{"id":16249,"date":"2014-08-13T15:09:00","date_gmt":"2014-08-13T15:09:00","guid":{"rendered":"https:\/\/www.soumissionassurancevie.ca\/?page_id=16249"},"modified":"2019-09-30T01:20:59","modified_gmt":"2019-09-30T05:20:59","slug":"form","status":"publish","type":"page","link":"https:\/\/assuredirect.ca\/en\/form\/","title":{"rendered":"Information request"},"content":{"rendered":"<div class='sp_form_composition_json'><\/div>\n<div class=\"gravForm grav_sidebar\">\n<div class=\"gravFormHeader\">\n<div style=\"text-align: center;\">\n COMPARE, SAVE !\n<\/div>\n<div style=\"font-size: 18px; text-align: center; padding-top: 6px;\">\n LET OUR CALCULATOR WORK FOR YOU<\/div>\n<\/div>\n<div class=\"gravFormContent\">\n\n\n<label for=\"gf_select_get_form\" class=\"label_gf_select_get_form\">Choose your insurance:<\/label><select id=\"gf_select_get_form\">  <optgroup class=\"pOptionNested\" label=\"Life insurances\">  <option class=\"cOptionNested\" value=\"35\" selected>Term Insurance<\/option>  <option class=\"cOptionNested\" value=\"36\" >Whole Life<\/option>  <option class=\"cOptionNested\" value=\"37\" >No Medical Exam<\/option>  <option class=\"cOptionNested\" value=\"38\" >Insure Your Parents<\/option> <\/optgroup>  <optgroup class=\"pOptionNested\" label=\"Others Insurance\">  <option class=\"cOptionNested\" value=\"24\" >Mortgage<\/option>  <option class=\"cOptionNested\" value=\"25\" >Loan Protection Insurance<\/option>  <option class=\"cOptionNested\" value=\"26\" >Critical Illness<\/option>  <option class=\"cOptionNested\" value=\"28\" >Disability Insurance<\/option>  <option class=\"cOptionNested\" value=\"27\" >Travel Insurance<\/option> <\/optgroup><\/select><div id='gf_select_form_container' ><div id='loader_wrapper_SavForm' class='hiddenLoader'><div class='loader_SavForm'><\/div><\/div> <div id='formElem'><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_35' style='display:none'><div id='gf_35' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_35' id='gform_35'  action='\/en\/wp-json\/wp\/v2\/pages\/16249#gf_35' data-formid='35' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Ld_tfApAAAAAB2RncBWLJSwCIzX7CiCQpncC0SW' data-tabindex='0'><input id=\"input_59d7ad2241c06971f43168962c3bad5b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_59d7ad2241c06971f43168962c3bad5b\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_35' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_35_4\" class=\"gfield gfield--type-simplesav gfield--input-type-simplesav field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_35_4\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_35_4'>Insurance Type<\/label><div class='ginput_container ginput_container_simplesav'><input name='input_4' id='input_35_4' type='text' value='Temporaire' class='medium '    aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_35_1\" class=\"gfield gfield--type-simplesav gfield--input-type-simplesav noTitle gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_1\" ><label class='gfield_label gform-field-label' for='input_35_1'>First and last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_simplesav'><input name='input_1' id='input_35_1' type='text' value='' class='medium '  placeholder='First and last name' aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_35_2\" class=\"gfield gfield--type-simplesav gfield--input-type-simplesav noTitle field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_2\" ><label class='gfield_label gform-field-label' for='input_35_2'>Email<\/label><div class='ginput_container ginput_container_simplesav'><input name='input_2' id='input_35_2' type='text' value='' class='medium '  placeholder='Email'  aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_35_3\" class=\"gfield gfield--type-simplesav gfield--input-type-simplesav noTitle gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_3\" ><label class='gfield_label gform-field-label' for='input_35_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_simplesav'><input name='input_3' id='input_35_3' type='text' value='' class='medium '  placeholder='Phone' aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_35_42\" class=\"gfield gfield--type-numbersav gfield--input-type-numbersav noTitle gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_42\" ><label class='gfield_label gform-field-label' for='input_35_42'>Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_42' id='input_35_42' type='number' step='any'   value='' class='medium'    placeholder='Age' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_35_20\" class=\"gfield gfield--type-radiosav gfield--input-type-radiosav noTitle gf_left_half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_20\" ><label class='gfield_label gform-field-label' >Gender<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_35_20'>\n\t\t\t<li class='gchoice gchoice_35_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Femme' checked='checked' id='choice_35_20_0'    \/>\n\t\t\t\t<label for='choice_35_20_0' id='label_35_20_0' class='gform-field-label gform-field-label--type-inline'>Woman<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_35_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='Homme'  id='choice_35_20_1'    \/>\n\t\t\t\t<label for='choice_35_20_1' id='label_35_20_1' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_35_50\" class=\"gfield gfield--type-radiosav gfield--input-type-radiosav noTitle gf_right_half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_50\" ><label class='gfield_label gform-field-label' >Smoker<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_35_50'>\n\t\t\t<li class='gchoice gchoice_35_50_0'>\n\t\t\t\t<input name='input_50' type='radio' value='Fumeur'  id='choice_35_50_0'    \/>\n\t\t\t\t<label for='choice_35_50_0' id='label_35_50_0' class='gform-field-label gform-field-label--type-inline'>Smoker<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_35_50_1'>\n\t\t\t\t<input name='input_50' type='radio' value='Non-fumeur' checked='checked' id='choice_35_50_1'    \/>\n\t\t\t\t<label for='choice_35_50_1' id='label_35_50_1' class='gform-field-label gform-field-label--type-inline'>Non-smoker<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_35_19\" class=\"gfield gfield--type-selectsav gfield--input-type-selectsav gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_19\" ><label class='gfield_label gform-field-label' for='input_35_19'>Sum insured<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_35_19' class='medium gfield_select'    aria-invalid=\"false\"><option value='10 000$' >10 000$<\/option><option value='15 000$' >15 000$<\/option><option value='20 000$' >20 000$<\/option><option value='25 000$' >25 000$<\/option><option value='30 000$' >30 000$<\/option><option value='35 000$' >35 000$<\/option><option value='40 000$' >40 000$<\/option><option value='45 000$' >45 000$<\/option><option value='50 000$' >50 000$<\/option><option value='55 000$' >55 000$<\/option><option value='60 000$' >60 000$<\/option><option value='65 000$' >65 000$<\/option><option value='70 000$' >70 000$<\/option><option value='75 000$' >75 000$<\/option><option value='80 000$' >80 000$<\/option><option value='85 000$' >85 000$<\/option><option value='90 000$' >90 000$<\/option><option value='95 000$' >95 000$<\/option><option value='100 000$' selected='selected'>100 000$<\/option><option value='125 000$' >125 000$<\/option><option value='150 000$' >150 000$<\/option><option value='175 000$' >175 000$<\/option><option value='200 000$' >200 000$<\/option><option value='225 000$' >225 000$<\/option><option value='250 000$' >250 000$<\/option><option value='275 000$' >275 000$<\/option><option value='300 000$' >300 000$<\/option><option value='325 000$' >325 000$<\/option><option value='350 000$' >350 000$<\/option><option value='375 000$' >375 000$<\/option><option value='400 000$' >400 000$<\/option><option value='425 000$' >425 000$<\/option><option value='450 000$' >450 000$<\/option><option value='475 000$' >475 000$<\/option><option value='500 000$' >500 000$<\/option><option value='600 000$' >600 000$<\/option><option value='650 000$' >650 000$<\/option><option value='700 000$' >700 000$<\/option><option value='750 000$' >750 000$<\/option><option value='1 000 000$' >1 000 000$<\/option><option value='1 500 000$' >1 500 000$<\/option><option value='2 000 000$' >2 000 000$<\/option><option value='2 500 000$' >2 500 000$<\/option><option value='3 000 000$' >3 000 000$<\/option><option value='5 000 000$' >5 000 000$<\/option><option value='10 000 000$' >10 000 000$ et plus<\/option><\/select><\/div> <script>gform.addFilter('gform_reset_pre_conditional_logic_field_action', function (reset, formId, targetId, defaultValues, isInit) {return false;});<\/script><\/li><li id=\"field_35_33\" class=\"gfield gfield--type-selectsav gfield--input-type-selectsav gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_33\" ><label class='gfield_label gform-field-label' for='input_35_33'>Term<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_35_33' class='medium gfield_select'    aria-invalid=\"false\"><option value='Temporaire de 5 ans' >5 years<\/option><option value='Temporaire de 10 ans' >10 years<\/option><option value='Temporaire de 15 ans' >15 years<\/option><option value='Temporaire de 20 ans' selected='selected'>20 years<\/option><option value='Temporaire de 25 ans' >25 years<\/option><option value='Temporaire de 30 ans' >30 years<\/option><option value='Temporaire de 35 ans' >35 years<\/option><option value='Temporaire de 40 ans' >40 years<\/option><\/select><\/div> <script>gform.addFilter('gform_reset_pre_conditional_logic_field_action', function (reset, formId, targetId, defaultValues, isInit) {return false;});<\/script><\/li><li id=\"field_35_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox noTitle field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_32\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Additional insured<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_35_32'><li class='gchoice gchoice_35_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Deuxi\u00e8me assur\u00e9'  id='choice_35_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_35_32_1' id='label_35_32_1' class='gform-field-label gform-field-label--type-inline'>Additional insured<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_35_23\" class=\"gfield gfield--type-simplesav gfield--input-type-simplesav noTitle field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_23\" ><label class='gfield_label gform-field-label' for='input_35_23'>First and last name of Co-Applicant<\/label><div class='ginput_container ginput_container_simplesav'><input name='input_23' id='input_35_23' type='text' value='' class='medium '  placeholder='First and last name of Co-Applicant'  aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_35_49\" class=\"gfield gfield--type-numbersav gfield--input-type-numbersav noTitle field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_49\" ><label class='gfield_label gform-field-label' for='input_35_49'>Co-Applicant&#039;s Age<\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_35_49' type='number' step='any'   value='' class='medium'    placeholder='Co-Applicant&#039;s Age'  aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_35_26\" class=\"gfield gfield--type-radiosav gfield--input-type-radiosav noTitle gf_left_half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_26\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_35_26'>\n\t\t\t<li class='gchoice gchoice_35_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Femme' checked='checked' id='choice_35_26_0'    \/>\n\t\t\t\t<label for='choice_35_26_0' id='label_35_26_0' class='gform-field-label gform-field-label--type-inline'>Woman<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_35_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Homme'  id='choice_35_26_1'    \/>\n\t\t\t\t<label for='choice_35_26_1' id='label_35_26_1' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_35_51\" class=\"gfield gfield--type-radiosav gfield--input-type-radiosav noTitle gf_right_half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_35_51\" ><label class='gfield_label gform-field-label' >Smoker<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_35_51'>\n\t\t\t<li class='gchoice gchoice_35_51_0'>\n\t\t\t\t<input name='input_51' type='radio' value='Fumeur'  id='choice_35_51_0'    \/>\n\t\t\t\t<label for='choice_35_51_0' id='label_35_51_0' class='gform-field-label gform-field-label--type-inline'>Smoker<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_35_51_1'>\n\t\t\t\t<input name='input_51' type='radio' value='Non-fumeur' checked='checked' id='choice_35_51_1'    \/>\n\t\t\t\t<label for='choice_35_51_1' id='label_35_51_1' class='gform-field-label gform-field-label--type-inline'>Non-smoker<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_35_52\" class=\"gfield gfield--type-checkbox 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