{"id":14274,"date":"2023-11-29T21:27:00","date_gmt":"2023-11-29T20:27:00","guid":{"rendered":"https:\/\/quercus-rc.be\/?page_id=14274"},"modified":"2023-11-29T21:34:24","modified_gmt":"2023-11-29T20:34:24","slug":"form-decla-sinistre","status":"publish","type":"page","link":"https:\/\/quercus-rc.be\/en\/form-decla-sinistre\/","title":{"rendered":"Formulaire D\u00e9claration de Sinistre"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14274\" class=\"elementor elementor-14274\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4c1ac24 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4c1ac24\" data-element_type=\"section\" data-e-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-002895d\" data-id=\"002895d\" data-element_type=\"column\" data-e-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-1394727 elementor-widget elementor-widget-spacer\" data-id=\"1394727\" data-element_type=\"widget\" data-e-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-168644f elementor-widget elementor-widget-heading\" data-id=\"168644f\" data-element_type=\"widget\" data-e-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\">Remplissez ce formulaire (au calme) pour tout type de sinistre<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-60c6b06 elementor-widget elementor-widget-text-editor\" data-id=\"60c6b06\" data-element_type=\"widget\" data-e-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<p>Soyez le plus complet possible, ceci facilitera le traitement de votre demande.&nbsp;<\/p><p><span style=\"color: var( --e-global-color-primary );\">Nous ne manquerons pas de vous recontacter dans les plus brefs d\u00e9lais.&nbsp;<\/span><\/p>\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-c52293e elementor-widget elementor-widget-shortcode\" data-id=\"c52293e\" data-element_type=\"widget\" data-e-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\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f13912-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"13912\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/14274#wpcf7-f13912-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"13912\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f13912-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<!-- Section : Mes informations de contact -->\n<p><label> Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label><br \/>\n<label> Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-first-name\" \/><\/span> <\/label><br \/>\n<label> Rue*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-street\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"street-address\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-street\" \/><\/span> <\/label><br \/>\n<label> Num\u00e9ro de rue*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-street-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-street-number\" \/><\/span> <\/label><br \/>\n<label> Boite<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-box\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-box\" \/><\/span> <\/label><br \/>\n<label> Code postal*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-postal-code\" \/><\/span> <\/label><br \/>\n<label> Localit\u00e9*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span> <\/label><br \/>\n<label> Soci\u00e9t\u00e9<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-company\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-company\" \/><\/span> <\/label><br \/>\n<label> Num\u00e9ro de t\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span> <\/label><br \/>\n<label> Email*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label><br \/>\n<br \/>\n<!-- Section : Identification du sinistre --><br \/>\n<label> Identification de la personne ou du bien assur\u00e9*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-insured\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-insured\" \/><\/span> <\/label><br \/>\n<label> Num\u00e9ro de police d'assurance*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-insurance-policy-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-insurance-policy-number\" \/><\/span> <\/label><br \/>\n<label> Date et Heure du sinistre*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-claim-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-claim-time\" \/><\/span> <\/label><br \/>\n<label> Lieu du sinistre*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-claim-location\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-claim-location\" \/><\/span> <\/label><br \/>\n<br \/>\n<label> D\u00e9tails du sinistre et des circonstances*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-claim-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-claim-details\"><\/textarea><\/span> <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"upload-file-957\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-invalid=\"false\" type=\"file\" multiple=\"multiple\" data-name=\"upload-file-957\" data-type=\"JPG|GIF|BMP|PDF|HEIC|PNG\" data-limit=\"15000000000\" data-min=\"0\" data-max=\"15\" data-id=\"13912\" data-version=\"free version 1.3.9.8\" accept=\".JPG, .GIF, .BMP, .PDF, .HEIC, .PNG\" data-black-list=\"exe|bat|com\" \/><\/span>\n<\/p>\n\n\n\n<!-- Checkbox -->\n<p><label> <span class=\"wpcf7-form-control-wrap\" data-name=\"your-agreement\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"your-agreement[]\" value=\"Je suis d&#039;accord avec la Politique de confidentialit\u00e9*\" \/><span class=\"wpcf7-list-item-label\">Je suis d&#039;accord avec la Politique de confidentialit\u00e9*<\/span><\/span><\/span><\/span> <\/label>\n<\/p>\n\n<!-- Submit button -->\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p>\n\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"12\"\/><script data-jetpack-boost=\"ignore\" data-jetpack-boost=\"ignore\" type=\"text\/javascript\">\n\/* <![CDATA[ *\/\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n\/* ]]> *\/\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Remplissez ce formulaire (au calme) pour tout type de sinistre Soyez le plus complet possible, ceci facilitera le traitement de votre demande.&nbsp; Nous ne manquerons pas de vous recontacter dans les plus brefs d\u00e9lais.&nbsp;<\/p>","protected":false},"author":103368776,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-default.php","meta":{"_crdt_document":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-14274","page","type-page","status-publish","hentry"],"jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PgPayC-3Ie","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/pages\/14274","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/users\/103368776"}],"replies":[{"embeddable":true,"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/comments?post=14274"}],"version-history":[{"count":10,"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/pages\/14274\/revisions"}],"predecessor-version":[{"id":14284,"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/pages\/14274\/revisions\/14284"}],"wp:attachment":[{"href":"https:\/\/quercus-rc.be\/en\/wp-json\/wp\/v2\/media?parent=14274"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}