{"id":9223,"date":"2023-06-30T10:27:28","date_gmt":"2023-06-30T08:27:28","guid":{"rendered":"https:\/\/dunach.com\/index_beta.php?page_id=9223"},"modified":"2025-07-23T11:47:14","modified_gmt":"2025-07-23T10:47:14","slug":"daily-allowance","status":"publish","type":"page","link":"https:\/\/dunach.com\/index_beta.php\/quotation\/individuals\/daily-allowance\/?lang=en","title":{"rendered":"daily allowance insurance quote"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9223\" class=\"elementor elementor-9223 elementor-9221\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4393e93 elementor-section-full_width elementor-section-height-min-height elementor-section-height-default elementor-section-items-middle\" data-id=\"4393e93\" 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-6b75e63\" data-id=\"6b75e63\" 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-ed9c48b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ed9c48b\" 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-f5a2280\" data-id=\"f5a2280\" 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-578bce0 elementor-widget elementor-widget-heading\" data-id=\"578bce0\" 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\">DAILY ALLOWANCE INSURANCE QUOTE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7006946 elementor-widget elementor-widget-heading\" data-id=\"7006946\" 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\">A daily amount for each day that the insured person is on sick leave or sickness. Extendable to accident leave, hospitalisation allowance or ICU stay<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ea2019 elementor-widget elementor-widget-heading\" data-id=\"3ea2019\" 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\">Ideal for self-employed individuals and workers with variable compensation. A daily amount for each day that the insured person is on sick leave or sickness. Expandable to accidents, hospitalization subsidy or stay in ICU. Provides a supplement to compensate for the reduction that the Social Security benefit entails when on sick leave.   <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4fcb9ba elementor-widget elementor-widget-heading\" data-id=\"4fcb9ba\" 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\">Remember: in the case of temporary leave due to illness or non-professional accident, there is no benefit for the first 3 days. From the 4th to the 20th day, Social Security only pays you 60% of the base, and from the 21st day onwards, 75%. <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-34b7def elementor-widget elementor-widget-heading\" data-id=\"34b7def\" 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\">&nbsp;<\/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-a20dc83\" data-id=\"a20dc83\" 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-49d16b6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"49d16b6\" 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-da1e5df\" data-id=\"da1e5df\" 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-e0553a2 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"e0553a2\" 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-sm\" href=\"#llista-cobertures\">\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-caret-down\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">WHAT COVERAGE DO WE OFFER?<\/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-4480664 elementor-widget elementor-widget-shortcode\" data-id=\"4480664\" 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-9208 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-9208\" data-uid=\"6aca22a720021\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-9208\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-9208 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=\"9208\"\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=\"6aca22a720021\"\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-9208--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-9208--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"CONTACTE\"\n\t\t\t\tdata-actual-label=\"DADES DEL PRENEDOR DE L&#039;ASSEGURAN\u00c7A\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p style=\"color: #0081c6\"><strong>DADES DEL PRENEDOR<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6aca22a720021\" id=\"forminator-field-text-1_6aca22a720021-label\" class=\"forminator-label\">Nom i cognoms: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6aca22a720021\" 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-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6aca22a720021\" id=\"forminator-field-text-2_6aca22a720021-label\" class=\"forminator-label\">NIF\/CIF\/NIE: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"9\" \/><span id=\"forminator-field-text-2_6aca22a720021-description\" class=\"forminator-description\"><span data-limit=\"9\" data-type=\"characters\">0 \/ 9<\/span><\/span><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6aca22a720021\" id=\"forminator-field-text-3_6aca22a720021-label\" class=\"forminator-label\">DATA DE NAIXEMENT: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"10\" aria-describedby=\"forminator-field-text-3_6aca22a720021-description\" \/><span id=\"forminator-field-text-3_6aca22a720021-description\" class=\"forminator-description\">DD\/MM\/AAAA<span data-limit=\"10\" data-type=\"characters\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6aca22a720021\" id=\"forminator-field-text-4_6aca22a720021-label\" class=\"forminator-label\">ADRE\u00c7A: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6aca22a720021\" 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_6aca22a720021\" id=\"forminator-field-text-5_6aca22a720021-label\" class=\"forminator-label\">CODI POSTAL: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"5\" \/><span id=\"forminator-field-text-5_6aca22a720021-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/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_6aca22a720021\" id=\"forminator-field-text-6_6aca22a720021-label\" class=\"forminator-label\">POBLACI\u00d3: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/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_6aca22a720021\" id=\"forminator-field-phone-1_6aca22a720021-label\" class=\"forminator-label\">TEL\u00c8FON: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6aca22a720021\" 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_6aca22a720021\" id=\"forminator-field-email-1_6aca22a720021-label\" class=\"forminator-label\">ADRE\u00c7A E-MAIL: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6aca22a720021\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><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-5-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-5-6aca22a720021-label\" class=\"forminator-label\">L&#039;ASSEGURAT \u00c9S EL PRENEDOR DE L&#039;ASSEGURAN\u00c7A?<\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"Si, amb altres assegurats\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-6aca22a720021\" 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\">Si, amb altres assegurats<\/span><\/label><label id=\"forminator-field-radio-5-label-3\" for=\"forminator-field-radio-5-3-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"No\" id=\"forminator-field-radio-5-3-6aca22a720021\" 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\">No<\/span><\/label><\/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-9208--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-9208--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"DADES DEL PRENEDOR DE L&#039;ASSEGURAN\u00c7A\"\n\t\t\t\tdata-actual-label=\"DADES DE L&#039;ASSEGURAT\"\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=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p style=\"color: #0081c6\"><strong>DADES DE L'ASSEGURAT I PRENEDOR<\/strong><\/p><\/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-3-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-3-6aca22a720021-label\" class=\"forminator-label\">SEXE <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6aca22a720021\" class=\"forminator-radio\" title=\"HOME\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">HOME<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6aca22a720021\" class=\"forminator-radio\" title=\"DONA\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">DONA<\/span><\/label><\/div><\/div><\/div><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_6aca22a720021\" id=\"forminator-field-text-13_6aca22a720021-label\" class=\"forminator-label\">PROFESSI\u00d3 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-13_6aca22a720021-description\" \/><span id=\"forminator-field-text-13_6aca22a720021-description\" class=\"forminator-description\">CAL DECLARAR LA DE MAJOR RISC SI S\u00d3N M\u00c9S D'UNA<\/span><\/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_6aca22a720021\" id=\"forminator-field-textarea-4_6aca22a720021-label\" class=\"forminator-label\">COMENTARIS SOBRE LA PROFESSI\u00d3:<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6aca22a720021\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/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-6-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-6-6aca22a720021-label\" class=\"forminator-label\">Condueix motocicletes?<\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6aca22a720021\" 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\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6aca22a720021\" 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=\"number-5\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-5_6aca22a720021\" id=\"forminator-field-number-5_6aca22a720021-label\" class=\"forminator-label\">Indicar cilindrada:<\/label><input name=\"number-5\" value=\"\" placeholder=\"\" id=\"forminator-field-number-5_6aca22a720021\" 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\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-22\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-22-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-22-6aca22a720021-label\" class=\"forminator-label\">Practica algun esport de risc?<\/span><label id=\"forminator-field-radio-22-label-1\" for=\"forminator-field-radio-22-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-22\" value=\"one\" id=\"forminator-field-radio-22-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-22-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-22-label-2\" for=\"forminator-field-radio-22-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-22\" value=\"two\" id=\"forminator-field-radio-22-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-22-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-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6aca22a720021\" id=\"forminator-field-textarea-5_6aca22a720021-label\" class=\"forminator-label\">COMENTARIS SOBRE ESPORTS QUE PRACTICA:<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6aca22a720021\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-20\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-20-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-20-6aca22a720021-label\" class=\"forminator-label\">HA ESTAT ASSEGURAT FINS ARA EN UNA ALTRA ENTITAT?:<\/span><label id=\"forminator-field-radio-20-label-1\" for=\"forminator-field-radio-20-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00cd\"><input type=\"radio\" name=\"radio-20\" value=\"one\" id=\"forminator-field-radio-20-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-20-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00cd<\/span><\/label><label id=\"forminator-field-radio-20-label-2\" for=\"forminator-field-radio-20-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"NO\"><input type=\"radio\" name=\"radio-20\" value=\"two\" id=\"forminator-field-radio-20-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-20-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-16\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6aca22a720021\" id=\"forminator-field-text-16_6aca22a720021-label\" class=\"forminator-label\">NOM DE L&#039;ENTITAT: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/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_6aca22a720021\" id=\"forminator-field-upload-1_6aca22a720021-label\" class=\"forminator-label\">C\u00d2PIA DE LA P\u00d2LISSA I DARRER REBUT:<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_6aca22a720021\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_6aca22a720021\" class=\"forminator-input-file forminator-field-upload-1_6aca22a720021-9208\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8388608\" data-size-message=\"Maximum file size allowed is 8 MB. \"><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-1_6aca22a720021\" href=\"#\" onclick=\"return false;\">Escolliu fitxers<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-1_6aca22a720021\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12  grup\"><label class=\"forminator-label forminator-repeater-label\">DADES DE L&#039;ASSEGURAT (diferent del prenedor)<\/label><div class=\"forminator-all-group-copies\"><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;:4,&quot;add_text&quot;:&quot;AFEGIR ASSEGURAT&quot;,&quot;remove_text&quot;:&quot;ELIMINAR ASSEGURAT&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6aca22a720021\" id=\"forminator-field-text-7_6aca22a720021-label\" class=\"forminator-label\">NOM I COGNOMS: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6aca22a720021\" id=\"forminator-field-text-8_6aca22a720021-label\" class=\"forminator-label\">NIF: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"9\" \/><span id=\"forminator-field-text-8_6aca22a720021-description\" class=\"forminator-description\"><span data-limit=\"9\" data-type=\"characters\">0 \/ 9<\/span><\/span><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6aca22a720021\" id=\"forminator-field-text-9_6aca22a720021-label\" class=\"forminator-label\">DATA DE NAIXEMENT: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"10\" aria-describedby=\"forminator-field-text-9_6aca22a720021-description\" \/><span id=\"forminator-field-text-9_6aca22a720021-description\" class=\"forminator-description\">DD\/MM\/AAAA<span data-limit=\"10\" data-type=\"characters\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6aca22a720021\" id=\"forminator-field-text-10_6aca22a720021-label\" class=\"forminator-label\">ADRE\u00c7A: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6aca22a720021\" id=\"forminator-field-text-14_6aca22a720021-label\" class=\"forminator-label\">CODI POSTAL: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"5\" \/><span id=\"forminator-field-text-14_6aca22a720021-description\" class=\"forminator-description\"><span data-limit=\"5\" data-type=\"characters\">0 \/ 5<\/span><\/span><\/div><\/div><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6aca22a720021\" id=\"forminator-field-text-15_6aca22a720021-label\" class=\"forminator-label\">POBLACI\u00d3: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6aca22a720021\" id=\"forminator-field-phone-2_6aca22a720021-label\" class=\"forminator-label\">Tel\u00e8fon <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_6aca22a720021\" 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-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6aca22a720021\" id=\"forminator-field-email-2_6aca22a720021-label\" class=\"forminator-label\">ADRE\u00c7A E-MAIL: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6aca22a720021\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/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-2-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-2-6aca22a720021-label\" class=\"forminator-label\">SEXE <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6aca22a720021\" class=\"forminator-radio\" title=\"HOME\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\" checked=\"checked\" \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">HOME<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6aca22a720021\" class=\"forminator-radio\" title=\"DONA\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">DONA<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6aca22a720021\" id=\"forminator-field-text-11_6aca22a720021-label\" class=\"forminator-label\">PROFESSI\u00d3: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-11_6aca22a720021-description\" \/><span id=\"forminator-field-text-11_6aca22a720021-description\" class=\"forminator-description\">CAL DECLARAR LA DE MAJOR RISC SI S\u00d3N M\u00c9S D'UNA<\/span><\/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_6aca22a720021\" id=\"forminator-field-textarea-1_6aca22a720021-label\" class=\"forminator-label\">COMENTARIS SOBRE LA PROFESSI\u00d3:<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6aca22a720021\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/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-7-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-7-6aca22a720021-label\" class=\"forminator-label\">Condueix motocicletes?<\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6aca22a720021\" 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\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6aca22a720021\" 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=\"radio-23\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-23-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-23-6aca22a720021-label\" class=\"forminator-label\">Practica algun esport de risc?<\/span><label id=\"forminator-field-radio-23-label-1\" for=\"forminator-field-radio-23-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-23\" value=\"one\" id=\"forminator-field-radio-23-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-23-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-23-label-2\" for=\"forminator-field-radio-23-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-23\" value=\"two\" id=\"forminator-field-radio-23-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-23-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-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6aca22a720021\" id=\"forminator-field-textarea-2_6aca22a720021-label\" class=\"forminator-label\">COMENTARIS SOBRE ESPORTS QUE PRACTICA:<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6aca22a720021\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-21\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-21-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-21-6aca22a720021-label\" class=\"forminator-label\">HA ESTAT ASSEGURAT FINS ARA EN UNA ALTRA ENTITAT?:<\/span><label id=\"forminator-field-radio-21-label-1\" for=\"forminator-field-radio-21-1-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"S\u00cd\"><input type=\"radio\" name=\"radio-21\" value=\"one\" id=\"forminator-field-radio-21-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-21-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00cd<\/span><\/label><label id=\"forminator-field-radio-21-label-2\" for=\"forminator-field-radio-21-2-6aca22a720021\" class=\"forminator-radio forminator-radio-inline\" title=\"NO\"><input type=\"radio\" name=\"radio-21\" value=\"two\" id=\"forminator-field-radio-21-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-21-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-17\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6aca22a720021\" id=\"forminator-field-text-17_6aca22a720021-label\" class=\"forminator-label\">NOM DE L&#039;ENTITAT: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/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_6aca22a720021\" id=\"forminator-field-upload-2_6aca22a720021-label\" class=\"forminator-label\">C\u00d2PIA DE LA P\u00d2LISSA I DARRER REBUT:<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-2_6aca22a720021\"><input type=\"file\" name=\"upload-2[]\" id=\"forminator-field-upload-2_6aca22a720021\" class=\"forminator-input-file forminator-field-upload-2_6aca22a720021-9208\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8388608\" data-size-message=\"Maximum file size allowed is 8 MB. \"><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_6aca22a720021\" href=\"#\" onclick=\"return false;\">Escolliu fitxers<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-2_6aca22a720021\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-6\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-6_6aca22a720021\" id=\"forminator-field-number-6_6aca22a720021-label\" class=\"forminator-label\">Indiqui cilindrada<\/label><input name=\"number-6\" value=\"\" placeholder=\"\" id=\"forminator-field-number-6_6aca22a720021\" 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\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"AFEGIR ASSEGURAT\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"ELIMINAR ASSEGURAT\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/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-9208--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-9208--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"DADES DE L&#039;ASSEGURAT\"\n\t\t\t\tdata-actual-label=\"COBERTURES I CAPITALS\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><p style=\"color: #0081c6\"><strong>COBERTURES I CAPITALS CONTRACTATS ASSEGURAT<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_6aca22a720021\" id=\"forminator-field-currency-1_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER MALALTIA (EN \u20ac) <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-1_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-12\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-12-6aca22a720021-label\" aria-describedby=\"forminator-radiogroup-radio-12-6aca22a720021-description\"><span id=\"forminator-radiogroup-radio-12-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-12-label-1\" for=\"forminator-field-radio-12-1-6aca22a720021\" class=\"forminator-radio\" title=\"BAREMADA\"><input type=\"radio\" name=\"radio-12\" value=\"one\" id=\"forminator-field-radio-12-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-12-label-1\" data-calculation=\"0\" checked=\"checked\"  aria-describedby=\"forminator-field-radio-12-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">BAREMADA<\/span><\/label><label id=\"forminator-field-radio-12-label-2\" for=\"forminator-field-radio-12-2-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: SENSE FRANQU\u00cdCIA\"><input type=\"radio\" name=\"radio-12\" value=\"two\" id=\"forminator-field-radio-12-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-12-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-12-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: SENSE FRANQU\u00cdCIA<\/span><\/label><label id=\"forminator-field-radio-12-label-3\" for=\"forminator-field-radio-12-3-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES\"><input type=\"radio\" name=\"radio-12\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-7-D\u00cdES\" id=\"forminator-field-radio-12-3-6aca22a720021\" aria-labelledby=\"forminator-field-radio-12-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-12-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-12-label-4\" for=\"forminator-field-radio-12-4-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES\"><input type=\"radio\" name=\"radio-12\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-14-D\u00cdES\" id=\"forminator-field-radio-12-4-6aca22a720021\" aria-labelledby=\"forminator-field-radio-12-label-4\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-12-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-12-label-5\" for=\"forminator-field-radio-12-5-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP\"><input type=\"radio\" name=\"radio-12\" value=\"NO-BAREMADA:-DIES-ESPECICATS-AL-SEG\u00dcENT-CAMP\" id=\"forminator-field-radio-12-5-6aca22a720021\" aria-labelledby=\"forminator-field-radio-12-label-5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-12-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP<\/span><\/label><span id=\"forminator-radiogroup-radio-12-6aca22a720021-description\" class=\"forminator-description\">Baremada: La p\u00f2lissa incorpora un barem que estableix els dies de baixa que corresponen a cada patolog\u00eda. En les modalitats \"no baremades\", en canvi, els dies de baixa s'estableixen a partir dels certificats m\u00e8dics de baixa i d'alta.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6aca22a720021\" id=\"forminator-field-number-1_6aca22a720021-label\" class=\"forminator-label\">N\u00daMERO DE D\u00cdES DE LA FRANQU\u00cdCIA<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6aca22a720021\" 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;\" type=\"number\" step=\"any\" min=\"1\" max=\"365\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><p style=\"color: #0081c6\"><strong>Cobertures opcionals i complement\u00e0ries<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-21\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-21_6aca22a720021\" id=\"forminator-field-currency-21_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER ACCIDENT (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-21\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-21_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-13-6aca22a720021-label\" aria-describedby=\"forminator-radiogroup-radio-13-6aca22a720021-description\"><span id=\"forminator-radiogroup-radio-13-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-6aca22a720021\" class=\"forminator-radio\" title=\"BAREMADA\"><input type=\"radio\" name=\"radio-13\" value=\"one\" id=\"forminator-field-radio-13-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\" checked=\"checked\"  aria-describedby=\"forminator-field-radio-13-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">BAREMADA<\/span><\/label><label id=\"forminator-field-radio-13-label-2\" for=\"forminator-field-radio-13-2-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: SENSE FRANQU\u00cdCIA\"><input type=\"radio\" name=\"radio-13\" value=\"two\" id=\"forminator-field-radio-13-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-13-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-13-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: SENSE FRANQU\u00cdCIA<\/span><\/label><label id=\"forminator-field-radio-13-label-3\" for=\"forminator-field-radio-13-3-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES\"><input type=\"radio\" name=\"radio-13\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-7-D\u00cdES\" id=\"forminator-field-radio-13-3-6aca22a720021\" aria-labelledby=\"forminator-field-radio-13-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-13-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-13-label-4\" for=\"forminator-field-radio-13-4-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES\"><input type=\"radio\" name=\"radio-13\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-14-D\u00cdES\" id=\"forminator-field-radio-13-4-6aca22a720021\" aria-labelledby=\"forminator-field-radio-13-label-4\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-13-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-13-label-5\" for=\"forminator-field-radio-13-5-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP\"><input type=\"radio\" name=\"radio-13\" value=\"NO-BAREMADA:-DIES-ESPECICATS-AL-SEG\u00dcENT-CAMP\" id=\"forminator-field-radio-13-5-6aca22a720021\" aria-labelledby=\"forminator-field-radio-13-label-5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-13-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP<\/span><\/label><span id=\"forminator-radiogroup-radio-13-6aca22a720021-description\" class=\"forminator-description\">Baremada: La p\u00f2lissa incorpora un barem que estableix els dies de baixa que corresponen a cada patolog\u00eda. En les modalitats \"no baremades\", en canvi, els dies de baixa s'estableixen a partir dels certificats m\u00e8dics de baixa i d'alta.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6aca22a720021\" id=\"forminator-field-number-2_6aca22a720021-label\" class=\"forminator-label\">N\u00daMERO DE D\u00cdES DE LA FRANQU\u00cdCIA<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6aca22a720021\" 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;\" type=\"number\" step=\"any\" min=\"1\" max=\"365\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-22\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-22_6aca22a720021\" id=\"forminator-field-currency-22_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER HOSPITALITZACI\u00d3 (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-22\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-22_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-14\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-14-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-14-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-14-label-1\" for=\"forminator-field-radio-14-1-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA\"><input type=\"radio\" name=\"radio-14\" value=\"one\" id=\"forminator-field-radio-14-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-14-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA<\/span><\/label><label id=\"forminator-field-radio-14-label-2\" for=\"forminator-field-radio-14-2-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA I ACCIDENT\"><input type=\"radio\" name=\"radio-14\" value=\"two\" id=\"forminator-field-radio-14-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-14-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA I ACCIDENT<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-23\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-23_6aca22a720021\" id=\"forminator-field-currency-23_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER ESTADA EN UCI (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-23\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-23_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-15\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-15-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-15-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-15-label-1\" for=\"forminator-field-radio-15-1-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA\"><input type=\"radio\" name=\"radio-15\" value=\"one\" id=\"forminator-field-radio-15-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-15-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA<\/span><\/label><label id=\"forminator-field-radio-15-label-2\" for=\"forminator-field-radio-15-2-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA I ACCIDENT\"><input type=\"radio\" name=\"radio-15\" value=\"two\" id=\"forminator-field-radio-15-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-15-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA I ACCIDENT<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12  grup\"><label class=\"forminator-label forminator-repeater-label\">COBERTURES I CAPITALS CONTRACTATS ASSEGURAT (DIFERENT DEL PRENEDOR)<\/label><div class=\"forminator-all-group-copies\"><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;:4,&quot;add_text&quot;:&quot;Afegir assegurat&quot;,&quot;remove_text&quot;:&quot;Eliminar assegurat&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_6aca22a720021\" id=\"forminator-field-text-18_6aca22a720021-label\" class=\"forminator-label\">NOM ASSEGURAT (DIFERENT DEL PRENEDOR): <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6aca22a720021\" id=\"forminator-field-text-19_6aca22a720021-label\" class=\"forminator-label\">NIF ASSEGURAT (DIFERENT DEL PRENEDOR): <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6aca22a720021\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"9\" \/><span id=\"forminator-field-text-19_6aca22a720021-description\" class=\"forminator-description\"><span data-limit=\"9\" data-type=\"characters\">0 \/ 9<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-24\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-24_6aca22a720021\" id=\"forminator-field-currency-24_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER MALALTIA (EN \u20ac) <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-24\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-24_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-16\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-16-6aca22a720021-label\" aria-describedby=\"forminator-radiogroup-radio-16-6aca22a720021-description\"><span id=\"forminator-radiogroup-radio-16-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-16-label-1\" for=\"forminator-field-radio-16-1-6aca22a720021\" class=\"forminator-radio\" title=\"BAREMADA\"><input type=\"radio\" name=\"radio-16\" value=\"one\" id=\"forminator-field-radio-16-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-16-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-16-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">BAREMADA<\/span><\/label><label id=\"forminator-field-radio-16-label-2\" for=\"forminator-field-radio-16-2-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: SENSE FRANQU\u00cdCIA\"><input type=\"radio\" name=\"radio-16\" value=\"two\" id=\"forminator-field-radio-16-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-16-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-16-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: SENSE FRANQU\u00cdCIA<\/span><\/label><label id=\"forminator-field-radio-16-label-3\" for=\"forminator-field-radio-16-3-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES\"><input type=\"radio\" name=\"radio-16\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-7-D\u00cdES\" id=\"forminator-field-radio-16-3-6aca22a720021\" aria-labelledby=\"forminator-field-radio-16-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-16-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-16-label-4\" for=\"forminator-field-radio-16-4-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES\"><input type=\"radio\" name=\"radio-16\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-14-D\u00cdES\" id=\"forminator-field-radio-16-4-6aca22a720021\" aria-labelledby=\"forminator-field-radio-16-label-4\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-16-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-16-label-5\" for=\"forminator-field-radio-16-5-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP\"><input type=\"radio\" name=\"radio-16\" value=\"NO-BAREMADA:-DIES-ESPECICATS-AL-SEG\u00dcENT-CAMP\" id=\"forminator-field-radio-16-5-6aca22a720021\" aria-labelledby=\"forminator-field-radio-16-label-5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-16-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP<\/span><\/label><span id=\"forminator-radiogroup-radio-16-6aca22a720021-description\" class=\"forminator-description\">Baremada: La p\u00f2lissa incorpora un barem que estableix els dies de baixa que corresponen a cada patolog\u00eda. En les modalitats \"no baremades\", en canvi, els dies de baixa s'estableixen a partir dels certificats m\u00e8dics de baixa i d'alta.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6aca22a720021\" id=\"forminator-field-number-3_6aca22a720021-label\" class=\"forminator-label\">N\u00daMERO DE D\u00cdES DE LA FRANQU\u00cdCIA<\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_6aca22a720021\" 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;\" type=\"number\" step=\"any\" min=\"1\" max=\"365\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><p style=\"color: #0081c6\"><strong>Cobertures opcionals i complement\u00e0ries<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-25\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-25_6aca22a720021\" id=\"forminator-field-currency-25_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER ACCIDENT (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-25\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-25_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-17\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-17-6aca22a720021-label\" aria-describedby=\"forminator-radiogroup-radio-17-6aca22a720021-description\"><span id=\"forminator-radiogroup-radio-17-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-17-label-1\" for=\"forminator-field-radio-17-1-6aca22a720021\" class=\"forminator-radio\" title=\"BAREMADA\"><input type=\"radio\" name=\"radio-17\" value=\"one\" id=\"forminator-field-radio-17-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-17-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-17-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">BAREMADA<\/span><\/label><label id=\"forminator-field-radio-17-label-2\" for=\"forminator-field-radio-17-2-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: SENSE FRANQU\u00cdCIA\"><input type=\"radio\" name=\"radio-17\" value=\"two\" id=\"forminator-field-radio-17-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-17-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-17-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: SENSE FRANQU\u00cdCIA<\/span><\/label><label id=\"forminator-field-radio-17-label-3\" for=\"forminator-field-radio-17-3-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES\"><input type=\"radio\" name=\"radio-17\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-7-D\u00cdES\" id=\"forminator-field-radio-17-3-6aca22a720021\" aria-labelledby=\"forminator-field-radio-17-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-17-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 7 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-17-label-4\" for=\"forminator-field-radio-17-4-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES\"><input type=\"radio\" name=\"radio-17\" value=\"NO-BAREMADA:-FRANQU\u00cdCIA-14-D\u00cdES\" id=\"forminator-field-radio-17-4-6aca22a720021\" aria-labelledby=\"forminator-field-radio-17-label-4\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-17-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: FRANQU\u00cdCIA 14 D\u00cdES<\/span><\/label><label id=\"forminator-field-radio-17-label-5\" for=\"forminator-field-radio-17-5-6aca22a720021\" class=\"forminator-radio\" title=\"NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP\"><input type=\"radio\" name=\"radio-17\" value=\"NO-BAREMADA:-DIES-ESPECICATS-AL-SEG\u00dcENT-CAMP\" id=\"forminator-field-radio-17-5-6aca22a720021\" aria-labelledby=\"forminator-field-radio-17-label-5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-17-6aca22a720021-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO BAREMADA: N\u00daMERO DE DIES ESPECIFICATS AL SEG\u00dcENT CAMP<\/span><\/label><span id=\"forminator-radiogroup-radio-17-6aca22a720021-description\" class=\"forminator-description\">Baremada: La p\u00f2lissa incorpora un barem que estableix els dies de baixa que corresponen a cada patolog\u00eda. En les modalitats \"no baremades\", en canvi, els dies de baixa s'estableixen a partir dels certificats m\u00e8dics de baixa i d'alta.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6aca22a720021\" id=\"forminator-field-number-4_6aca22a720021-label\" class=\"forminator-label\">N\u00daMERO DE D\u00cdES DE LA FRANQU\u00cdCIA<\/label><input name=\"number-4\" value=\"\" placeholder=\"\" id=\"forminator-field-number-4_6aca22a720021\" 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;\" type=\"number\" step=\"any\" min=\"1\" max=\"365\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-26\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-26_6aca22a720021\" id=\"forminator-field-currency-26_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER HOSPITALITZACI\u00d3 (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-26\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-26_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-18\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-18-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-18-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-18-label-1\" for=\"forminator-field-radio-18-1-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA\"><input type=\"radio\" name=\"radio-18\" value=\"one\" id=\"forminator-field-radio-18-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-18-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA<\/span><\/label><label id=\"forminator-field-radio-18-label-2\" for=\"forminator-field-radio-18-2-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA I ACCIDENT\"><input type=\"radio\" name=\"radio-18\" value=\"two\" id=\"forminator-field-radio-18-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-18-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA I ACCIDENT<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-27\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-27_6aca22a720021\" id=\"forminator-field-currency-27_6aca22a720021-label\" class=\"forminator-label\">SUBSIDI DIARI PER ESTADA EN UCI (EN \u20ac)<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-27\" value=\"0\" placeholder=\"\" id=\"forminator-field-currency-27_6aca22a720021\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;.&#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><span class=\"forminator-suffix\">EUR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-19\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-19-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-19-6aca22a720021-label\" class=\"forminator-label\">MODALITAT<\/span><label id=\"forminator-field-radio-19-label-1\" for=\"forminator-field-radio-19-1-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA\"><input type=\"radio\" name=\"radio-19\" value=\"one\" id=\"forminator-field-radio-19-1-6aca22a720021\" aria-labelledby=\"forminator-field-radio-19-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA<\/span><\/label><label id=\"forminator-field-radio-19-label-2\" for=\"forminator-field-radio-19-2-6aca22a720021\" class=\"forminator-radio\" title=\"PER MALALT\u00cdA I ACCIDENT\"><input type=\"radio\" name=\"radio-19\" value=\"two\" id=\"forminator-field-radio-19-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-19-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">PER MALALT\u00cdA I ACCIDENT<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Afegir assegurat\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Eliminar assegurat\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/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-9208--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-9208--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"COBERTURES I CAPITALS\"\n\t\t\t\tdata-actual-label=\"CONTACTE\"\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-4\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6aca22a720021-label\"><span id=\"forminator-radiogroup-radio-4-6aca22a720021-label\" class=\"forminator-label\">DESITJO REBRE L&#039;INFORMACI\u00d3 PER MITJ\u00c0 DE:<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6aca22a720021\" class=\"forminator-radio\" title=\"E-MAIL\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-6aca22a720021\" 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\">E-MAIL<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6aca22a720021\" class=\"forminator-radio\" title=\"TEL\u00c8FON\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-6aca22a720021\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">TEL\u00c8FON<\/span><\/label><label id=\"forminator-field-radio-4-label-3\" for=\"forminator-field-radio-4-3-6aca22a720021\" class=\"forminator-radio\" title=\"CORREU\"><input type=\"radio\" name=\"radio-4\" value=\"CORREU\" id=\"forminator-field-radio-4-3-6aca22a720021\" aria-labelledby=\"forminator-field-radio-4-label-3\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">CORREU<\/span><\/label><label id=\"forminator-field-radio-4-label-4\" for=\"forminator-field-radio-4-4-6aca22a720021\" class=\"forminator-radio\" title=\"VISITA D\u2019UN COMERCIAL\"><input type=\"radio\" name=\"radio-4\" value=\"VISITA-D\u2019UN-COMERCIAL\" id=\"forminator-field-radio-4-4-6aca22a720021\" aria-labelledby=\"forminator-field-radio-4-label-4\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">VISITA D\u2019UN COMERCIAL<\/span><\/label><label id=\"forminator-field-radio-4-label-5\" for=\"forminator-field-radio-4-5-6aca22a720021\" class=\"forminator-radio\" title=\"EN PERSONA A L\u2019OFICINA DE DU\u00d1ACH A ROSES\"><input type=\"radio\" name=\"radio-4\" value=\"EN-PERSONA-A-L\u2019OFICINA-DE-DU\u00d1ACH-A-ROSES\" id=\"forminator-field-radio-4-5-6aca22a720021\" aria-labelledby=\"forminator-field-radio-4-label-5\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">EN PERSONA A L\u2019OFICINA DE DU\u00d1ACH A ROSES<\/span><\/label><label id=\"forminator-field-radio-4-label-6\" for=\"forminator-field-radio-4-6-6aca22a720021\" class=\"forminator-radio\" title=\"EN PERSONA A L\u2019OFICINA DE DU\u00d1ACH A EMPURIABRAVA\"><input type=\"radio\" name=\"radio-4\" value=\"EN-PERSONA-A-L\u2019OFICINA-DE-DU\u00d1ACH-A-EMPURIABRAVA\" id=\"forminator-field-radio-4-6-6aca22a720021\" aria-labelledby=\"forminator-field-radio-4-label-6\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">EN PERSONA A L\u2019OFICINA DE DU\u00d1ACH A EMPURIABRAVA<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><p style=\"color: red !important\">EL PRESENT DOCUMENT \u00c9S UNA MERA PRESA DE DADES, SENSE CAP VALOR CONTRACTUAL<\/p><\/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_6aca22a720021\" id=\"forminator-field-consent-1_6aca22a720021-label\" class=\"forminator-label\">Consento \/ Consentim: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6aca22a720021__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6aca22a720021\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6aca22a720021-label\" aria-describedby=\"forminator-field-consent-1_6aca22a720021__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6aca22a720021__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>CONFIRMO QUE ACCEPTO LA\u00a0<a href=\"#link-popup\" rel=\"noopener\">POL\u00cdTICA DE PRIVACITAT<\/a>\u00a0D\u2019AQUEST LLOC WEB PER TAL QUE PUGUIN RESPONDRE LA MEVA SOL\u00b7LICITUD.<\/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_6aca22a720021\" 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_6aca22a720021\" name=\"hidden-2\" value=\"\" \/><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Enviar missatge<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"518d709fae\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index_beta.php\/wp-json\/wp\/v2\/pages\/9223\" \/><input type=\"hidden\" name=\"form_id\" value=\"9208\"><input type=\"hidden\" name=\"page_id\" value=\"9223\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/dunach.com\/index_beta.php\/quotation\/individuals\/daily-allowance\/?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-c145a75 elementor-widget elementor-widget-html\" data-id=\"c145a75\" 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\">window.addEventListener(\"load\", function() {\r\nconst cobertura = document.getElementsByName(\"text-1\");;\r\nconst nif = document.getElementsByName(\"text-2\");\r\nconst nai = document.getElementsByName(\"text-3\");\r\nconst addr = document.getElementsByName(\"text-4\");\r\nconst cp = document.getElementsByName(\"text-5\");\r\nconst pobl = document.getElementsByName(\"text-6\");\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        nai[0].value = \"12\/12\/1962\";\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<div class=\"elementor-element elementor-element-5f88547 elementor-widget elementor-widget-html\" data-id=\"5f88547\" 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\">window.addEventListener(\"load\", function() {\r\nconst cobertura = document.getElementsByName(\"text-1\");;\r\nconst nif = document.getElementsByName(\"text-2\");\r\nconst naix = document.getElementsByName(\"text-3\");\r\nconst addr = document.getElementsByName(\"text-4\");\r\nconst cp = document.getElementsByName(\"text-5\");\r\nconst pobl = document.getElementsByName(\"text-6\");\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 == \"broker\") {\r\n        nif[0].value = \"12345678A\";\r\n        naix[0].value = \"12\/12\/1970\";\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-1b7a613\" data-id=\"1b7a613\" 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-c77ce5b elementor-widget elementor-widget-template\" data-id=\"c77ce5b\" data-element_type=\"widget\" data-settings=\"{&quot;sticky&quot;:&quot;top&quot;,&quot;sticky_offset&quot;:330,&quot;sticky_effects_offset&quot;:150,&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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ddd4998 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"ddd4998\" data-element_type=\"section\" id=\"llista-cobertures\" 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-100 elementor-top-column elementor-element elementor-element-1654374 cobertures-oferim\" data-id=\"1654374\" 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-7da55a6 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"7da55a6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3 style=\"text-align: center;\">WHAT COVERAGE DO WE OFFER?<\/h3><ul><li>DAILY SICK PAY<\/li><li>POSSIBLE COMPLEMENTARY COVERAGE<ul><li>DAILY ACCIDENT ALLOWANCE<\/li><li>DAILY ALLOWANCE PER DAY OF HOSPITALISATION<\/li><li>DAILY ALLOWANCE PER DAY OF HOSPITALISATION IN THE ICU<\/li><\/ul><\/li><li>SCALED MODALITY (ADVANCE PAYMENT OF THE BENEFIT WHEN DECLARING THE SUFFERED PATHOLOGY, BASED ON A SCALED ESTIMATION OF THE DAYS OF SICKNESS)<\/li><\/ul>\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-ae945c6 elementor-widget elementor-widget-heading\" data-id=\"ae945c6\" 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\">THIS LIST OF GUARANTEES IS FOR INFORMATION VALUE ONLY<br> COVER WOULD BE SUBJECT TO THE GENERAL\/INDIVIDUAL CONDITIONS OF THE POLICY<\/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\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DAILY ALLOWANCE INSURANCE QUOTE A daily amount for each day that the insured person is on sick leave or &#8230;<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":10801,"menu_order":21,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-9223","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>daily allowance insurance quote - Dunach<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dunach.com\/index_beta.php\/quotation\/individuals\/daily-allowance\/\" \/>\n<meta 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