{"id":103518,"date":"2024-06-06T09:15:31","date_gmt":"2024-06-06T09:15:31","guid":{"rendered":"https:\/\/sfizabelagajowska.dev10.pro\/?page_id=103518"},"modified":"2024-06-06T09:50:27","modified_gmt":"2024-06-06T09:50:27","slug":"insurance-survey","status":"publish","type":"page","link":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/insurance-survey\/","title":{"rendered":"Insurance Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"103518\" class=\"elementor elementor-103518\">\n\t\t\t\t<div class=\"default show_shadow elementor-element elementor-element-2ff8b62 e-flex e-con-boxed e-con e-parent\" data-id=\"2ff8b62\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-53b70d8 elementor-widget elementor-widget-shortcode\" data-id=\"53b70d8\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f103547-o1\" lang=\"pl-PL\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/103518#wpcf7-f103547-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formularz kontaktowy\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"103547\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"pl_PL\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f103547-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<h2>Insurance Survey\n<\/h2>\n<h3>Select gender:\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plec\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"plec\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"plec\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>In the past 12 months, have you smoked cigarettes or used any substances containing nicotine?\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nikotyna\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"nikotyna\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"nikotyna\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>Quotation for:\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"wycena\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"wycena\" value=\"Only for me\" \/><span class=\"wpcf7-list-item-label\">Only for me<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"wycena\" value=\"For me and my partner\" \/><span class=\"wpcf7-list-item-label\">For me and my partner<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"wycena\" value=\"For me, my partner, and child\/children\" \/><span class=\"wpcf7-list-item-label\">For me, my partner, and child\/children<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>Select the policy benefits you are most interested in for the basic package:\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"benefity\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Bone fractures\" \/><span class=\"wpcf7-list-item-label\">Bone fractures<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Accidental death\" \/><span class=\"wpcf7-list-item-label\">Accidental death<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Total permanent disablement\" \/><span class=\"wpcf7-list-item-label\">Total permanent disablement<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Permanent injuries caused by an accident\" \/><span class=\"wpcf7-list-item-label\">Permanent injuries caused by an accident<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Compensation for hospital stays in the UK and selected European countries, including Poland\" \/><span class=\"wpcf7-list-item-label\">Compensation for hospital stays in the UK and selected European countries, including Poland<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"benefity[]\" value=\"Non-accidental death\" \/><span class=\"wpcf7-list-item-label\">Non-accidental death<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>Selectpolicy add-ons:\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"dodatki\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"dodatki[]\" value=\"Child protection\" \/><span class=\"wpcf7-list-item-label\">Child protection<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"dodatki[]\" value=\"Protection for those with an active lifestyle\" \/><span class=\"wpcf7-list-item-label\">Protection for those with an active lifestyle<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"dodatki[]\" value=\"Protection for healthcare workers\" \/><span class=\"wpcf7-list-item-label\">Protection for healthcare workers<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>Using the slider, select the life insurance coverage amount for which you would like to know the price: From \u00a310.000 to \u00a31,000,000\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kwota_ubezpieczenia_slider\"><input class=\"wpcf7-form-control wpcf7-range wpcf7-validates-as-number slider-input\" id=\"ubezpieczenie-slider\" min=\"10000\" max=\"1000000\" step=\"10000\" aria-invalid=\"false\" value=\"505000\" type=\"range\" name=\"kwota_ubezpieczenia_slider\" \/><\/span>\n<\/p>\n<div class=\"insurenc-price\">\n\t<p>\u00a3\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kwota_ubezpieczenia\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text slider-value\" id=\"ubezpieczenie-output\" readonly=\"readonly\" aria-invalid=\"false\" value=\"10000\" type=\"text\" name=\"kwota_ubezpieczenia\" \/><\/span>\n\t<\/p>\n<\/div>\n<h3>Upewnij si\u0119, \u017ce poni\u017csze dane s\u0105 w\u0142a\u015bciwe, \u017ceby otrzyma\u0107 spersonalizowan\u0105 i niezobowi\u0105zuj\u0105c\u0105 wycen\u0119:\n<\/h3>\n<div class=\"form-input\">\n\t<p>Name:\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"imie\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"imie\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-input\">\n\t<p>Surname:\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nazwisko\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nazwisko\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-input\">\n\t<p>Phone number:\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"telefon\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telefon\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-input\">\n\t<p>Date of Birth\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date required\" min=\"1900-01-01\" max=\"2024-12-31\" step=\"7\" aria-required=\"true\" aria-invalid=\"false\" value=\"2023-04-01\" type=\"date\" name=\"your-date\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-input\">\n\t<p>Country of residence:\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kraj\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"kraj\"><option value=\"Anglia\">Anglia<\/option><option value=\"Szkocja\">Szkocja<\/option><option value=\"Walia\">Walia<\/option><option value=\"Irlandia P\u00f3\u0142nocna\">Irlandia P\u00f3\u0142nocna<\/option><\/select><\/span>\n\t<\/p>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-103518","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/pages\/103518","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/comments?post=103518"}],"version-history":[{"count":4,"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/pages\/103518\/revisions"}],"predecessor-version":[{"id":103551,"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/pages\/103518\/revisions\/103551"}],"wp:attachment":[{"href":"https:\/\/sfizabelagajowska.dev10.pro\/index.php\/wp-json\/wp\/v2\/media?parent=103518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}