is carried out i.e warehouse, godown, shop, offices, factories,others\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6oj4m\" name=\"item_meta[1272]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1273_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_a6um3\" id=\"field_a6um3_label\" class=\"frm_primary_label\">Name of building\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_a6um3\" name=\"item_meta[1273]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1280_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ione7\" id=\"field_ione7_label\" class=\"frm_primary_label\">Plot number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ione7\" name=\"item_meta[1280]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1279_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6sskf\" id=\"field_6sskf_label\" class=\"frm_primary_label\">Street \/ road\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6sskf\" name=\"item_meta[1279]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1278_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ovg7i\" id=\"field_ovg7i_label\" class=\"frm_primary_label\">City \/ town\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ovg7i\" name=\"item_meta[1278]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1277_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_33y83\" id=\"field_33y83_label\" class=\"frm_primary_label\">District\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_33y83\" name=\"item_meta[1277]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1276_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_z3hj7\" id=\"field_z3hj7_label\" class=\"frm_primary_label\">What are your usual business hours? From:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_z3hj7\" name=\"item_meta[1276]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1275_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_9sutz\" id=\"field_9sutz_label\" class=\"frm_primary_label\">To:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9sutz\" name=\"item_meta[1275]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1281_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_esg71_label\" class=\"frm_primary_label\">Do you require cover for cash contained in a lock safe or strong room?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_esg71_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1281-1270-0\"><label for=\"field_esg71-0\">\t\t<input type=\"radio\" name=\"item_meta[1281]\" id=\"field_esg71-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1270\" data-invmsg=\"Do you require cover for cash contained in a lock safe or strong room? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1281-1270-1\"><label for=\"field_esg71-1\">\t\t<input type=\"radio\" name=\"item_meta[1281]\" id=\"field_esg71-1\" value=\"No\"\n\t\t   data-sectionid=\"1270\" data-invmsg=\"Do you require cover for cash contained in a lock safe or strong room? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1282_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ddpqv\" id=\"field_ddpqv_label\" class=\"frm_primary_label\">If yes, please state the make of safe or strong room\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ddpqv\" name=\"item_meta[1282]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1287_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_g4rcq\" id=\"field_g4rcq_label\" class=\"frm_primary_label\">The type\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_g4rcq\" name=\"item_meta[1287]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1285_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_trvkd\" id=\"field_trvkd_label\" class=\"frm_primary_label\">The size\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_trvkd\" name=\"item_meta[1285]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1286_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_n2950\" id=\"field_n2950_label\" class=\"frm_primary_label\">The weight\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_n2950\" name=\"item_meta[1286]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1284_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_c26i1\" id=\"field_c26i1_label\" class=\"frm_primary_label\">Where will it be kept?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c26i1\" name=\"item_meta[1284]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1283_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6rdzl\" id=\"field_6rdzl_label\" class=\"frm_primary_label\">How is the safe secured and\/ or anchored?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6rdzl\" name=\"item_meta[1283]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1288_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_3ztiw_label\" class=\"frm_primary_label\">Describe how your money is conveyed.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_3ztiw_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1288-1270-0\"><label for=\"field_3ztiw-0\"><input type=\"checkbox\" name=\"item_meta[1288][]\" id=\"field_3ztiw-0\" value=\"By employees\"  data-sectionid=\"1270\" data-invmsg=\"Describe how your money is conveyed. is invalid\" aria-invalid=\"false\"   \/> By employees<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1288-1270-1\"><label for=\"field_3ztiw-1\"><input type=\"checkbox\" name=\"item_meta[1288][]\" id=\"field_3ztiw-1\" value=\"By security firm\"  data-sectionid=\"1270\" data-invmsg=\"Describe how your money is conveyed. is invalid\" aria-invalid=\"false\"   \/> By security firm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1288-1270-2\"><label for=\"field_3ztiw-2\"><input type=\"checkbox\" name=\"item_meta[1288][]\" id=\"field_3ztiw-2\" value=\"By police escort\"  data-sectionid=\"1270\" data-invmsg=\"Describe how your money is conveyed. is invalid\" aria-invalid=\"false\"   \/> By police escort<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1288-1270-3\"><label for=\"field_3ztiw-3\"><input type=\"checkbox\" name=\"item_meta[1288][]\" id=\"field_3ztiw-3\" value=\"Others\"  data-sectionid=\"1270\" data-invmsg=\"Describe how your money is conveyed. is invalid\" aria-invalid=\"false\"   \/> Others<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1289_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_bsdfy\" id=\"field_bsdfy_label\" class=\"frm_primary_label\">If others, please specify\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bsdfy\" name=\"item_meta[1289]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1290_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_gt32n_label\" class=\"frm_primary_label\">Do you have a Fidelity Guarantee Policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_gt32n_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1290-1270-0\"><label for=\"field_gt32n-0\">\t\t<input type=\"radio\" name=\"item_meta[1290]\" id=\"field_gt32n-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1270\" data-invmsg=\"Do you have a Fidelity Guarantee Policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1290-1270-1\"><label for=\"field_gt32n-1\">\t\t<input type=\"radio\" name=\"item_meta[1290]\" id=\"field_gt32n-1\" value=\"No\"\n\t\t   data-sectionid=\"1270\" data-invmsg=\"Do you have a Fidelity Guarantee Policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1291_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7imoo\" id=\"field_7imoo_label\" class=\"frm_primary_label\">If yes, give details of the amounts guaranteed\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7imoo\" name=\"item_meta[1291]\" value=\"\"  data-sectionid=\"1270\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1294_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Fidelity Guarantee<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[1294][form]\" value=\"36\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1294-0\" class=\"frm_repeat_sec frm_repeat_1294 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1294][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1294][0][0]\" value=\"\" \/><div id=\"frm_field_1297-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1297_container\">\r\n    <label for=\"field_dkhcm-0\" id=\"field_dkhcm-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_dkhcm-0\" name=\"item_meta[1294][0][1297]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1298-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1298_container\">\r\n    <label for=\"field_beudu-0\" id=\"field_beudu-0_label\" class=\"frm_primary_label\">Duties\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_beudu-0\" name=\"item_meta[1294][0][1298]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1303-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1303_container\">\r\n    <label for=\"field_29o0g-0\" id=\"field_29o0g-0_label\" class=\"frm_primary_label\">Time in service\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_29o0g-0\" name=\"item_meta[1294][0][1303]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1302-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1302_container\">\r\n    <label for=\"field_eqjm2-0\" id=\"field_eqjm2-0_label\" class=\"frm_primary_label\">Place of employment\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eqjm2-0\" name=\"item_meta[1294][0][1302]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1301-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1301_container\">\r\n    <label for=\"field_s4nfa-0\" id=\"field_s4nfa-0_label\" class=\"frm_primary_label\">Total remuneration\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_s4nfa-0\" name=\"item_meta[1294][0][1301]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1300-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1300_container\">\r\n    <label for=\"field_rrbz4-0\" id=\"field_rrbz4-0_label\" class=\"frm_primary_label\">Amount to guarantee \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rrbz4-0\" name=\"item_meta[1294][0][1300]\" value=\"\"  data-sectionid=\"1294\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1299-1294-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1299_container\">\r\n    <label for=\"field_nl8gu-0\" id=\"field_nl8gu-0_label\" class=\"frm_primary_label\">Any other security taken\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nl8gu-0\" name=\"item_meta[1294][0][1299]\" value=\"\"  data-sectionid=\"1294\" 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=\"1294\" 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=\"1294\" 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_1292_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_1304_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ph8gp_label\" class=\"frm_primary_label\">Is there a system to obtain references from previous employers?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ph8gp_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1304-1292-0\"><label for=\"field_ph8gp-0\">\t\t<input type=\"radio\" name=\"item_meta[1304]\" id=\"field_ph8gp-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Is there a system to obtain references from previous employers? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1304-1292-1\"><label for=\"field_ph8gp-1\">\t\t<input type=\"radio\" name=\"item_meta[1304]\" id=\"field_ph8gp-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Is there a system to obtain references from previous employers? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1306_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k4qf4\" id=\"field_k4qf4_label\" class=\"frm_primary_label\">State the estimate of maximum amount held by any employee at any time and for how long?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k4qf4\" name=\"item_meta[1306]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1305_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2zaty\" id=\"field_2zaty_label\" class=\"frm_primary_label\">Money\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2zaty\" name=\"item_meta[1305]\" value=\"\"  data-sectionid=\"1292\" placeholder=\"Amount\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1309_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_v58h9\" id=\"field_v58h9_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_v58h9\" name=\"item_meta[1309]\" value=\"\"  data-sectionid=\"1292\" placeholder=\"Period\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1308_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_wjdeq\" id=\"field_wjdeq_label\" class=\"frm_primary_label\">Stock\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wjdeq\" name=\"item_meta[1308]\" value=\"\"  data-sectionid=\"1292\" placeholder=\"Amount\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1307_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4xdcv\" id=\"field_4xdcv_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_4xdcv\" name=\"item_meta[1307]\" value=\"\"  data-sectionid=\"1292\" placeholder=\"period\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1310_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7oy6j\" id=\"field_7oy6j_label\" class=\"frm_primary_label\">Has there been any occasion to questio honesty or conduct of any person proposed for guarantee?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7oy6j\" name=\"item_meta[1310]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1311_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_13f3c\" id=\"field_13f3c_label\" class=\"frm_primary_label\">How often are the employees required to account for money?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_13f3c\" name=\"item_meta[1311]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1312_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5b53\" id=\"field_5b53_label\" class=\"frm_primary_label\">What independent system is there to check that all sums received by employees are accounted for?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5b53\" name=\"item_meta[1312]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1315_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mahsx\" id=\"field_mahsx_label\" class=\"frm_primary_label\">Do employees pay out money to draw cash from the employers account?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mahsx\" name=\"item_meta[1315]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1314_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uuvfu\" id=\"field_uuvfu_label\" class=\"frm_primary_label\">System of operation of bank account and precautions taken? \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uuvfu\" name=\"item_meta[1314]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1313_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_99tt4\" id=\"field_99tt4_label\" class=\"frm_primary_label\">Whether such payments\/withdrawals are authorized by a senior employee and compared with supporting documents?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_99tt4\" name=\"item_meta[1313]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1321_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ke2az\" id=\"field_ke2az_label\" class=\"frm_primary_label\">How often the cash book is balanced, the entries checked with vouchers and Bank's pass book and with counterfoils of receipt books?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ke2az\" name=\"item_meta[1321]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1320_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4dsm8\" id=\"field_4dsm8_label\" class=\"frm_primary_label\">How often are the proposer's books balanced?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4dsm8\" name=\"item_meta[1320]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1319_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_jys0p\" id=\"field_jys0p_label\" class=\"frm_primary_label\">System followed for purchase of goods and recovering deliveries:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jys0p\" name=\"item_meta[1319]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1318_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_kecmp\" id=\"field_kecmp_label\" class=\"frm_primary_label\">System followed for authorizing dispatch of goods and ensuring that dispatch is recorded and charged to the customer\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kecmp\" name=\"item_meta[1318]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1317_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qfgk7\" id=\"field_qfgk7_label\" class=\"frm_primary_label\">How often and by whom stock verification is done?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qfgk7\" name=\"item_meta[1317]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1316_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9uztb\" id=\"field_9uztb_label\" class=\"frm_primary_label\">System for collecting outstanding accounts?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9uztb\" name=\"item_meta[1316]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1324_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_83744a\" id=\"field_83744a_label\" class=\"frm_primary_label\">How often will statements of account be furnished by the proposer direct to customers?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_83744a\" name=\"item_meta[1324]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1323_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_x0hnh\" id=\"field_x0hnh_label\" class=\"frm_primary_label\">What will be the extent and frequency of audit?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_x0hnh\" name=\"item_meta[1323]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1322_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_au55f\" id=\"field_au55f_label\" class=\"frm_primary_label\">Details of losses suffered on account of infidelity of any employees during last 5 years and steps taken to prevent recurrence:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_au55f\" name=\"item_meta[1322]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1325_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_pky52_label\" class=\"frm_primary_label\">Has any of your employees been dismissed in the last 12 months?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_pky52_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1325-1292-0\"><label for=\"field_pky52-0\">\t\t<input type=\"radio\" name=\"item_meta[1325]\" id=\"field_pky52-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Has any of your employees been dismissed in the last 12 months? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1325-1292-1\"><label for=\"field_pky52-1\">\t\t<input type=\"radio\" name=\"item_meta[1325]\" id=\"field_pky52-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Has any of your employees been dismissed in the last 12 months? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1326_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9k065\" id=\"field_9k065_label\" class=\"frm_primary_label\">If Yes, please give details:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9k065\" name=\"item_meta[1326]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1327_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ggmh9_label\" class=\"frm_primary_label\">Do you have a current policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ggmh9_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1327-1292-0\"><label for=\"field_ggmh9-0\">\t\t<input type=\"radio\" name=\"item_meta[1327]\" id=\"field_ggmh9-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Do you have a current policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1327-1292-1\"><label for=\"field_ggmh9-1\">\t\t<input type=\"radio\" name=\"item_meta[1327]\" id=\"field_ggmh9-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Do you have a current policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1328_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yfknl\" id=\"field_yfknl_label\" class=\"frm_primary_label\">If Yes, please give details:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yfknl\" name=\"item_meta[1328]\" value=\"\"  data-sectionid=\"1292\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1331_container\" class=\"frm_form_field  frm_html_container form-field\">Has any Company in respect of any infidelity guarantee insurance:<\/div>\n<div id=\"frm_field_1330_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ontni_label\" class=\"frm_primary_label\">Declined your proposal?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ontni_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1330-1292-0\"><label for=\"field_ontni-0\">\t\t<input type=\"radio\" name=\"item_meta[1330]\" id=\"field_ontni-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Declined your proposal? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1330-1292-1\"><label for=\"field_ontni-1\">\t\t<input type=\"radio\" name=\"item_meta[1330]\" id=\"field_ontni-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Declined your proposal? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1333_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_eqfsc_label\" class=\"frm_primary_label\">Cancelled or refused to renew policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_eqfsc_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1333-1292-0\"><label for=\"field_eqfsc-0\">\t\t<input type=\"radio\" name=\"item_meta[1333]\" id=\"field_eqfsc-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Cancelled or refused to renew policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1333-1292-1\"><label for=\"field_eqfsc-1\">\t\t<input type=\"radio\" name=\"item_meta[1333]\" id=\"field_eqfsc-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Cancelled or refused to renew policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1332_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_p4nib_label\" class=\"frm_primary_label\">Accepted your proposal on special terms and conditions?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_p4nib_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1332-1292-0\"><label for=\"field_p4nib-0\">\t\t<input type=\"radio\" name=\"item_meta[1332]\" id=\"field_p4nib-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Accepted your proposal on special terms and conditions? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1332-1292-1\"><label for=\"field_p4nib-1\">\t\t<input type=\"radio\" name=\"item_meta[1332]\" id=\"field_p4nib-1\" value=\"No\"\n\t\t   data-sectionid=\"1292\" data-invmsg=\"Accepted your proposal on special terms and conditions? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1334_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Goods in Transit<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1336_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_458f5\" id=\"field_458f5_label\" class=\"frm_primary_label\">Limit of liability in respect of any one consignment: KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_458f5\" name=\"item_meta[1336]\" value=\"\"  data-sectionid=\"1334\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1339_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mxddn\" id=\"field_mxddn_label\" class=\"frm_primary_label\">Limit of liability in respect of any one consignment: KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mxddn\" name=\"item_meta[1339]\" value=\"\"  data-sectionid=\"1334\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1338_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_tbcsx\" id=\"field_tbcsx_label\" class=\"frm_primary_label\">Estimated annual carry\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tbcsx\" name=\"item_meta[1338]\" value=\"\"  data-sectionid=\"1334\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1340_container\" class=\"frm_form_field  frm_html_container form-field\">If cover is required on specified vehicles, please complete the following schedule;<\/div>\n<\/div>\n<div id=\"frm_field_1343_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Vehicles<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[1343][form]\" value=\"38\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1343-0\" class=\"frm_repeat_sec frm_repeat_1343 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1343][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1343][0][0]\" value=\"\" \/><div id=\"frm_field_1345-1343-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1345_container\">\r\n    <label for=\"field_4rvxh-0\" id=\"field_4rvxh-0_label\" class=\"frm_primary_label\">Make and description of vehicle\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4rvxh-0\" name=\"item_meta[1343][0][1345]\" value=\"\"  data-sectionid=\"1343\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1348-1343-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1348_container\">\r\n    <label for=\"field_4cxfk-0\" id=\"field_4cxfk-0_label\" class=\"frm_primary_label\">Reg number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4cxfk-0\" name=\"item_meta[1343][0][1348]\" value=\"\"  data-sectionid=\"1343\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1347-1343-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1347_container\">\r\n    <label for=\"field_zihp4-0\" id=\"field_zihp4-0_label\" class=\"frm_primary_label\">Carrying capacity\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zihp4-0\" name=\"item_meta[1343][0][1347]\" value=\"\"  data-sectionid=\"1343\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1346-1343-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1346_container\">\r\n    <label for=\"field_jl19a-0\" id=\"field_jl19a-0_label\" class=\"frm_primary_label\">Sum Instead\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jl19a-0\" name=\"item_meta[1343][0][1346]\" value=\"\"  data-sectionid=\"1343\" 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=\"1343\" 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=\"1343\" 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_1341_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Trailers<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[1341][form]\" value=\"37\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1341-0\" class=\"frm_repeat_sec frm_repeat_1341 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1341][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1341][0][0]\" value=\"\" \/><div id=\"frm_field_1349-1341-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1349_container\">\r\n    <label for=\"field_22ixg-0\" id=\"field_22ixg-0_label\" class=\"frm_primary_label\">Make and description of vehicle\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_22ixg-0\" name=\"item_meta[1341][0][1349]\" value=\"\"  data-sectionid=\"1341\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1352-1341-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1352_container\">\r\n    <label for=\"field_lvvxk-0\" id=\"field_lvvxk-0_label\" class=\"frm_primary_label\">Reg number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lvvxk-0\" name=\"item_meta[1341][0][1352]\" value=\"\"  data-sectionid=\"1341\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1351-1341-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1351_container\">\r\n    <label for=\"field_nlsi6-0\" id=\"field_nlsi6-0_label\" class=\"frm_primary_label\">Carrying capacity\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nlsi6-0\" name=\"item_meta[1341][0][1351]\" value=\"\"  data-sectionid=\"1341\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1350-1341-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1350_container\">\r\n    <label for=\"field_9e9yb-0\" id=\"field_9e9yb-0_label\" class=\"frm_primary_label\">Sum Instead\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9e9yb-0\" name=\"item_meta[1341][0][1350]\" value=\"\"  data-sectionid=\"1341\" 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=\"1341\" 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=\"1341\" 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_1353_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Burglary Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1355_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_j6ibo\" id=\"field_j6ibo_label\" class=\"frm_primary_label\">Who is responsible for the security arrangements?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_j6ibo\" name=\"item_meta[1355]\" value=\"\"  data-sectionid=\"1353\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1357_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_m02e4\" id=\"field_m02e4_label\" class=\"frm_primary_label\">What security arrangements are in place?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_m02e4\" name=\"item_meta[1357]\" value=\"\"  data-sectionid=\"1353\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1356_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_boklz\" id=\"field_boklz_label\" class=\"frm_primary_label\">If you engage a security guard company, state the name and address of the firm\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_boklz\" name=\"item_meta[1356]\" value=\"\"  data-sectionid=\"1353\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1358_container\" class=\"frm_form_field  frm_html_container form-field\">Do you require the following extensions to your policy?<\/div>\n<div id=\"frm_field_1359_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_g6aq7_label\" class=\"frm_primary_label\">Hold up your cover\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_g6aq7_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1359-1353-0\"><label for=\"field_g6aq7-0\">\t\t<input type=\"radio\" name=\"item_meta[1359]\" id=\"field_g6aq7-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1353\" data-invmsg=\"Hold up your cover is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1359-1353-1\"><label for=\"field_g6aq7-1\">\t\t<input type=\"radio\" name=\"item_meta[1359]\" id=\"field_g6aq7-1\" value=\"No\"\n\t\t   data-sectionid=\"1353\" data-invmsg=\"Hold up your cover is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1360_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_msi6r_label\" class=\"frm_primary_label\">Riot and strike\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_msi6r_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1360-1353-0\"><label for=\"field_msi6r-0\">\t\t<input type=\"radio\" name=\"item_meta[1360]\" id=\"field_msi6r-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1353\" data-invmsg=\"Riot and strike is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1360-1353-1\"><label for=\"field_msi6r-1\">\t\t<input type=\"radio\" name=\"item_meta[1360]\" id=\"field_msi6r-1\" value=\"No\"\n\t\t   data-sectionid=\"1353\" data-invmsg=\"Riot and strike is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1364_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Industrial All Risks Proposal<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1366_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_fnsls\" id=\"field_fnsls_label\" class=\"frm_primary_label\">Buildings\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fnsls\" name=\"item_meta[1366]\" value=\"\"  data-sectionid=\"1364\" placeholder=\"Sum to be insured (Kshs)\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1370_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_x6axg\" id=\"field_x6axg_label\" class=\"frm_primary_label\">Furniture, fixture and fittings\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_x6axg\" name=\"item_meta[1370]\" value=\"\"  data-sectionid=\"1364\" placeholder=\"Sum to be insured (Kshs)\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1369_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cwt9s\" id=\"field_cwt9s_label\" class=\"frm_primary_label\">Stock in trade consisting of\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cwt9s\" name=\"item_meta[1369]\" value=\"\"  data-sectionid=\"1364\" placeholder=\"Sum to be insured (Kshs)\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1368_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_c5odm\" id=\"field_c5odm_label\" class=\"frm_primary_label\">Goods held in trust or on commission for which the proposer is responsible consisting of\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c5odm\" name=\"item_meta[1368]\" value=\"\"  data-sectionid=\"1364\" placeholder=\"Sum to be insured (Kshs)\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1367_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4t54t\" id=\"field_4t54t_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=\"text\" id=\"field_4t54t\" name=\"item_meta[1367]\" value=\"\"  data-sectionid=\"1364\" placeholder=\"Sum to be insured (Kshs)\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1371_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_faqqd\" id=\"field_faqqd_label\" class=\"frm_primary_label\">Maximum indemnity period (in months)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_faqqd\" name=\"item_meta[1371]\" value=\"\"  data-sectionid=\"1364\" 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_1372_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Machinery Breakdown Insurance <\/h3>\r\n\r\n\r\n<div id=\"frm_field_1374_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_t93du\" id=\"field_t93du_label\" class=\"frm_primary_label\">Situation\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t93du\" name=\"item_meta[1374]\" value=\"\"  data-sectionid=\"1372\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1376_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_n6l4v\" id=\"field_n6l4v_label\" class=\"frm_primary_label\">Plot No.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_n6l4v\" name=\"item_meta[1376]\" value=\"\"  data-sectionid=\"1372\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1375_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_f722i\" id=\"field_f722i_label\" class=\"frm_primary_label\">Nature of business\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_f722i\" name=\"item_meta[1375]\" value=\"\"  data-sectionid=\"1372\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1377_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Fire Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1379_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_iywfi\" id=\"field_iywfi_label\" class=\"frm_primary_label\">Name of the building\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_iywfi\" name=\"item_meta[1379]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1380_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p9cir\" id=\"field_p9cir_label\" class=\"frm_primary_label\">Height in stories\/meters\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_p9cir\" name=\"item_meta[1380]\" value=\"\"  data-sectionid=\"1377\" 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_1385_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ptnqb\" id=\"field_ptnqb_label\" class=\"frm_primary_label\">Materials used in construction of the walls\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ptnqb\" name=\"item_meta[1385]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1386_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p4hpi\" id=\"field_p4hpi_label\" class=\"frm_primary_label\">Materials used in construction of the roof\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p4hpi\" name=\"item_meta[1386]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1384_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gt0sd\" id=\"field_gt0sd_label\" class=\"frm_primary_label\">Materials used in construction of the partitions\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gt0sd\" name=\"item_meta[1384]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1383_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_n9slt\" id=\"field_n9slt_label\" class=\"frm_primary_label\">Situate LR \/ Plot No.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_n9slt\" name=\"item_meta[1383]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1382_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_6tny3\" id=\"field_6tny3_label\" class=\"frm_primary_label\">Street\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6tny3\" name=\"item_meta[1382]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1381_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ax4sf\" id=\"field_ax4sf_label\" class=\"frm_primary_label\">Township \/ county\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ax4sf\" name=\"item_meta[1381]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1387_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hm3hr\" id=\"field_hm3hr_label\" class=\"frm_primary_label\">The building is occupied by the insured as\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hm3hr\" name=\"item_meta[1387]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1388_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9dgfa\" id=\"field_9dgfa_label\" class=\"frm_primary_label\">(if more than one location prepared a list)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9dgfa\" name=\"item_meta[1388]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1389_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hijf1\" id=\"field_hijf1_label\" class=\"frm_primary_label\">If there be any stove or furnace (odlier than a common Fue place or cooking stove, set in brick, with brick chimney) in the building, or if machinery of any kind be used therein, state full particulars.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hijf1\" name=\"item_meta[1389]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1391_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9f0jl\" id=\"field_9f0jl_label\" class=\"frm_primary_label\">On what material the stove is fixed\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9f0jl\" name=\"item_meta[1391]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1393_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_bbkw8_label\" class=\"frm_primary_label\">Whether pipe is carried into brick flue\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_bbkw8_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1393-1377-0\"><label for=\"field_bbkw8-0\">\t\t<input type=\"radio\" name=\"item_meta[1393]\" id=\"field_bbkw8-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Whether pipe is carried into brick flue is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1393-1377-1\"><label for=\"field_bbkw8-1\">\t\t<input type=\"radio\" name=\"item_meta[1393]\" id=\"field_bbkw8-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Whether pipe is carried into brick flue is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1392_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_y8ija_label\" class=\"frm_primary_label\">Whether pipe is within nine inches of unprotected wood work\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_y8ija_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1392-1377-0\"><label for=\"field_y8ija-0\">\t\t<input type=\"radio\" name=\"item_meta[1392]\" id=\"field_y8ija-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Whether pipe is within nine inches of unprotected wood work is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1392-1377-1\"><label for=\"field_y8ija-1\">\t\t<input type=\"radio\" name=\"item_meta[1392]\" id=\"field_y8ija-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Whether pipe is within nine inches of unprotected wood work is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1395_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_pya05_label\" class=\"frm_primary_label\">Does the building have a fire alarm\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_pya05_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1395-1377-0\"><label for=\"field_pya05-0\">\t\t<input type=\"radio\" name=\"item_meta[1395]\" id=\"field_pya05-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Does the building have a fire alarm is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1395-1377-1\"><label for=\"field_pya05-1\">\t\t<input type=\"radio\" name=\"item_meta[1395]\" id=\"field_pya05-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Does the building have a fire alarm is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1394_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_rl0lq_label\" class=\"frm_primary_label\">Does the building have a fire extinguisher \/ hose reels\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_rl0lq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1394-1377-0\"><label for=\"field_rl0lq-0\">\t\t<input type=\"radio\" name=\"item_meta[1394]\" id=\"field_rl0lq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Does the building have a fire extinguisher \/ hose reels is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1394-1377-1\"><label for=\"field_rl0lq-1\">\t\t<input type=\"radio\" name=\"item_meta[1394]\" id=\"field_rl0lq-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Does the building have a fire extinguisher \/ hose reels is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1396_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_t28ku\" id=\"field_t28ku_label\" class=\"frm_primary_label\">If so, state full particulars\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t28ku\" name=\"item_meta[1396]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1397_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_b6rfo\" id=\"field_b6rfo_label\" class=\"frm_primary_label\">If you have rented out parts of the building, please describe the occupations of your tenants\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1397]\" id=\"field_b6rfo\" rows=\"5\"  data-sectionid=\"1377\" data-invmsg=\"If you have rented out parts of the building, please describe the occupations of your tenants is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1398_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uqv5r\" id=\"field_uqv5r_label\" class=\"frm_primary_label\">State the nature of business carried out by the immediate neighbors.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1398]\" id=\"field_uqv5r\" rows=\"5\"  data-sectionid=\"1377\" data-invmsg=\"State the nature of business carried out by the immediate neighbors. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1399_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_an0og\" id=\"field_an0og_label\" class=\"frm_primary_label\">How often do you take an inventory of the business?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_an0og\" name=\"item_meta[1399]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1402_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_94esq_label\" class=\"frm_primary_label\">Do you keep a set of books showing a complete record of business transacted including all purchases and sales for cash and credit, together with the last inventory to the business?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_94esq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1402-1377-0\"><label for=\"field_94esq-0\">\t\t<input type=\"radio\" name=\"item_meta[1402]\" id=\"field_94esq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Do you keep a set of books showing a complete record of business transacted including all purchases and sales for cash and credit, together with the last inventory to the business? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1402-1377-1\"><label for=\"field_94esq-1\">\t\t<input type=\"radio\" name=\"item_meta[1402]\" id=\"field_94esq-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Do you keep a set of books showing a complete record of business transacted including all purchases and sales for cash and credit, together with the last inventory to the business? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1401_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_g0ao8_label\" class=\"frm_primary_label\">Are the books securely locked in a fireproof safe at night and at all times when the warehouse or store is not actually open for business?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_g0ao8_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1401-1377-0\"><label for=\"field_g0ao8-0\">\t\t<input type=\"radio\" name=\"item_meta[1401]\" id=\"field_g0ao8-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Are the books securely locked in a fireproof safe at night and at all times when the warehouse or store is not actually open for business? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1401-1377-1\"><label for=\"field_g0ao8-1\">\t\t<input type=\"radio\" name=\"item_meta[1401]\" id=\"field_g0ao8-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Are the books securely locked in a fireproof safe at night and at all times when the warehouse or store is not actually open for business? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1405_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pby9x\" id=\"field_pby9x_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_pby9x\" name=\"item_meta[1405]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1403_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_c6c03\" id=\"field_c6c03_label\" class=\"frm_primary_label\">Nationality of ownership\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c6c03\" name=\"item_meta[1403]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1404_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_nu4zx\" id=\"field_nu4zx_label\" class=\"frm_primary_label\">Date of commencement of operations\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nu4zx\" name=\"item_meta[1404]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1406_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_meitq\" id=\"field_meitq_label\" class=\"frm_primary_label\">Is business interruption cover required?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_meitq\" name=\"item_meta[1406]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1407_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_5dlw5_label\" class=\"frm_primary_label\">Limit of cover required:(single combined limit each and every loss and in the aggregate during the period of insurance for physical damage and business interruption)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_5dlw5_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1407-1377-0\"><label for=\"field_5dlw5-0\">\t\t<input type=\"radio\" name=\"item_meta[1407]\" id=\"field_5dlw5-0\" value=\"Material damage\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Limit of cover required:(single combined limit each and every loss and in the aggregate during the period of insurance for physical damage and business interruption) is invalid\" aria-invalid=\"false\"  \/> Material damage<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1407-1377-1\"><label for=\"field_5dlw5-1\">\t\t<input type=\"radio\" name=\"item_meta[1407]\" id=\"field_5dlw5-1\" value=\"Business Interruption\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Limit of cover required:(single combined limit each and every loss and in the aggregate during the period of insurance for physical damage and business interruption) is invalid\" aria-invalid=\"false\"  \/> Business Interruption<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1407-1377-2\"><label for=\"field_5dlw5-2\">\t\t<input type=\"radio\" name=\"item_meta[1407]\" id=\"field_5dlw5-2\" value=\"Aggregate during the period of insurance for physical damage and business interruptions\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Limit of cover required:(single combined limit each and every loss and in the aggregate during the period of insurance for physical damage and business interruption) is invalid\" aria-invalid=\"false\"  \/> Aggregate during the period of insurance for physical damage and business interruptions<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1408_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_njxgt\" id=\"field_njxgt_label\" class=\"frm_primary_label\">Description of the area surrounding the location(E.G rural, commercial, government, etc. including name(s) of landmarks\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_njxgt\" name=\"item_meta[1408]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1410_container\" class=\"frm_form_field  frm_html_container form-field\">Are there any of the following within 500 meters of the location?<\/div>\n<div id=\"frm_field_1409_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2j0ms\" id=\"field_2j0ms_label\" class=\"frm_primary_label\">Military premises?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2j0ms\" name=\"item_meta[1409]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1417_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ljrse\" id=\"field_ljrse_label\" class=\"frm_primary_label\">Government premises?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ljrse\" name=\"item_meta[1417]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1416_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_tfg8m\" id=\"field_tfg8m_label\" class=\"frm_primary_label\">Tourist attractions?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tfg8m\" name=\"item_meta[1416]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1415_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_nhmmw\" id=\"field_nhmmw_label\" class=\"frm_primary_label\">Airport \/ other transport facilities?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nhmmw\" name=\"item_meta[1415]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1414_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2mmbc\" id=\"field_2mmbc_label\" class=\"frm_primary_label\">Landmarks\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2mmbc\" name=\"item_meta[1414]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1413_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4j8ez\" id=\"field_4j8ez_label\" class=\"frm_primary_label\">Sporting venues\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4j8ez\" name=\"item_meta[1413]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1412_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9nafn\" id=\"field_9nafn_label\" class=\"frm_primary_label\">Religious institutions?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9nafn\" name=\"item_meta[1412]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1423_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dhbxo\" id=\"field_dhbxo_label\" class=\"frm_primary_label\">What, if any, business occupy the other parts of the building?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dhbxo\" name=\"item_meta[1423]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1424_container\" class=\"frm_form_field  frm_html_container form-field\"><b>Building Location Details<\/b><\/div>\n<div id=\"frm_field_1425_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_1ushb\" id=\"field_1ushb_label\" class=\"frm_primary_label\">Name and address of location\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1ushb\" name=\"item_meta[1425]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1430_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_oaip4\" id=\"field_oaip4_label\" class=\"frm_primary_label\">Zip or postal code\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_oaip4\" name=\"item_meta[1430]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1429_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_t502o\" id=\"field_t502o_label\" class=\"frm_primary_label\">Value of building\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t502o\" name=\"item_meta[1429]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1428_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pquoi\" id=\"field_pquoi_label\" class=\"frm_primary_label\">Value of contents\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pquoi\" name=\"item_meta[1428]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1427_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_kpyk0\" id=\"field_kpyk0_label\" class=\"frm_primary_label\">Business interruption value (12months)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kpyk0\" name=\"item_meta[1427]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1426_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5rniy\" id=\"field_5rniy_label\" class=\"frm_primary_label\">Total insured value\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5rniy\" name=\"item_meta[1426]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1431_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_7i1hz_label\" class=\"frm_primary_label\">Is there a guard force?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_7i1hz_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1431-1377-0\"><label for=\"field_7i1hz-0\">\t\t<input type=\"radio\" name=\"item_meta[1431]\" id=\"field_7i1hz-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is there a guard force? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1431-1377-1\"><label for=\"field_7i1hz-1\">\t\t<input type=\"radio\" name=\"item_meta[1431]\" id=\"field_7i1hz-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is there a guard force? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1432_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9okf9\" id=\"field_9okf9_label\" class=\"frm_primary_label\">If yes, how many guards?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9okf9\" name=\"item_meta[1432]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1433_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dakk9\" id=\"field_dakk9_label\" class=\"frm_primary_label\">are there intrusion detection systems and CCTV cameras?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dakk9\" name=\"item_meta[1433]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1434_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_g76tx_label\" class=\"frm_primary_label\">Is the perimeter fence?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_g76tx_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1434-1377-0\"><label for=\"field_g76tx-0\">\t\t<input type=\"radio\" name=\"item_meta[1434]\" id=\"field_g76tx-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is the perimeter fence? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1434-1377-1\"><label for=\"field_g76tx-1\">\t\t<input type=\"radio\" name=\"item_meta[1434]\" id=\"field_g76tx-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is the perimeter fence? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1435_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rb4gc\" id=\"field_rb4gc_label\" class=\"frm_primary_label\">If yes, is it illuminated at night?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rb4gc\" name=\"item_meta[1435]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1436_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_lcc64\" id=\"field_lcc64_label\" class=\"frm_primary_label\">Is there an access control system? (E.G card access or sign in procedure)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lcc64\" name=\"item_meta[1436]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1437_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_f1rzc_label\" class=\"frm_primary_label\">Is there a parking area?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_f1rzc_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1437-1377-0\"><label for=\"field_f1rzc-0\">\t\t<input type=\"radio\" name=\"item_meta[1437]\" id=\"field_f1rzc-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is there a parking area? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1437-1377-1\"><label for=\"field_f1rzc-1\">\t\t<input type=\"radio\" name=\"item_meta[1437]\" id=\"field_f1rzc-1\" value=\"No\"\n\t\t   data-sectionid=\"1377\" data-invmsg=\"Is there a parking area? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1438_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_bdnak\" id=\"field_bdnak_label\" class=\"frm_primary_label\">If yes, where? (E.G. within the building, outside, etc)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bdnak\" name=\"item_meta[1438]\" value=\"\"  data-sectionid=\"1377\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1439_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Products Liability Insurance <\/h3>\r\n\r\n\r\n<div id=\"frm_field_1474_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vh0zd\" id=\"field_vh0zd_label\" class=\"frm_primary_label\">Business\/Trade\/Occupation (Give full description)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1474]\" id=\"field_vh0zd\" rows=\"5\"  data-sectionid=\"1439\" data-invmsg=\"Business\/Trade\/Occupation (Give full description) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1475_container\" class=\"frm_form_field  frm_html_container form-field\">Explain what your business entails:<\/div>\n<div id=\"frm_field_1476_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_yxmde_label\" class=\"frm_primary_label\">Manufacturing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_yxmde_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1476-1439-0\"><label for=\"field_yxmde-0\">\t\t<input type=\"radio\" name=\"item_meta[1476]\" id=\"field_yxmde-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Manufacturing is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1476-1439-1\"><label for=\"field_yxmde-1\">\t\t<input type=\"radio\" name=\"item_meta[1476]\" id=\"field_yxmde-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Manufacturing is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1483_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_7clow_label\" class=\"frm_primary_label\">Processing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_7clow_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1483-1439-0\"><label for=\"field_7clow-0\">\t\t<input type=\"radio\" name=\"item_meta[1483]\" id=\"field_7clow-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Processing is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1483-1439-1\"><label for=\"field_7clow-1\">\t\t<input type=\"radio\" name=\"item_meta[1483]\" id=\"field_7clow-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Processing is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1482_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_lz3li_label\" class=\"frm_primary_label\">Packaging\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lz3li_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1482-1439-0\"><label for=\"field_lz3li-0\">\t\t<input type=\"radio\" name=\"item_meta[1482]\" id=\"field_lz3li-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Packaging is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1482-1439-1\"><label for=\"field_lz3li-1\">\t\t<input type=\"radio\" name=\"item_meta[1482]\" id=\"field_lz3li-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Packaging is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1480_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_n9n4h_label\" class=\"frm_primary_label\">Assembling\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_n9n4h_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1480-1439-0\"><label for=\"field_n9n4h-0\">\t\t<input type=\"radio\" name=\"item_meta[1480]\" id=\"field_n9n4h-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Assembling is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1480-1439-1\"><label for=\"field_n9n4h-1\">\t\t<input type=\"radio\" name=\"item_meta[1480]\" id=\"field_n9n4h-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Assembling is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1481_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_s4kbi_label\" class=\"frm_primary_label\">Wholesaling\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_s4kbi_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1481-1439-0\"><label for=\"field_s4kbi-0\">\t\t<input type=\"radio\" name=\"item_meta[1481]\" id=\"field_s4kbi-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Wholesaling is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1481-1439-1\"><label for=\"field_s4kbi-1\">\t\t<input type=\"radio\" name=\"item_meta[1481]\" id=\"field_s4kbi-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Wholesaling is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1479_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_qli5z_label\" class=\"frm_primary_label\">Retailing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qli5z_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1479-1439-0\"><label for=\"field_qli5z-0\">\t\t<input type=\"radio\" name=\"item_meta[1479]\" id=\"field_qli5z-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Retailing is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1479-1439-1\"><label for=\"field_qli5z-1\">\t\t<input type=\"radio\" name=\"item_meta[1479]\" id=\"field_qli5z-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Retailing is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1478_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_v1vbx_label\" class=\"frm_primary_label\">Importing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_v1vbx_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1478-1439-0\"><label for=\"field_v1vbx-0\">\t\t<input type=\"radio\" name=\"item_meta[1478]\" id=\"field_v1vbx-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Importing is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1478-1439-1\"><label for=\"field_v1vbx-1\">\t\t<input type=\"radio\" name=\"item_meta[1478]\" id=\"field_v1vbx-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Importing is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1477_container\" class=\"frm_form_field form-field  frm_top_container frm_half vertical_radio\">\r\n    <div  id=\"field_jdu62_label\" class=\"frm_primary_label\">Exporting\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jdu62_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1477-1439-0\"><label for=\"field_jdu62-0\">\t\t<input type=\"radio\" name=\"item_meta[1477]\" id=\"field_jdu62-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Exporting is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1477-1439-1\"><label for=\"field_jdu62-1\">\t\t<input type=\"radio\" name=\"item_meta[1477]\" id=\"field_jdu62-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Exporting is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1484_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7h2ij\" id=\"field_7h2ij_label\" class=\"frm_primary_label\">Any other?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7h2ij\" name=\"item_meta[1484]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1486_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_u7h13\" id=\"field_u7h13_label\" class=\"frm_primary_label\">Give details of products subdivided into different categories (range) if more than one type of product is involved\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u7h13\" name=\"item_meta[1486]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1485_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mluyf\" id=\"field_mluyf_label\" class=\"frm_primary_label\">Describe the purpose or use of the product(s).\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mluyf\" name=\"item_meta[1485]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_mluyf\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_mluyf\">Note: Brochures or leaflets describing the product can be enclosed if available.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1487_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_g9t91\" id=\"field_g9t91_label\" class=\"frm_primary_label\">If you incorporate parts manufactured elsewhere for any of the above listed products, wholly or partly, including raw materials, state the part or component and from where they are sourced.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_g9t91\" name=\"item_meta[1487]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1488_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_frtvq_label\" class=\"frm_primary_label\">Are the products used as a component?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_frtvq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1488-1439-0\"><label for=\"field_frtvq-0\">\t\t<input type=\"radio\" name=\"item_meta[1488]\" id=\"field_frtvq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Are the products used as a component? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1488-1439-1\"><label for=\"field_frtvq-1\">\t\t<input type=\"radio\" name=\"item_meta[1488]\" id=\"field_frtvq-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Are the products used as a component? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1489_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_f5kfo\" id=\"field_f5kfo_label\" class=\"frm_primary_label\">If so what type of products and by which industry?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_f5kfo\" name=\"item_meta[1489]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1490_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_1mra3_label\" class=\"frm_primary_label\">Are any of your products assembled by another firm (or persons)?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1mra3_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1490-1439-0\"><label for=\"field_1mra3-0\">\t\t<input type=\"radio\" name=\"item_meta[1490]\" id=\"field_1mra3-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Are any of your products assembled by another firm (or persons)? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1490-1439-1\"><label for=\"field_1mra3-1\">\t\t<input type=\"radio\" name=\"item_meta[1490]\" id=\"field_1mra3-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Are any of your products assembled by another firm (or persons)? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1491_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2dyva\" id=\"field_2dyva_label\" class=\"frm_primary_label\">If so, give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2dyva\" name=\"item_meta[1491]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1492_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_r51sx\" id=\"field_r51sx_label\" class=\"frm_primary_label\">Are any of your products sourced locally or abroad? Please give details.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r51sx\" name=\"item_meta[1492]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1493_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_puro2\" id=\"field_puro2_label\" class=\"frm_primary_label\">Are any of your products exported? If so, please list the countries to which you export:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1493]\" id=\"field_puro2\" rows=\"5\"  data-sectionid=\"1439\" data-invmsg=\"Are any of your products exported? If so, please list the countries to which you export: is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_puro2\"><\/textarea>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_puro2\">Note: This cover excludes exports to the USA and Canada.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1494_container\" class=\"frm_form_field  frm_html_container form-field\">Are any of the products supplied for use in connection with:<\/div>\n<div id=\"frm_field_1495_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_og4ki_label\" class=\"frm_primary_label\">Aircraft, aerospace equipment or aerial devices of ant kind?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_og4ki_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1495-1439-0\"><label for=\"field_og4ki-0\">\t\t<input type=\"radio\" name=\"item_meta[1495]\" id=\"field_og4ki-0\" value=\"Option 1\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Aircraft, aerospace equipment or aerial devices of ant kind? is invalid\" aria-invalid=\"false\"  \/> Option 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1495-1439-1\"><label for=\"field_og4ki-1\">\t\t<input type=\"radio\" name=\"item_meta[1495]\" id=\"field_og4ki-1\" value=\"Option 2\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Aircraft, aerospace equipment or aerial devices of ant kind? is invalid\" aria-invalid=\"false\"  \/> Option 2<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1497_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_xz0sb_label\" class=\"frm_primary_label\">Pharmaceuticals?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_xz0sb_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1497-1439-0\"><label for=\"field_xz0sb-0\">\t\t<input type=\"radio\" name=\"item_meta[1497]\" id=\"field_xz0sb-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Pharmaceuticals? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1497-1439-1\"><label for=\"field_xz0sb-1\">\t\t<input type=\"radio\" name=\"item_meta[1497]\" id=\"field_xz0sb-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Pharmaceuticals? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1496_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_79lke_label\" class=\"frm_primary_label\">Offshore platforms and rigs?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_79lke_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1496-1439-0\"><label for=\"field_79lke-0\">\t\t<input type=\"radio\" name=\"item_meta[1496]\" id=\"field_79lke-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Offshore platforms and rigs? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1496-1439-1\"><label for=\"field_79lke-1\">\t\t<input type=\"radio\" name=\"item_meta[1496]\" id=\"field_79lke-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Offshore platforms and rigs? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1498_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_na6wp\" id=\"field_na6wp_label\" class=\"frm_primary_label\">How long have you engaged in manufacturing\/supplying these products?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_na6wp\" name=\"item_meta[1498]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1499_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_6i02k_label\" class=\"frm_primary_label\">Do you enter into any agreement or undertaking to indemnify or compensate supplier of materials or components or subcontractors or processors in respect of any injury or damage?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6i02k_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1499-1439-0\"><label for=\"field_6i02k-0\">\t\t<input type=\"radio\" name=\"item_meta[1499]\" id=\"field_6i02k-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Do you enter into any agreement or undertaking to indemnify or compensate supplier of materials or components or subcontractors or processors in respect of any injury or damage? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1499-1439-1\"><label for=\"field_6i02k-1\">\t\t<input type=\"radio\" name=\"item_meta[1499]\" id=\"field_6i02k-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Do you enter into any agreement or undertaking to indemnify or compensate supplier of materials or components or subcontractors or processors in respect of any injury or damage? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_6i02k\">If so, please provide a copy of such agreement or undertaking.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1500_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_fh0wp\" id=\"field_fh0wp_label\" class=\"frm_primary_label\">What type of packaging do you use?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fh0wp\" name=\"item_meta[1500]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1501_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_leadk_label\" class=\"frm_primary_label\">Do you manufacture the packaging materials?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_leadk_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1501-1439-0\"><label for=\"field_leadk-0\">\t\t<input type=\"radio\" name=\"item_meta[1501]\" id=\"field_leadk-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Do you manufacture the packaging materials? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1501-1439-1\"><label for=\"field_leadk-1\">\t\t<input type=\"radio\" name=\"item_meta[1501]\" id=\"field_leadk-1\" value=\"No\"\n\t\t   data-sectionid=\"1439\" data-invmsg=\"Do you manufacture the packaging materials? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1502_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_bfkeh\" id=\"field_bfkeh_label\" class=\"frm_primary_label\">If not, where are the packaging\/containers acquired?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bfkeh\" name=\"item_meta[1502]\" value=\"\"  data-sectionid=\"1439\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1503_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contractors Plant & Machinery <\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[1503][form]\" value=\"41\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_1503-0\" class=\"frm_repeat_sec frm_repeat_1503 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[1503][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[1503][0][0]\" value=\"\" \/><div id=\"frm_field_1506-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1506_container\">\r\n    <label for=\"field_4e149a-0\" id=\"field_4e149a-0_label\" class=\"frm_primary_label\">Item No.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4e149a-0\" name=\"item_meta[1503][0][1506]\" value=\"\"  data-sectionid=\"1503\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1512-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1512_container\">\r\n    <label for=\"field_caaet-0\" id=\"field_caaet-0_label\" class=\"frm_primary_label\">Description of items (Please give full and exact description of all plant and machinery)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_caaet-0\" name=\"item_meta[1503][0][1512]\" value=\"\"  data-sectionid=\"1503\" placeholder=\"Name of manufacturer\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1511-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1511_container\">\r\n    <label for=\"field_6xtio-0\" id=\"field_6xtio-0_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_6xtio-0\" name=\"item_meta[1503][0][1511]\" value=\"\"  data-sectionid=\"1503\" placeholder=\"Type and serial No.\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1510-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1510_container\">\r\n    <label for=\"field_7tlcn-0\" id=\"field_7tlcn-0_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_7tlcn-0\" name=\"item_meta[1503][0][1510]\" value=\"\"  data-sectionid=\"1503\" placeholder=\"Output\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1509-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1509_container\">\r\n    <label for=\"field_3v4qf-0\" id=\"field_3v4qf-0_label\" class=\"frm_primary_label\">Year of manufacture\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3v4qf-0\" name=\"item_meta[1503][0][1509]\" value=\"\"  data-sectionid=\"1503\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1508-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1508_container\">\r\n    <label for=\"field_wnk3s-0\" id=\"field_wnk3s-0_label\" class=\"frm_primary_label\">High exposure to special hazards. (Please specify from hazards of item 3 overleaf)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wnk3s-0\" name=\"item_meta[1503][0][1508]\" value=\"\"  data-sectionid=\"1503\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1507-1503-0_container\" class=\"frm_form_field form-field  frm_top_container frm_field_1507_container\">\r\n    <label for=\"field_ht8xa-0\" id=\"field_ht8xa-0_label\" class=\"frm_primary_label\">Replacement Value (state current cost of replacing the machine by new machinery of same kind and capacity)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ht8xa-0\" name=\"item_meta[1503][0][1507]\" value=\"\"  data-sectionid=\"1503\" 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=\"1503\" 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=\"1503\" 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_1513_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_1515_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ln7d6\" id=\"field_ln7d6_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=\"text\" id=\"field_ln7d6\" name=\"item_meta[1515]\" value=\"\"  data-sectionid=\"1513\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1516_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Electronic Equipment Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1518_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_w2mlr\" id=\"field_w2mlr_label\" class=\"frm_primary_label\">Trade business \/ occupation\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_w2mlr\" name=\"item_meta[1518]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1523_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dqw5f\" id=\"field_dqw5f_label\" class=\"frm_primary_label\">Location of equipment to be insured\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dqw5f\" name=\"item_meta[1523]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1522_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_e4kc2\" id=\"field_e4kc2_label\" class=\"frm_primary_label\">Name of building\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e4kc2\" name=\"item_meta[1522]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1521_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_x6r7y\" id=\"field_x6r7y_label\" class=\"frm_primary_label\">Location : Plot number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_x6r7y\" name=\"item_meta[1521]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1520_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_rbenj\" id=\"field_rbenj_label\" class=\"frm_primary_label\">Street \/ road\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rbenj\" name=\"item_meta[1520]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1519_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_35j3g\" id=\"field_35j3g_label\" class=\"frm_primary_label\">Town\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_35j3g\" name=\"item_meta[1519]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1524_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_try4t_label\" class=\"frm_primary_label\">Is there a risk of flooding or water damage?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_try4t_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1524-1516-0\"><label for=\"field_try4t-0\">\t\t<input type=\"radio\" name=\"item_meta[1524]\" id=\"field_try4t-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is there a risk of flooding or water damage? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1524-1516-1\"><label for=\"field_try4t-1\">\t\t<input type=\"radio\" name=\"item_meta[1524]\" id=\"field_try4t-1\" value=\"No\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is there a risk of flooding or water damage? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1525_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ae1vv\" id=\"field_ae1vv_label\" class=\"frm_primary_label\">If so, please specify\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ae1vv\" name=\"item_meta[1525]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1526_container\" class=\"frm_form_field  frm_html_container form-field\"><b>Condition of the equipment<\/b><\/div>\n<div id=\"frm_field_1528_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_zbkmx_label\" class=\"frm_primary_label\">Is the Equipment new?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zbkmx_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1528-1516-0\"><label for=\"field_zbkmx-0\">\t\t<input type=\"radio\" name=\"item_meta[1528]\" id=\"field_zbkmx-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the Equipment new? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1528-1516-1\"><label for=\"field_zbkmx-1\">\t\t<input type=\"radio\" name=\"item_meta[1528]\" id=\"field_zbkmx-1\" value=\"No\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the Equipment new? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1527_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_esbpb\" id=\"field_esbpb_label\" class=\"frm_primary_label\">If not please specify the equipment that are second hand\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_esbpb\" name=\"item_meta[1527]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1529_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_qdjki_label\" class=\"frm_primary_label\">Was the equipment obtained ex works, that is, were all costs from the sellers premises borne by you?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qdjki_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1529-1516-0\"><label for=\"field_qdjki-0\">\t\t<input type=\"radio\" name=\"item_meta[1529]\" id=\"field_qdjki-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Was the equipment obtained ex works, that is, were all costs from the sellers premises borne by you? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1529-1516-1\"><label for=\"field_qdjki-1\">\t\t<input type=\"radio\" name=\"item_meta[1529]\" id=\"field_qdjki-1\" value=\"No\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Was the equipment obtained ex works, that is, were all costs from the sellers premises borne by you? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1530_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_mr4n4_label\" class=\"frm_primary_label\">Is the air conditioner\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_mr4n4_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1530-1516-0\"><label for=\"field_mr4n4-0\">\t\t<input type=\"radio\" name=\"item_meta[1530]\" id=\"field_mr4n4-0\" value=\"Pressurized?\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the air conditioner is invalid\" aria-invalid=\"false\"  \/> Pressurized?<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1530-1516-1\"><label for=\"field_mr4n4-1\">\t\t<input type=\"radio\" name=\"item_meta[1530]\" id=\"field_mr4n4-1\" value=\"Recommended by manufacturer of the equipment?\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the air conditioner is invalid\" aria-invalid=\"false\"  \/> Recommended by manufacturer of the equipment?<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1530-1516-2\"><label for=\"field_mr4n4-2\">\t\t<input type=\"radio\" name=\"item_meta[1530]\" id=\"field_mr4n4-2\" value=\"Not necessary\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the air conditioner is invalid\" aria-invalid=\"false\"  \/> Not necessary<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1531_container\" class=\"frm_form_field  frm_html_container form-field\"><b>Maintenance<\/b><\/div>\n<div id=\"frm_field_1533_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_i5inm_label\" class=\"frm_primary_label\">Is the equipment maintained in accordance with the manufacturers instructions?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_i5inm_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1533-1516-0\"><label for=\"field_i5inm-0\">\t\t<input type=\"radio\" name=\"item_meta[1533]\" id=\"field_i5inm-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the equipment maintained in accordance with the manufacturers instructions? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1533-1516-1\"><label for=\"field_i5inm-1\">\t\t<input type=\"radio\" name=\"item_meta[1533]\" id=\"field_i5inm-1\" value=\"No\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is the equipment maintained in accordance with the manufacturers instructions? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1534_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p0rgw\" id=\"field_p0rgw_label\" class=\"frm_primary_label\">Please give details\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p0rgw\" name=\"item_meta[1534]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1535_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_kb4wp_label\" class=\"frm_primary_label\">Is there a valid maintenance contract in place? \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_kb4wp_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1535-1516-0\"><label for=\"field_kb4wp-0\">\t\t<input type=\"radio\" name=\"item_meta[1535]\" id=\"field_kb4wp-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is there a valid maintenance contract in place?  is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1535-1516-1\"><label for=\"field_kb4wp-1\">\t\t<input type=\"radio\" name=\"item_meta[1535]\" id=\"field_kb4wp-1\" value=\"No\"\n\t\t   data-sectionid=\"1516\" data-invmsg=\"Is there a valid maintenance contract in place?  is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1536_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_a7ngf\" id=\"field_a7ngf_label\" class=\"frm_primary_label\">If not, explain how the maintenance is carried out and by whom?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_a7ngf\" name=\"item_meta[1536]\" value=\"\"  data-sectionid=\"1516\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1538_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_nml98\" id=\"field_nml98_label\" class=\"frm_primary_label\">If yes, please provide a copy\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\" name=\"item_meta[1538]\"  value=\"\" data-frmfile=\"1538\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file1538_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1538\" id=\"field_nml98\"\n\t\t\t data-sectionid=\"1516\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t<span class=\"frm_icon_font frm_upload_icon\"><\/span>\n\t\t<span class=\"frm_upload_text\"><button type=\"button\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\tMaximum upload size: 104.86MB\t\t<\/div>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1539_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Carriers Legal Liability Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1541_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_zqrsc_label\" class=\"frm_primary_label\">Please indicate whether you operate as a :\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zqrsc_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1541-1539-0\"><label for=\"field_zqrsc-0\">\t\t<input type=\"radio\" name=\"item_meta[1541]\" id=\"field_zqrsc-0\" value=\"Sole trader\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Please indicate whether you operate as a : is invalid\" aria-invalid=\"false\"  \/> Sole trader<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1541-1539-1\"><label for=\"field_zqrsc-1\">\t\t<input type=\"radio\" name=\"item_meta[1541]\" id=\"field_zqrsc-1\" value=\"Partnership\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Please indicate whether you operate as a : is invalid\" aria-invalid=\"false\"  \/> Partnership<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1541-1539-2\"><label for=\"field_zqrsc-2\">\t\t<input type=\"radio\" name=\"item_meta[1541]\" id=\"field_zqrsc-2\" value=\"Limited Company\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Please indicate whether you operate as a : is invalid\" aria-invalid=\"false\"  \/> Limited Company<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1542_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qjncs\" id=\"field_qjncs_label\" class=\"frm_primary_label\">Name the main type of goods likely to be carried, handled and\/or warehoused by you:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qjncs\" name=\"item_meta[1542]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1557_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_4ukdb_label\" class=\"frm_primary_label\">Indicate whether the vehicles are :\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4ukdb_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1557-1539-0\"><label for=\"field_4ukdb-0\">\t\t<input type=\"radio\" name=\"item_meta[1557]\" id=\"field_4ukdb-0\" value=\"Owned\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Indicate whether the vehicles are : is invalid\" aria-invalid=\"false\"  \/> Owned<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1557-1539-1\"><label for=\"field_4ukdb-1\">\t\t<input type=\"radio\" name=\"item_meta[1557]\" id=\"field_4ukdb-1\" value=\"Hired\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Indicate whether the vehicles are : is invalid\" aria-invalid=\"false\"  \/> Hired<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1557-1539-2\"><label for=\"field_4ukdb-2\">\t\t<input type=\"radio\" name=\"item_meta[1557]\" id=\"field_4ukdb-2\" value=\"Owned &amp; Hired\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Indicate whether the vehicles are : is invalid\" aria-invalid=\"false\"  \/> Owned &amp; Hired<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1559_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_p1t6r_label\" class=\"frm_primary_label\">Do you subcontract any carriage?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_p1t6r_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1559-1539-0\"><label for=\"field_p1t6r-0\">\t\t<input type=\"radio\" name=\"item_meta[1559]\" id=\"field_p1t6r-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Do you subcontract any carriage? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1559-1539-1\"><label for=\"field_p1t6r-1\">\t\t<input type=\"radio\" name=\"item_meta[1559]\" id=\"field_p1t6r-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Do you subcontract any carriage? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1558_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_iote5_label\" class=\"frm_primary_label\">If yes do you have written contracts with the subcontractors?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_iote5_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1558-1539-0\"><label for=\"field_iote5-0\">\t\t<input type=\"radio\" name=\"item_meta[1558]\" id=\"field_iote5-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"If yes do you have written contracts with the subcontractors? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1558-1539-1\"><label for=\"field_iote5-1\">\t\t<input type=\"radio\" name=\"item_meta[1558]\" id=\"field_iote5-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"If yes do you have written contracts with the subcontractors? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1560_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_dvtoe\" id=\"field_dvtoe_label\" class=\"frm_primary_label\">If no, how do you hold subcontractors responsible for any goods entrusted to them?(briefly explain) \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dvtoe\" name=\"item_meta[1560]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1563_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_egocb_label\" class=\"frm_primary_label\">Do you maintain a detail register of all vehicles that are used for carriage of goods?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_egocb_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1563-1539-0\"><label for=\"field_egocb-0\">\t\t<input type=\"radio\" name=\"item_meta[1563]\" id=\"field_egocb-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Do you maintain a detail register of all vehicles that are used for carriage of goods? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1563-1539-1\"><label for=\"field_egocb-1\">\t\t<input type=\"radio\" name=\"item_meta[1563]\" id=\"field_egocb-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Do you maintain a detail register of all vehicles that are used for carriage of goods? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1562_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_att6j\" id=\"field_att6j_label\" class=\"frm_primary_label\">If not, explain how you keep such records:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_att6j\" name=\"item_meta[1562]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1573_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Security of Vehicles<\/p>\n<p>Are the vehicles fitted with:<\/p>\n<\/div>\n<div id=\"frm_field_1564_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_rr77u_label\" class=\"frm_primary_label\">Tracking Devices ?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_rr77u_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1564-1539-0\"><label for=\"field_rr77u-0\">\t\t<input type=\"radio\" name=\"item_meta[1564]\" id=\"field_rr77u-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Tracking Devices ? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1564-1539-1\"><label for=\"field_rr77u-1\">\t\t<input type=\"radio\" name=\"item_meta[1564]\" id=\"field_rr77u-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Tracking Devices ? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1577_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_3uvui_label\" class=\"frm_primary_label\">Radio Communication?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_3uvui_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1577-1539-0\"><label for=\"field_3uvui-0\">\t\t<input type=\"radio\" name=\"item_meta[1577]\" id=\"field_3uvui-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Radio Communication? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1577-1539-1\"><label for=\"field_3uvui-1\">\t\t<input type=\"radio\" name=\"item_meta[1577]\" id=\"field_3uvui-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Radio Communication? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1576_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_zctcu_label\" class=\"frm_primary_label\">Engine immobilizers?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zctcu_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1576-1539-0\"><label for=\"field_zctcu-0\">\t\t<input type=\"radio\" name=\"item_meta[1576]\" id=\"field_zctcu-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Engine immobilizers? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1576-1539-1\"><label for=\"field_zctcu-1\">\t\t<input type=\"radio\" name=\"item_meta[1576]\" id=\"field_zctcu-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Engine immobilizers? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1575_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_diyfi_label\" class=\"frm_primary_label\">Overloading Devices?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_diyfi_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1575-1539-0\"><label for=\"field_diyfi-0\">\t\t<input type=\"radio\" name=\"item_meta[1575]\" id=\"field_diyfi-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Overloading Devices? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1575-1539-1\"><label for=\"field_diyfi-1\">\t\t<input type=\"radio\" name=\"item_meta[1575]\" id=\"field_diyfi-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Overloading Devices? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1574_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_4ysi6_label\" class=\"frm_primary_label\">Any other Devices (please specify:)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4ysi6_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1574-1539-0\"><label for=\"field_4ysi6-0\">\t\t<input type=\"radio\" name=\"item_meta[1574]\" id=\"field_4ysi6-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Any other Devices (please specify:) is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1574-1539-1\"><label for=\"field_4ysi6-1\">\t\t<input type=\"radio\" name=\"item_meta[1574]\" id=\"field_4ysi6-1\" value=\"No\"\n\t\t   data-sectionid=\"1539\" data-invmsg=\"Any other Devices (please specify:) is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1578_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Limits of Liability Required<\/p>\n<p>State the limits of liability required:<\/p>\n<\/div>\n<div id=\"frm_field_1579_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_yqggp\" id=\"field_yqggp_label\" class=\"frm_primary_label\">In respect of any one claim\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yqggp\" name=\"item_meta[1579]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1584_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_1r1ac\" id=\"field_1r1ac_label\" class=\"frm_primary_label\">KES:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1r1ac\" name=\"item_meta[1584]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1583_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_oium1\" id=\"field_oium1_label\" class=\"frm_primary_label\">In respect of all claims arising out of one event:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_oium1\" name=\"item_meta[1583]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1582_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_2ej6f\" id=\"field_2ej6f_label\" class=\"frm_primary_label\">KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2ej6f\" name=\"item_meta[1582]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1581_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_nms45\" id=\"field_nms45_label\" class=\"frm_primary_label\">In respect of all claims during the period of insurance\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nms45\" name=\"item_meta[1581]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1580_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_zqbd0\" id=\"field_zqbd0_label\" class=\"frm_primary_label\">KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zqbd0\" name=\"item_meta[1580]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1592_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uo9po\" id=\"field_uo9po_label\" class=\"frm_primary_label\">What is your estimated annual carry:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uo9po\" name=\"item_meta[1592]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1591_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_jeopj\" id=\"field_jeopj_label\" class=\"frm_primary_label\">KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jeopj\" name=\"item_meta[1591]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1590_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hmj5b\" id=\"field_hmj5b_label\" class=\"frm_primary_label\">Provide your actual annual carry for each of the last three years\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hmj5b\" name=\"item_meta[1590]\" value=\"\"  data-sectionid=\"1539\" placeholder=\"Year\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1589_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_aaxn7\" id=\"field_aaxn7_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_aaxn7\" name=\"item_meta[1589]\" value=\"\"  data-sectionid=\"1539\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1588_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ukvah\" id=\"field_ukvah_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_ukvah\" name=\"item_meta[1588]\" value=\"\"  data-sectionid=\"1539\" placeholder=\"Year\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1587_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pvlx5\" id=\"field_pvlx5_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_pvlx5\" name=\"item_meta[1587]\" value=\"\"  data-sectionid=\"1539\" placeholder=\"KES\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1586_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gfj6x\" id=\"field_gfj6x_label\" class=\"frm_primary_label\">Year\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gfj6x\" name=\"item_meta[1586]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1585_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_tfkcw\" id=\"field_tfkcw_label\" class=\"frm_primary_label\">KES\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tfkcw\" name=\"item_meta[1585]\" value=\"\"  data-sectionid=\"1539\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1593_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contractors All Risk Insurance<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1595_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_xglf2\" id=\"field_xglf2_label\" class=\"frm_primary_label\">Title of contract (If project consists of several sections, specify section(s) to be insured.)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xglf2\" name=\"item_meta[1595]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1596_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_sc7d9\" id=\"field_sc7d9_label\" class=\"frm_primary_label\">Site of contract: Plot no_\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_sc7d9\" name=\"item_meta[1596]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1598_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_ca8jx\" id=\"field_ca8jx_label\" class=\"frm_primary_label\">Road\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ca8jx\" name=\"item_meta[1598]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1597_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_94sel\" id=\"field_94sel_label\" class=\"frm_primary_label\">Town\/county:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_94sel\" name=\"item_meta[1597]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1599_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_jla2w\" id=\"field_jla2w_label\" class=\"frm_primary_label\">Name and address of principal\/employer\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jla2w\" name=\"item_meta[1599]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1601_container\" class=\"frm_form_field  frm_html_container form-field\"><\/div>\n<div id=\"frm_field_1600_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uvk7m\" id=\"field_uvk7m_label\" class=\"frm_primary_label\">Dimensions (Length, height, depth, spans, number of floors) Yes\/No\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uvk7m\" name=\"item_meta[1600]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1602_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_jmaqm\" id=\"field_jmaqm_label\" class=\"frm_primary_label\">Type of foundation and level of deepest excavation\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jmaqm\" name=\"item_meta[1602]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1604_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_gyztq\" id=\"field_gyztq_label\" class=\"frm_primary_label\">Construction method\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gyztq\" name=\"item_meta[1604]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1603_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_l4ih0\" id=\"field_l4ih0_label\" class=\"frm_primary_label\">Construction materials\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_l4ih0\" name=\"item_meta[1603]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1605_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_cdgm_label\" class=\"frm_primary_label\">Details of subsoil: (Tick where applicable)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cdgm_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-0\"><label for=\"field_cdgm-0\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-0\" value=\"Rock\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Rock<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-1\"><label for=\"field_cdgm-1\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-1\" value=\"Gravel\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Gravel<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-2\"><label for=\"field_cdgm-2\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-2\" value=\"Sand\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Sand<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-3\"><label for=\"field_cdgm-3\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-3\" value=\"Clay\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Clay<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-4\"><label for=\"field_cdgm-4\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-4\" value=\"Filled ground\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Filled ground<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1605-1593-5\"><label for=\"field_cdgm-5\">\t\t<input type=\"radio\" name=\"item_meta[1605]\" id=\"field_cdgm-5\" value=\"Other subsoil conditions:\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Details of subsoil: (Tick where applicable) is invalid\" aria-invalid=\"false\"  \/> Other subsoil conditions:<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1607_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_1ja61_label\" class=\"frm_primary_label\">Do geological faults exist in the vicinity?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1ja61_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1607-1593-0\"><label for=\"field_1ja61-0\">\t\t<input type=\"radio\" name=\"item_meta[1607]\" id=\"field_1ja61-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Do geological faults exist in the vicinity? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1607-1593-1\"><label for=\"field_1ja61-1\">\t\t<input type=\"radio\" name=\"item_meta[1607]\" id=\"field_1ja61-1\" value=\"No\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Do geological faults exist in the vicinity? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1608_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rgzy9\" id=\"field_rgzy9_label\" class=\"frm_primary_label\">Ground water level below grade (m, ft)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rgzy9\" name=\"item_meta[1608]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1609_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_vtsz8\" id=\"field_vtsz8_label\" class=\"frm_primary_label\">Nearest river, lake, sea etc. . Name:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vtsz8\" name=\"item_meta[1609]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1619_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_yw1y6\" id=\"field_yw1y6_label\" class=\"frm_primary_label\">Distance (m)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yw1y6\" name=\"item_meta[1619]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1618_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_gn1vs\" id=\"field_gn1vs_label\" class=\"frm_primary_label\">Levels\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gn1vs\" name=\"item_meta[1618]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1617_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_e0ssr\" id=\"field_e0ssr_label\" class=\"frm_primary_label\">Low water\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e0ssr\" name=\"item_meta[1617]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1616_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_k3vay\" id=\"field_k3vay_label\" class=\"frm_primary_label\">Mean water\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k3vay\" name=\"item_meta[1616]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1615_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_lxtis\" id=\"field_lxtis_label\" class=\"frm_primary_label\">Highest ever recorded\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lxtis\" name=\"item_meta[1615]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1620_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_qayji\" id=\"field_qayji_label\" class=\"frm_primary_label\">Meteorological conditions: Rainy season from\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qayji\" name=\"item_meta[1620]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1621_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_k8leb\" id=\"field_k8leb_label\" class=\"frm_primary_label\">To\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k8leb\" name=\"item_meta[1621]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1627_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_8bfat\" id=\"field_8bfat_label\" class=\"frm_primary_label\">Max. rainfall in mm: per hour\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8bfat\" name=\"item_meta[1627]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1626_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_aja9l\" id=\"field_aja9l_label\" class=\"frm_primary_label\">per day\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_aja9l\" name=\"item_meta[1626]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1625_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_w2xlg\" id=\"field_w2xlg_label\" class=\"frm_primary_label\">per month\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_w2xlg\" name=\"item_meta[1625]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1624_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_xm6hj\" id=\"field_xm6hj_label\" class=\"frm_primary_label\">Storm hazard: Minor\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xm6hj\" name=\"item_meta[1624]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1623_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_6o5wl\" id=\"field_6o5wl_label\" class=\"frm_primary_label\">Medium\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6o5wl\" name=\"item_meta[1623]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1622_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_v1s21\" id=\"field_v1s21_label\" class=\"frm_primary_label\">High\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_v1s21\" name=\"item_meta[1622]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1628_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_nomg4_label\" class=\"frm_primary_label\">Is third party liability to be included?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nomg4_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1628-1593-0\"><label for=\"field_nomg4-0\">\t\t<input type=\"radio\" name=\"item_meta[1628]\" id=\"field_nomg4-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Is third party liability to be included? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1628-1593-1\"><label for=\"field_nomg4-1\">\t\t<input type=\"radio\" name=\"item_meta[1628]\" id=\"field_nomg4-1\" value=\"No\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Is third party liability to be included? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1629_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pqiqe\" id=\"field_pqiqe_label\" class=\"frm_primary_label\">If yes, Limit any one event\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pqiqe\" name=\"item_meta[1629]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1630_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_9lgw4_label\" class=\"frm_primary_label\">Has the contractor concluded a separate policy for TPL?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_9lgw4_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1630-1593-0\"><label for=\"field_9lgw4-0\">\t\t<input type=\"radio\" name=\"item_meta[1630]\" id=\"field_9lgw4-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Has the contractor concluded a separate policy for TPL? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1630-1593-1\"><label for=\"field_9lgw4-1\">\t\t<input type=\"radio\" name=\"item_meta[1630]\" id=\"field_9lgw4-1\" value=\"No\"\n\t\t   data-sectionid=\"1593\" data-invmsg=\"Has the contractor concluded a separate policy for TPL? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1632_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_kjhft\" id=\"field_kjhft_label\" class=\"frm_primary_label\">Limit of indemnity\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kjhft\" name=\"item_meta[1632]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1633_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_65s2n\" id=\"field_65s2n_label\" class=\"frm_primary_label\">Contract works( permanent and temporary work, including all materials to be incorporated herein)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_65s2n\" name=\"item_meta[1633]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1639_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cq29a\" id=\"field_cq29a_label\" class=\"frm_primary_label\">Contract Price\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cq29a\" name=\"item_meta[1639]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1638_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_86pt1\" id=\"field_86pt1_label\" class=\"frm_primary_label\">Materials or items supplied by principal(s)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_86pt1\" name=\"item_meta[1638]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1637_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7qtxt\" id=\"field_7qtxt_label\" class=\"frm_primary_label\">Constriction plant and equipment\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7qtxt\" name=\"item_meta[1637]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1636_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p29kd\" id=\"field_p29kd_label\" class=\"frm_primary_label\">Construction machinery (list items)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p29kd\" name=\"item_meta[1636]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1635_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_cfxms\" id=\"field_cfxms_label\" class=\"frm_primary_label\">Clearance of debris\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cfxms\" name=\"item_meta[1635]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1634_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_zu8v6\" id=\"field_zu8v6_label\" class=\"frm_primary_label\">Others\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zu8v6\" name=\"item_meta[1634]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1640_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ppiaa\" id=\"field_ppiaa_label\" class=\"frm_primary_label\">Total sum to be insured under section 1\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ppiaa\" name=\"item_meta[1640]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1641_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5g19o\" id=\"field_5g19o_label\" class=\"frm_primary_label\">Earthquake, volcanism, tsunami\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5g19o\" name=\"item_meta[1641]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1642_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hqyzt\" id=\"field_hqyzt_label\" class=\"frm_primary_label\">Storm, cyclone, flood, inundation, landslide\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hqyzt\" name=\"item_meta[1642]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1643_container\" class=\"frm_form_field  frm_html_container form-field\"><\/div>\n<div id=\"frm_field_1644_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hlvzt\" id=\"field_hlvzt_label\" class=\"frm_primary_label\">Bodily injury\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hlvzt\" name=\"item_meta[1644]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1646_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ojnst\" id=\"field_ojnst_label\" class=\"frm_primary_label\">Any one person \/ event\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ojnst\" name=\"item_meta[1646]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1645_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5nsg4\" id=\"field_5nsg4_label\" class=\"frm_primary_label\">Property damage limit of indemnity in respect of each and every loss or damage and \/ or series of losses arising out of any one event\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5nsg4\" name=\"item_meta[1645]\" value=\"\"  data-sectionid=\"1593\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1654_container\" class=\"frm_form_field  frm_html_container form-field\">Have you either alone or in partnership or jointly with any other party or office holders:<\/div>\n<div id=\"frm_field_1649_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_whbzi_label\" class=\"frm_primary_label\">Incurred legal costs in a contractual dispute in the last 3 years?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_whbzi_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1649-1647-0\"><label for=\"field_whbzi-0\">\t\t<input type=\"radio\" name=\"item_meta[1649]\" id=\"field_whbzi-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Incurred legal costs in a contractual dispute in the last 3 years? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1649-1647-1\"><label for=\"field_whbzi-1\">\t\t<input type=\"radio\" name=\"item_meta[1649]\" id=\"field_whbzi-1\" value=\"No\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Incurred legal costs in a contractual dispute in the last 3 years? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1647_container\" class=\"frm_form_field frm_section_heading form-field  frm_color_block\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contractual Legal Liability Proposal<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1651_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_31qkw_label\" class=\"frm_primary_label\">Been charged with or convicted of any criminal offence?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_31qkw_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1651-1647-0\"><label for=\"field_31qkw-0\">\t\t<input type=\"radio\" name=\"item_meta[1651]\" id=\"field_31qkw-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Been charged with or convicted of any criminal offence? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1651-1647-1\"><label for=\"field_31qkw-1\">\t\t<input type=\"radio\" name=\"item_meta[1651]\" id=\"field_31qkw-1\" value=\"No\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Been charged with or convicted of any criminal offence? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1650_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_qj6d9_label\" class=\"frm_primary_label\">Been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qj6d9_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1650-1647-0\"><label for=\"field_qj6d9-0\">\t\t<input type=\"radio\" name=\"item_meta[1650]\" id=\"field_qj6d9-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1650-1647-1\"><label for=\"field_qj6d9-1\">\t\t<input type=\"radio\" name=\"item_meta[1650]\" id=\"field_qj6d9-1\" value=\"No\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1653_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_67wkx\" id=\"field_67wkx_label\" class=\"frm_primary_label\">If Yes to any of the above, please provide full details here.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_67wkx\" name=\"item_meta[1653]\" value=\"\"  data-sectionid=\"1647\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1655_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_kwil9_label\" class=\"frm_primary_label\">Insurance Cover (Please tick): \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_kwil9_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1655-1647-0\"><label for=\"field_kwil9-0\">\t\t<input type=\"radio\" name=\"item_meta[1655]\" id=\"field_kwil9-0\" value=\"Single contract\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Insurance Cover (Please tick):  is invalid\" aria-invalid=\"false\"  \/> Single contract<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1655-1647-1\"><label for=\"field_kwil9-1\">\t\t<input type=\"radio\" name=\"item_meta[1655]\" id=\"field_kwil9-1\" value=\"Annual Contract\"\n\t\t   data-sectionid=\"1647\" data-invmsg=\"Insurance Cover (Please tick):  is invalid\" aria-invalid=\"false\"  \/> Annual Contract<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1656_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Limits of Liability<\/p>\n<\/div>\n<div id=\"frm_field_1657_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k99qr\" id=\"field_k99qr_label\" class=\"frm_primary_label\">Legal and other costs\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_k99qr\" name=\"item_meta[1657]\" value=\"\"  data-sectionid=\"1647\" placeholder=\"Ksh\" 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_1661_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_srlnj\" id=\"field_srlnj_label\" class=\"frm_primary_label\">Other policies\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_srlnj\" name=\"item_meta[1661]\" value=\"\"  data-sectionid=\"1647\" placeholder=\"Ksh\" 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_1660_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_pmwcg\" id=\"field_pmwcg_label\" class=\"frm_primary_label\">Hire, lease or bailment \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_pmwcg\" name=\"item_meta[1660]\" value=\"\"  data-sectionid=\"1647\" placeholder=\"Ksh\" 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_1659_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_s7hl9\" id=\"field_s7hl9_label\" class=\"frm_primary_label\">Contractual dispute\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_s7hl9\" name=\"item_meta[1659]\" value=\"\"  data-sectionid=\"1647\" placeholder=\"Ksh\" 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_1658_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_m5e86\" id=\"field_m5e86_label\" class=\"frm_primary_label\">Underground services\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_m5e86\" name=\"item_meta[1658]\" value=\"\"  data-sectionid=\"1647\" placeholder=\"Ksh\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"10\" step=\"1\"\/>\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" name=\"item_meta[1662]\" id=\"field_jsnxw\" value=\"\" data-frmval=\"\"\/>\n<\/div>\n<div id=\"frm_field_1669_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_1652_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_jurlq_label\" class=\"frm_primary_label\">Had an insurer decline any claim, cancel any insurance policy or impose special tersm to any insurance policy?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jurlq_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1652-1669-0\"><label for=\"field_jurlq-0\">\t\t<input type=\"radio\" name=\"item_meta[1652]\" id=\"field_jurlq-0\" value=\"Yes\"\n\t\t   data-sectionid=\"1669\" data-invmsg=\"Had an insurer decline any claim, cancel any insurance policy or impose special tersm to any insurance policy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1652-1669-1\"><label for=\"field_jurlq-1\">\t\t<input type=\"radio\" name=\"item_meta[1652]\" id=\"field_jurlq-1\" value=\"No\"\n\t\t   data-sectionid=\"1669\" data-invmsg=\"Had an insurer decline any claim, cancel any insurance policy or impose special tersm to any insurance policy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1555_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_vx883_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div id=\"field_vx883\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdVVsocAAAAAOgjDivHYkal8o3gpAwv2O-q5PmS\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    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