{"id":8995,"date":"2023-04-21T12:40:43","date_gmt":"2023-04-21T10:40:43","guid":{"rendered":"https:\/\/dunach.com\/index_beta.php\/accident-report\/"},"modified":"2024-12-16T12:32:35","modified_gmt":"2024-12-16T10:32:35","slug":"accident-report","status":"publish","type":"page","link":"https:\/\/dunach.com\/index_beta.php\/accident-report\/?lang=en","title":{"rendered":"ACCIDENT REPORT"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8995\" class=\"elementor elementor-8995 elementor-3539\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d70cb83 elementor-section-full_width elementor-section-height-min-height elementor-section-height-default elementor-section-items-middle\" data-id=\"d70cb83\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;background_motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateY_effect&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateY_direction&quot;:&quot;negative&quot;,&quot;background_motion_fx_translateY_speed&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:4,&quot;sizes&quot;:[]},&quot;background_motion_fx_translateY_affectedRange&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:{&quot;start&quot;:0,&quot;end&quot;:100}},&quot;background_motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-6fedc89\" data-id=\"6fedc89\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bcf806b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bcf806b\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-50 elementor-top-column elementor-element elementor-element-8d02bcc\" data-id=\"8d02bcc\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2b8bad5 elementor-widget elementor-widget-heading\" data-id=\"2b8bad5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">ACCIDENT REPORT\n\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ecdd02 elementor-widget elementor-widget-heading\" data-id=\"3ecdd02\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Fill in this form and we will get in touch with you<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-e9f96d8\" data-id=\"e9f96d8\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ebe0b90 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ebe0b90\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-50 elementor-top-column elementor-element elementor-element-dc76175\" data-id=\"dc76175\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-71994ee elementor-widget elementor-widget-breadcrumbs\" data-id=\"71994ee\" data-element_type=\"widget\" data-widget_type=\"breadcrumbs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p id=\"breadcrumbs\"><span><span><a href=\"https:\/\/dunach.com\/index_beta.php\">Inici<\/a><\/span><\/span><\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18d90fe elementor-widget elementor-widget-shortcode\" data-id=\"18d90fe\" 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\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-8982 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-8982\" data-uid=\"6aca18e016f0a\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-8982\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-8982 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"8982\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6aca18e016f0a\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-8982--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-8982--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"CONTACT\"\n\t\t\t\tdata-actual-label=\"DATA\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6aca18e016f0a\" id=\"forminator-field-text-1_6aca18e016f0a-label\" class=\"forminator-label\">FULL NAME: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6aca18e016f0a\" id=\"forminator-field-text-17_6aca18e016f0a-label\" class=\"forminator-label\">NIF\/CIF\/NIE: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6aca18e016f0a\" id=\"forminator-field-text-2_6aca18e016f0a-label\" class=\"forminator-label\">ADDRESS: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6aca18e016f0a\" id=\"forminator-field-text-3_6aca18e016f0a-label\" class=\"forminator-label\">POST CODE: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"5\" \/><span id=\"forminator-field-text-3_6aca18e016f0a-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6aca18e016f0a\" id=\"forminator-field-text-4_6aca18e016f0a-label\" class=\"forminator-label\">CITY:<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6aca18e016f0a\" id=\"forminator-field-phone-1_6aca18e016f0a-label\" class=\"forminator-label\">TELEPHONE: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6aca18e016f0a\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"disabled\" data-country=\"es\" data-validation=\"international\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6aca18e016f0a\" id=\"forminator-field-email-1_6aca18e016f0a-label\" class=\"forminator-label\">E-MAIL: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6aca18e016f0a\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-8982--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-8982--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"DATA\"\n\t\t\t\tdata-actual-label=\"ACCIDENT\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12  races\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-8-6aca18e016f0a-label\" class=\"forminator-label\">TYPE OF INSURANCE<\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-6aca18e016f0a\" class=\"forminator-radio\" title=\"Pleasure boats\"><input type=\"radio\" name=\"radio-8\" value=\"one\" id=\"forminator-field-radio-8-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Pleasure boats<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-6aca18e016f0a\" class=\"forminator-radio\" title=\"Home\"><input type=\"radio\" name=\"radio-8\" value=\"two\" id=\"forminator-field-radio-8-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Home<\/span><\/label><label id=\"forminator-field-radio-8-label-3\" for=\"forminator-field-radio-8-3-6aca18e016f0a\" class=\"forminator-radio\" title=\"Business\"><input type=\"radio\" name=\"radio-8\" value=\"Business\" id=\"forminator-field-radio-8-3-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Business<\/span><\/label><label id=\"forminator-field-radio-8-label-4\" for=\"forminator-field-radio-8-4-6aca18e016f0a\" class=\"forminator-radio\" title=\"Personal risk\"><input type=\"radio\" name=\"radio-8\" value=\"Personal-risk\" id=\"forminator-field-radio-8-4-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Personal risk<\/span><\/label><label id=\"forminator-field-radio-8-label-5\" for=\"forminator-field-radio-8-5-6aca18e016f0a\" class=\"forminator-radio\" title=\"Vehicle\"><input type=\"radio\" name=\"radio-8\" value=\"Vehicle\" id=\"forminator-field-radio-8-5-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Vehicle<\/span><\/label><label id=\"forminator-field-radio-8-label-6\" for=\"forminator-field-radio-8-6-6aca18e016f0a\" class=\"forminator-radio\" title=\"Civil liability\"><input type=\"radio\" name=\"radio-8\" value=\"Civil-liability\" id=\"forminator-field-radio-8-6-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-8-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Civil liability<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6aca18e016f0a\" id=\"forminator-field-text-7_6aca18e016f0a-label\" class=\"forminator-label\">DAY OF ACCIDENT: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"10\" aria-describedby=\"forminator-field-text-7_6aca18e016f0a-description\" \/><span id=\"forminator-field-text-7_6aca18e016f0a-description\" class=\"forminator-description\">DD\/MM\/AAAA<span data-limit=\"10\" data-type=\"characters\">0 \/ 10<\/span><\/span><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6aca18e016f0a\" id=\"forminator-field-text-8_6aca18e016f0a-label\" class=\"forminator-label\">TIME: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"5\" \/><span id=\"forminator-field-text-8_6aca18e016f0a-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6aca18e016f0a\" id=\"forminator-field-text-9_6aca18e016f0a-label\" class=\"forminator-label\">PLACE: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6aca18e016f0a\" id=\"forminator-field-text-5_6aca18e016f0a-label\" class=\"forminator-label\">INSURER:<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6aca18e016f0a\" id=\"forminator-field-text-6_6aca18e016f0a-label\" class=\"forminator-label\">POLICY NUMBER:<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12  races\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-10-6aca18e016f0a-label\" class=\"forminator-label\">Cause by:<\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6aca18e016f0a\" class=\"forminator-radio\" title=\"FIRE\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">FIRE<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6aca18e016f0a\" class=\"forminator-radio\" title=\"WATER\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">WATER<\/span><\/label><label id=\"forminator-field-radio-10-label-3\" for=\"forminator-field-radio-10-3-6aca18e016f0a\" class=\"forminator-radio\" title=\"VANDALISM\"><input type=\"radio\" name=\"radio-10\" value=\"VANDALISM\" id=\"forminator-field-radio-10-3-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">VANDALISM<\/span><\/label><label id=\"forminator-field-radio-10-label-4\" for=\"forminator-field-radio-10-4-6aca18e016f0a\" class=\"forminator-radio\" title=\"THEFT\"><input type=\"radio\" name=\"radio-10\" value=\"THEFT\" id=\"forminator-field-radio-10-4-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">THEFT<\/span><\/label><label id=\"forminator-field-radio-10-label-5\" for=\"forminator-field-radio-10-5-6aca18e016f0a\" class=\"forminator-radio\" title=\"ELECTRIC DAMAGE\"><input type=\"radio\" name=\"radio-10\" value=\"ELECTRIC-DAMAGE\" id=\"forminator-field-radio-10-5-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">ELECTRIC DAMAGE<\/span><\/label><label id=\"forminator-field-radio-10-label-6\" for=\"forminator-field-radio-10-6-6aca18e016f0a\" class=\"forminator-radio\" title=\"GLASS BREAKING\"><input type=\"radio\" name=\"radio-10\" value=\"GLASS-BREAKING\" id=\"forminator-field-radio-10-6-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">GLASS BREAKING<\/span><\/label><label id=\"forminator-field-radio-10-label-7\" for=\"forminator-field-radio-10-7-6aca18e016f0a\" class=\"forminator-radio\" title=\"ATMOSPHERIC PHENOMENA\"><input type=\"radio\" name=\"radio-10\" value=\"ATMOSPHERIC-PHENOMENA\" id=\"forminator-field-radio-10-7-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">ATMOSPHERIC PHENOMENA<\/span><\/label><label id=\"forminator-field-radio-10-label-8\" for=\"forminator-field-radio-10-8-6aca18e016f0a\" class=\"forminator-radio\" title=\"CIVIL LIABILITY\"><input type=\"radio\" name=\"radio-10\" value=\"CIVIL-LIABILITY\" id=\"forminator-field-radio-10-8-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">CIVIL LIABILITY<\/span><\/label><label id=\"forminator-field-radio-10-label-9\" for=\"forminator-field-radio-10-9-6aca18e016f0a\" class=\"forminator-radio\" title=\"COLLISION\"><input type=\"radio\" name=\"radio-10\" value=\"COLLISION\" id=\"forminator-field-radio-10-9-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-9\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">COLLISION<\/span><\/label><label id=\"forminator-field-radio-10-label-10\" for=\"forminator-field-radio-10-10-6aca18e016f0a\" class=\"forminator-radio\" title=\"OTHER CAUSES\"><input type=\"radio\" name=\"radio-10\" value=\"OTHER-CAUSES\" id=\"forminator-field-radio-10-10-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-10-label-10\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OTHER CAUSES<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6aca18e016f0a\" id=\"forminator-field-textarea-1_6aca18e016f0a-label\" class=\"forminator-label\">OTHER CAUSES DESCRIPTION:<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">List of affected items:<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6aca18e016f0a\" id=\"forminator-field-text-18_6aca18e016f0a-label\" class=\"forminator-label\">affected item:<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6aca18e016f0a\" id=\"forminator-field-number-1_6aca18e016f0a-label\" class=\"forminator-label\">years of service:<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6aca18e016f0a\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"0\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6aca18e016f0a\" id=\"forminator-field-upload-1_6aca18e016f0a-label\" class=\"forminator-label\">Attach a copy of the complaint filed with the authorities:<\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_6aca18e016f0a\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6aca18e016f0a\" class=\"forminator-input-file\" accept=\".avif,.heif,.heics,.heifs,.wav,.jpg,.jpeg,.jpe,.gif,.png,.bmp,.webp,.heic,.doc,.docx,.odt,.pages,.pdf,image\/avif,image\/heif,image\/heic-sequence,image\/heif-sequence,audio\/wav,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/webp,image\/heic,application\/msword,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.oasis.opendocument.text,application\/vnd.apple.pages,application\/pdf\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_6aca18e016f0a_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6aca18e016f0a\">Escolliu fitxer<\/button><span data-empty-text=\"Cap fitxer escollit\">Cap fitxer escollit<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-9-6aca18e016f0a-label\" class=\"forminator-label\">Is a third party responsible for the damage?: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6aca18e016f0a\" id=\"forminator-field-text-10_6aca18e016f0a-label\" class=\"forminator-label\">Driver\/pilot<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6aca18e016f0a\" id=\"forminator-field-phone-2_6aca18e016f0a-label\" class=\"forminator-label\">Telephone<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_6aca18e016f0a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"disabled\" data-country=\"es\" data-validation=\"international\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6aca18e016f0a\" id=\"forminator-field-text-11_6aca18e016f0a-label\" class=\"forminator-label\">Birthdate<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6aca18e016f0a\" id=\"forminator-field-text-12_6aca18e016f0a-label\" class=\"forminator-label\">Driving license date<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6aca18e016f0a\" id=\"forminator-field-textarea-2_6aca18e016f0a-label\" class=\"forminator-label\">Version and circumstances of the events: <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6aca18e016f0a\" id=\"forminator-field-textarea-3_6aca18e016f0a-label\" class=\"forminator-label\">TYPE OF DAMAGE (MATERIAL AND PERSONAL) ESTIMATED TO HAVE BEEN CAUSED\/SUFFERED AND APPROXIMATE VALUE OF THE PROPERTY: <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" aria-describedby=\"forminator-field-textarea-3_6aca18e016f0a-description\" ><\/textarea><span id=\"forminator-field-textarea-3_6aca18e016f0a-description\" class=\"forminator-description\">WE RECOMMEND TAKING PHOTOS OF THE DAMAGE<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-6-6aca18e016f0a-label\" class=\"forminator-label\">Is a third party responsible for the damage?: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6aca18e016f0a\" id=\"forminator-field-textarea-4_6aca18e016f0a-label\" class=\"forminator-label\">Details of the third party causer: <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" aria-describedby=\"forminator-field-textarea-4_6aca18e016f0a-description\" ><\/textarea><span id=\"forminator-field-textarea-4_6aca18e016f0a-description\" class=\"forminator-description\">DETAILS OF OTHER PERSON INVOLVED (VEHICLE REGISTRATION, ADDRESS, ETC.), DETAILS OF INSURANCE COMPANY, DESCRIPTION OF VISIBLE DAMAGE, DRIVER'S DETAIL<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-7-6aca18e016f0a-label\" class=\"forminator-label\">Have you caused damage to a third party?: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_6aca18e016f0a\" id=\"forminator-field-textarea-8_6aca18e016f0a-label\" class=\"forminator-label\">Details of the injured third party: <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6aca18e016f0a\" id=\"forminator-field-text-19_6aca18e016f0a-label\" class=\"forminator-label\">Relationship to the insured and approximate age:<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-2-6aca18e016f0a-label\" class=\"forminator-label\">INJURED PERSONS: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">INJURED PERSONS DATA:<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add injured&quot;,&quot;remove_text&quot;:&quot;Remove injured&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6aca18e016f0a\" id=\"forminator-field-text-13_6aca18e016f0a-label\" class=\"forminator-label\">Full name:<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6aca18e016f0a\" id=\"forminator-field-text-14_6aca18e016f0a-label\" class=\"forminator-label\">Address:<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6aca18e016f0a\" id=\"forminator-field-text-15_6aca18e016f0a-label\" class=\"forminator-label\">Postal Code:<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"5\" \/><span id=\"forminator-field-text-15_6aca18e016f0a-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/div><\/div><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6aca18e016f0a\" id=\"forminator-field-text-16_6aca18e016f0a-label\" class=\"forminator-label\">City:<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add injured\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove injured\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6aca18e016f0a\" id=\"forminator-field-textarea-5_6aca18e016f0a-label\" class=\"forminator-label\">DETAILS OF INJURY:<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6aca18e016f0a\" id=\"forminator-field-text-20_6aca18e016f0a-label\" class=\"forminator-label\">Medical assistance provided:<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6aca18e016f0a\" id=\"forminator-field-text-21_6aca18e016f0a-label\" class=\"forminator-label\">Means used to transport the injured person:<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6aca18e016f0a\" id=\"forminator-field-text-22_6aca18e016f0a-label\" class=\"forminator-label\">Medical center to which he was transferred:<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-3-6aca18e016f0a-label\" class=\"forminator-label\">WITNESS(ES): <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Witness details:<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add injured&quot;,&quot;remove_text&quot;:&quot;Remove injured&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-26\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-26_6aca18e016f0a\" id=\"forminator-field-text-26_6aca18e016f0a-label\" class=\"forminator-label\">Full name:<\/label><input type=\"text\" name=\"text-26\" value=\"\" placeholder=\"\" id=\"forminator-field-text-26_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-25\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-25_6aca18e016f0a\" id=\"forminator-field-text-25_6aca18e016f0a-label\" class=\"forminator-label\">Address:<\/label><input type=\"text\" name=\"text-25\" value=\"\" placeholder=\"\" id=\"forminator-field-text-25_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6aca18e016f0a\" id=\"forminator-field-text-23_6aca18e016f0a-label\" class=\"forminator-label\">Postal Code:<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"5\" \/><span id=\"forminator-field-text-23_6aca18e016f0a-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/div><\/div><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_6aca18e016f0a\" id=\"forminator-field-text-24_6aca18e016f0a-label\" class=\"forminator-label\">City:<\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add injured\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove injured\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-4-6aca18e016f0a-label\" class=\"forminator-label\">THE AUTHORITY INTERVENED: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6aca18e016f0a\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6aca18e016f0a\" id=\"forminator-field-textarea-7_6aca18e016f0a-label\" class=\"forminator-label\">AUTHORITY\/COURT INVOLVED:<\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-27\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-27_6aca18e016f0a\" id=\"forminator-field-text-27_6aca18e016f0a-label\" class=\"forminator-label\">Repair location:<\/label><input type=\"text\" name=\"text-27\" value=\"\" placeholder=\"\" id=\"forminator-field-text-27_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-28\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-28_6aca18e016f0a\" id=\"forminator-field-text-28_6aca18e016f0a-label\" class=\"forminator-label\">Contact person for expert assessment:<\/label><input type=\"text\" name=\"text-28\" value=\"\" placeholder=\"\" id=\"forminator-field-text-28_6aca18e016f0a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_6aca18e016f0a\" id=\"forminator-field-upload-2_6aca18e016f0a-label\" class=\"forminator-label\">Submission of documents:<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-2_6aca18e016f0a\" aria-describedby=\"forminator-field-upload-2_6aca18e016f0a-description\"><input type=\"file\" name=\"upload-2[]\" id=\"forminator-field-upload-2_6aca18e016f0a\" class=\"forminator-input-file forminator-field-upload-2_6aca18e016f0a-8982\" multiple=\"multiple\" data-method=\"ajax\" accept=\".avif,.heif,.heics,.heifs,.wav,.jpg,.jpeg,.jpe,.gif,.png,.bmp,.heic,.webp,.doc,.docx,.odt,.pages,.pdf,image\/avif,image\/heif,image\/heic-sequence,image\/heif-sequence,audio\/wav,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/heic,image\/webp,application\/msword,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.oasis.opendocument.text,application\/vnd.apple.pages,application\/pdf\" data-size=\"8388608\" data-size-message=\"Maximum file size allowed is 8 MB. \" data-filetype=\"avif|heif|heics|heifs|wav|jpg|jpeg|jpe|gif|png|bmp|heic|webp|doc|docx|odt|pages|pdf\" data-filetype-message=\"file extension is not allowed.\"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Arrosegar i llan\u00e7ar (o) <a class=\"forminator-upload-file--forminator-field-upload-2_6aca18e016f0a\" href=\"#\" onclick=\"return false;\">Escolliu fitxers<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-2_6aca18e016f0a-description\" class=\"forminator-description\">(REPORT FORM, AMICABLE ACCIDENT REPORT, WITNESS STATEMENT, ETC.)<\/span><ul class=\"forminator-uploaded-files upload-container-upload-2_6aca18e016f0a\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-9_6aca18e016f0a\" id=\"forminator-field-textarea-9_6aca18e016f0a-label\" class=\"forminator-label\">COMMENTS:<\/label><textarea name=\"textarea-9\" placeholder=\"\" id=\"forminator-field-textarea-9_6aca18e016f0a\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" aria-describedby=\"forminator-field-textarea-9_6aca18e016f0a-description\" ><\/textarea><span id=\"forminator-field-textarea-9_6aca18e016f0a-description\" class=\"forminator-description\">PRESENT WHAT YOU CONSIDER RELEVANT TO THE CASE.<\/span><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-8982--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-8982--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"ACCIDENT\"\n\t\t\t\tdata-actual-label=\"CONTACT\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6aca18e016f0a-label\"><span id=\"forminator-radiogroup-radio-5-6aca18e016f0a-label\" class=\"forminator-label\">FOR FURTHER CLARIFICATION, CONTACT BY: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6aca18e016f0a\" class=\"forminator-radio\" title=\"E-MAIL\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">E-MAIL<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6aca18e016f0a\" class=\"forminator-radio\" title=\"PHONE\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PHONE<\/span><\/label><label id=\"forminator-field-radio-5-label-3\" for=\"forminator-field-radio-5-3-6aca18e016f0a\" class=\"forminator-radio\" title=\"MAIL\"><input type=\"radio\" name=\"radio-5\" value=\"CORREU-POSTAL\" id=\"forminator-field-radio-5-3-6aca18e016f0a\" aria-labelledby=\"forminator-field-radio-5-label-3\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">MAIL<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6aca18e016f0a\" id=\"forminator-field-consent-1_6aca18e016f0a-label\" class=\"forminator-label\">I Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6aca18e016f0a__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6aca18e016f0a\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6aca18e016f0a-label\" aria-describedby=\"forminator-field-consent-1_6aca18e016f0a__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6aca18e016f0a__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I CONFIRM THAT I ACCEPT THE\u00a0<a href=\"#link-popup\">PRIVACY POLICY<\/a>\u00a0OF THIS WEBSITE IN ORDER FOR YOU TO BE ABLE TO RESPOND TO MY REQUEST<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"hidden-1\" class=\"forminator-field-hidden  forminator-col-12 \"><input type=\"hidden\" id=\"hidden-1_6aca18e016f0a\" name=\"hidden-1\" value=\"\" \/><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"hidden-2\" class=\"forminator-field-hidden  forminator-col-12 \"><input type=\"hidden\" id=\"hidden-2_6aca18e016f0a\" name=\"hidden-2\" value=\"\" \/><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Send form<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"e6fe58e0ca\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index_beta.php\/wp-json\/wp\/v2\/pages\/8995\" \/><input type=\"hidden\" name=\"form_id\" value=\"8982\"><input type=\"hidden\" name=\"page_id\" value=\"8995\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/dunach.com\/index_beta.php\/accident-report\/?lang=en\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c10ba54 elementor-widget elementor-widget-html\" data-id=\"c10ba54\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"text\/javascript\">\r\nwindow.addEventListener(\"load\", function() {\r\nconst cobertura = document.getElementsByName(\"text-1\");;\r\nconst nif = document.getElementsByName(\"text-17\");\r\nconst addr = document.getElementsByName(\"text-2\");\r\nconst cp = document.getElementsByName(\"text-3\");\r\nconst pobl = document.getElementsByName(\"text-4\");\r\nconst phon = document.getElementsByName(\"phone-1\");\r\nconst ema = document.getElementsByName(\"email-1\");\r\n\r\n\/\/ alternative is to use \"change\" - explained below\r\ncobertura[0].addEventListener(\"keyup\", buttonState);\r\n\r\nfunction buttonState() {\r\n    if (cobertura[0].value.toLowerCase() === \"broker\") {\r\n        nif[0].value = \"12345678A\";\r\n        addr[0].value = \"C\/ Nou, 123\";\r\n        cp[0].value = 17487;\r\n        pobl[0].value =\"Empuriabrava\";\r\n        phon[0].value = \"+34972450430\";\r\n        ema[0].value = \"broker@dunach.com\";\r\n    }}});\r\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-b00e29f\" data-id=\"b00e29f\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d2658ba elementor-widget elementor-widget-template\" data-id=\"d2658ba\" data-element_type=\"widget\" data-settings=\"{&quot;sticky&quot;:&quot;top&quot;,&quot;sticky_offset&quot;:330,&quot;sticky_effects_offset&quot;:200,&quot;sticky_parent&quot;:&quot;yes&quot;,&quot;sticky_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;],&quot;sticky_anchor_link_offset&quot;:0}\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"section\" data-elementor-id=\"1965\" class=\"elementor elementor-1965\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b7952de franja-lateral-contacte elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b7952de\" 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-9e7b5e4\" data-id=\"9e7b5e4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-68ab834 elementor-widget elementor-widget-spacer\" data-id=\"68ab834\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c897f95 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"c897f95\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-comments\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">voleu contactar-nos?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-471adda elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"471adda\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-17957a5\" data-id=\"17957a5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-079f24a elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"079f24a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Oficina Empuriabrava \/ <br>Castell\u00f3 d'Emp\u00faries<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1758c20 elementor-widget elementor-widget-spacer\" data-id=\"1758c20\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-735138c elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"735138c\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"tel:972450430\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">972 45 04 30<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb1510d elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"cb1510d\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"mailto:broker@dunach.com\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-envelope\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">broker@dunach.com<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cc2fd95 elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"cc2fd95\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"https:\/\/www.google.com\/maps\/dir\/\/Du\u00f1ach+S.A.+Corredoria+d&#039;Assegurances,+Carrer+de+Sant+Mor\u00ed,+14,+Bajo,+17487+Empuriabrava,+Girona\/@42.241695,3.0877434,13z\/data=!3m1!4b1!4m8!4m7!1m0!1m5!1m1!1s0x12ba61b0ce87c3e5:0xf5316c2e78113760!2m2!1d3.1228485!2d42.2417004\" target=\"_blank\" rel=\"nofollow\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marker-alt\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Com arribar<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-405aaab elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"405aaab\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4210322\" data-id=\"4210322\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-089ca2b elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"089ca2b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Oficina roses<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ae99ddc elementor-widget elementor-widget-spacer\" data-id=\"ae99ddc\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68abc79 elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"68abc79\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"tel:972257322\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">972 25 73 22<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39bac28 elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"39bac28\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"mailto:broker@dunach.com\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-envelope\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">broker@dunach.com<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-313117e elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"313117e\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"https:\/\/www.google.com\/maps\/dir\/\/Du\u00f1ach+S.A.+Corredoria+d&#039;Assegurances,+Av.+de+Rhode,+89,+17480+Roses,+Girona\/@42.2531743,3.1129588,13z\/data=!4m8!4m7!1m0!1m5!1m1!1s0x12ba6153d851d44d:0x660b32b34718eaae!2m2!1d3.1731079!2d42.2646588\" target=\"_blank\" rel=\"nofollow\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marker-alt\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Com arribar<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>ACCIDENT REPORT Fill in this form and we will get in touch with you<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-8995","page","type-page","status-publish"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>ACCIDENT REPORT - Dunach<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" 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