{"id":1753,"date":"2023-09-28T11:20:31","date_gmt":"2023-09-28T09:20:31","guid":{"rendered":"https:\/\/secure.adminplus.co.za\/tric\/?page_id=1753"},"modified":"2023-09-29T06:35:35","modified_gmt":"2023-09-29T04:35:35","slug":"warranty","status":"publish","type":"page","link":"https:\/\/secure.adminplus.co.za\/tric\/warranty\/","title":{"rendered":"Warranty"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;individual&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;0px||0px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_button button_url=&#8221;https:\/\/secure.adminplus.co.za\/tric\/wp-content\/uploads\/2023\/09\/TRIC-Warranty-2.pdf&#8221; button_text=&#8221;Full Warranty Wording&#8221; button_alignment=&#8221;right&#8221; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;14px&#8221; sticky_enabled=&#8221;0&#8243;][\/et_pb_button][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_code disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_5' style='display:none'><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/tric\/wp-json\/wp\/v2\/pages\/1753#gf_5' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_5_1' class='gform_page ' data-js='page-field-id-79' >\n                                    <div class='gform_page_fields'><div id='gform_fields_5' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_23\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_23\"><h1><strong>12 Month Extended Warranty For Apple Devices<\/strong><\/h1>\nAny cell phone supplied by Cellucity or affiliate companies which has been approved for redistribution by TRIC is eligible to take up this extended warranty.<\/div><div id=\"field_5_46\"  class=\"gfield gfield--type-html error-message-old-purchase gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_46\">This insurance is only available for items purchased from an authorised network retailer. Devices can not be more than 60 days old in order to qualify for this insurance product.<\/div><fieldset id=\"field_5_2\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_2\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Your name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_2'>\n                            <span id='input_5_2_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_2.2' id='input_5_2_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Mr' >Mr<\/option><option value='Ms' >Ms<\/option><option value='Mrs' >Mrs<\/option><option value='Doctor' >Doctor<\/option><option value='Reverend' >Reverend<\/option><option value='Honorable' >Honorable<\/option><option value='Professor' >Professor<\/option>\n                      <\/select>\n                                                    <label for='input_5_2_2' class='gform-field-label gform-field-label--type-sub '>Title<\/label>\n                                                  <\/span>\n                            <span id='input_5_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_5_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_2_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_5_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_2_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_3\"  class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_3\"><label class='gfield_label gform-field-label' for='input_5_3' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_5_3' type='email' value='' class='medium'   placeholder='example@example.com'  aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_72\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_72\"><label class='gfield_label gform-field-label' for='input_5_72' >Date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_72' id='input_5_72' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_72_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_72_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_72' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_5_74\"  class=\"gfield gfield--type-select gfield--width-full calculated-age field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_74\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_74' >Calculated age<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_5_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='under-35' >Under 35<\/option><option value='over-35' >Over 35<\/option><\/select><\/div><\/div><div id=\"field_5_4\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_4\"><label class='gfield_label gform-field-label' for='input_5_4' >Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_5_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_48\"  class=\"gfield gfield--type-radio gfield--type-choice new-or-preowned gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_48\"><legend class='gfield_label gform-field-label'  >Please select either:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_48'>\n\t\t\t<div class='gchoice gchoice_5_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='contract' checked='checked' id='choice_5_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_48_0' id='label_5_48_0' class='gform-field-label gform-field-label--type-inline'>Contract<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='prepaid'  id='choice_5_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_48_1' id='label_5_48_1' class='gform-field-label gform-field-label--type-inline'>Prepaid<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_75\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full device-condition gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_75\"><legend class='gfield_label gform-field-label'  >Device condition<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_75'>\n\t\t\t<div class='gchoice gchoice_5_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='New' checked='checked' id='choice_5_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_75_0' id='label_5_75_0' class='gform-field-label gform-field-label--type-inline'>New<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Pre-owned'  id='choice_5_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_75_1' id='label_5_75_1' class='gform-field-label gform-field-label--type-inline'>Pre-owned<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_76\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full preowned-condition gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_76\"><legend class='gfield_label gform-field-label'  >Pre-owned condition<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_76'>\n\t\t\t<div class='gchoice gchoice_5_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Pre-owned Pristine' checked='checked' id='choice_5_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_76_0' id='label_5_76_0' class='gform-field-label gform-field-label--type-inline'>Pre-owned Pristine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Pre-owned Premium'  id='choice_5_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_76_1' id='label_5_76_1' class='gform-field-label gform-field-label--type-inline'>Pre-owned Premium<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_45\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-purchase gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_45\"><label class='gfield_label gform-field-label' for='input_5_45' >Date of Purchase<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_5_45' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_45_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_45_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_45' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_5_50' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_2' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_2' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_49\"  class=\"gfield gfield--type-select device-type gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_49\"><label class='gfield_label gform-field-label' for='input_5_49' >Device Make<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select data-current=\"\" name='input_49' id='input_5_49' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='APPLE' >APPLE<\/option><option value='CAT' >CAT<\/option><option value='HONOR' >HONOR<\/option><option value='HUAWEI' >HUAWEI<\/option><option value='OPPO' >OPPO<\/option><option value='SAMSUNG' >SAMSUNG<\/option><option value='TABLETS' >TABLETS<\/option><option value='VIVO' >VIVO<\/option><option value='WEARABLES' >WEARABLES<\/option><option value='XIAOMI' >XIAOMI<\/option><option value='Others' >Others<\/option><\/select><\/div><\/div><div id=\"field_5_73\"  class=\"gfield gfield--type-select gfield--width-full device-model gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_73\"><label class='gfield_label gform-field-label' for='input_5_73' >Device Model<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select data-current=\"\" name='input_73' id='input_5_73' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select Device Make<\/option><option value='' ><\/option><\/select><\/div><\/div><div id=\"field_5_62\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_62\"><label class='gfield_label gform-field-label' for='input_5_62' >Device Model<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_5_62' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_64\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_64\"><label class='gfield_label gform-field-label' for='input_5_64' >Purchase Price<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_64' id='input_5_64' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_6\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_6\"><div class=\"quotation-response\"><\/div><\/div><div id=\"field_5_65\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_65\">As your device is not on our list, one of our underwriting staff will contact you to obtain further details & finalise your application.<\/div><div id=\"field_5_24\"  class=\"gfield gfield--type-text gfield--width-full device-imei gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_24\"><label class='gfield_label gform-field-label' for='input_5_24' >IMEI Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_5_24' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_38\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full device-imei-na field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_5_38\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >IMEI Not Available<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_38'><div class='gchoice gchoice_5_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='1'  id='choice_5_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_38_1' id='label_5_38_1' class='gform-field-label gform-field-label--type-inline'>IMEI is not yet available<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_7' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"1\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"1\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_7' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_25\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_25\"><h2>Bank Details & Debit Authority<\/h2><\/div><fieldset id=\"field_5_11\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_11\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Postal Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_5_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_11_1' id='input_5_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_5_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_11_2' id='input_5_11_2_label' class='gform-field-label gform-field-label--type-sub '>Street Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_5_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_11_3' id='input_5_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_5_11_4' value=''      aria-required='true'    \/>\n                                        <label for='input_5_11_4' id='input_5_11_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_5_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_11_5' id='input_5_11_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_5_11_6' value='South Africa' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_12\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_12\"><label class='gfield_label gform-field-label' for='input_5_12' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_41\"  class=\"gfield gfield--type-select bank-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_41\"><label class='gfield_label gform-field-label' for='input_5_41' >Bank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_5_41' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option data-branch-code=\"632005\" value='ABSA BANK' >ABSA BANK<\/option><option data-branch-code=\"470010\" value='CAPITEC BANK' >CAPITEC BANK<\/option><option data-branch-code=\"250655\" value='FIRST NATIONAL BANK' >FIRST NATIONAL BANK<\/option><option data-branch-code=\"198765\" value='NEDBANK LIMITED' >NEDBANK LIMITED<\/option><option data-branch-code=\"051001\" value='STANDARD BANK' >STANDARD BANK<\/option><option data-branch-code=\"430000\" value='AFRICAN BANK' >AFRICAN BANK<\/option><option data-branch-code=\"800000\" value='ALBARAKA BANK' >ALBARAKA BANK<\/option><option data-branch-code=\"688000\" value='BNP PARIBAS' >BNP PARIBAS<\/option><option data-branch-code=\"888000\" value='BANK ZERO' >BANK ZERO<\/option><option data-branch-code=\"462005\" value='BIDVEST BANK' >BIDVEST BANK<\/option><option data-branch-code=\"350005\" value='CITIBANK' >CITIBANK<\/option><option data-branch-code=\"679000\" value='DISCOVERY BANK' >DISCOVERY BANK<\/option><option data-branch-code=\"589000\" value='FINBOND MUTUAL BANK' >FINBOND MUTUAL BANK<\/option><option data-branch-code=\"591000\" value='FINBOND EPE' >FINBOND EPE<\/option><option data-branch-code=\"410342\" value='GROBANK LTD' >GROBANK LTD<\/option><option data-branch-code=\"223626\" value='GRINDRODBANK' >GRINDRODBANK<\/option><option data-branch-code=\"570100\" value='HBZ BANK' >HBZ BANK<\/option><option data-branch-code=\"587000\" value='HSBC BANK' >HSBC BANK<\/option><option data-branch-code=\"700066\" value='HABIB OVERSEAS BANK' >HABIB OVERSEAS BANK<\/option><option data-branch-code=\"580105\" value='INVESTEC BANK' >INVESTEC BANK<\/option><option data-branch-code=\"757026\" value='ITHALA' >ITHALA<\/option><option data-branch-code=\"432000\" value='JP MORGAN CHASE' >JP MORGAN CHASE<\/option><option data-branch-code=\"450105\" value='MERCANTILE BANK' >MERCANTILE BANK<\/option><option data-branch-code=\"261251\" value='RAND MERCHANT BANK' >RAND MERCHANT BANK<\/option><option data-branch-code=\"585001\" value='OLYMPUS MOBILE' >OLYMPUS MOBILE<\/option><option data-branch-code=\"720026\" value='PEOPLES BANK LTD INC NBS' >PEOPLES BANK LTD INC NBS<\/option><option data-branch-code=\"460005\" value='POSTBANK' >POSTBANK<\/option><option data-branch-code=\"900145\" value='S.A. RESERVE BANK' >S.A. RESERVE BANK<\/option><option data-branch-code=\"683000\" value='SASFIN BANK' >SASFIN BANK<\/option><option data-branch-code=\"351005\" value='SOCIETE GENERAL' >SOCIETE GENERAL<\/option><option data-branch-code=\"730020\" value='STANDARD CHARTERED BANK' >STANDARD CHARTERED BANK<\/option><option data-branch-code=\"801000\" value='STATE BANK OF INDIA' >STATE BANK OF INDIA<\/option><option data-branch-code=\"678910\" value='TYMEBANK' >TYMEBANK<\/option><option data-branch-code=\"431010\" value='UBANK LIMITED' >UBANK LIMITED<\/option><option data-branch-code=\"790005\" value='UNIBANK' >UNIBANK<\/option><option data-branch-code=\"588000\" value='VBS MUTUAL BANK' >VBS MUTUAL BANK<\/option><\/select><\/div><\/div><div id=\"field_5_14\"  class=\"gfield gfield--type-text bank-branch-code gf_readonly gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_14\"><label class='gfield_label gform-field-label' for='input_5_14' >Branch Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_5_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_42\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_42\"><label class='gfield_label gform-field-label' for='input_5_42' >Account Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_5_42' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Savings' >Savings<\/option><option value='Current' >Current<\/option><option value='Cheque' >Cheque<\/option><\/select><\/div><\/div><div id=\"field_5_13\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_13\"><label class='gfield_label gform-field-label' for='input_5_13' >Bank Account Holder&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_34\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_34\"><label class='gfield_label gform-field-label' for='input_5_34' >Account Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_5_34' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_17\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_17\"><label class='gfield_label gform-field-label' for='input_5_17' >Debit Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_5_17' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1st' >1st<\/option><option value='7th' >7th<\/option><option value='15th' >15th<\/option><option value='25th' >25th<\/option><option value='27th' >27th<\/option><\/select><\/div><\/div><div id=\"field_5_10\"  class=\"gfield gfield--type-html client-declaration gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_10\"><ul style=\"font-size: 14px\">\n \t<li>I authorise\u00a0Renasa Insurance Company Ltd to draw against the above account, the amount necessary for payment of the monthly premium every month until this arrangement is cancelled in writing by either party.<\/li>\n \t<li>I accept that if the debit date falls on a weekend or public holiday, we will be debited on the following working day.<\/li>\n \t<li>I am the authorised signatory on the above banking account and am authorised to apply for insurance on behalf of the company.<\/li>\n \t<li>I declare that I have applied for insurance cover on our mobile devices.<\/li>\n \t<li>I am aware of the first amount payable in the event of a claim.<\/li>\n \t<li>I am aware\u00a0of the premium payable and that the premium will be deducted in the cover month via monthly debit order by Renasa Insurance Company Ltd.<\/li>\n \t<li>I understand that failure to pay the monthly premium will result in cover lapsing.<\/li>\n \t<li>I confirm that I am in possession of the mobile devices\u00a0stated in the schedule.<\/li>\n \t<li>I understand that this declaration forms part of the policy of insurance.<\/li>\n \t<br><strong>Broker Acknowledgement:<\/strong><li>I hereby acknowledge that Econorisk Broker Consultants (Pty) Limited is the broker on The Real Insurance Cover mobile device policy and appoint them as our broker with effect from the commencement date of the policy to act on all matters related to this insurance policy and keep me informed of any additional cover options related to it at no additional fees to me. For any further advice or escalation, please contact tric@econorisk.co.za<\/li>\n<li><strong>Your monthly bank debit order reference will contain 'RENASAINS'<\/strong><\/li>\n<\/ul><\/div><div id=\"field_5_58\"  class=\"gfield gfield--type-signature gfield--width-full client-declaration-signature field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_58\"><label class='gfield_label gform-field-label' for='input_5_58' >Client Signature<\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' style='display:-moz-inline-stack; display: inline-block; zoom: 1; *display: inline;'><div id='input_5_58_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_5_58_valid' id='input_5_58_valid' \/><canvas id='input_5_58' width='300' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_5_58_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_5_58_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_19' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_67\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_67\"><h2>Documents Upload<\/h2><\/div><div id=\"field_5_68\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_68\"><label class='gfield_label gform-field-label' for='input_5_68' >Proof of identity (ID, drivers license, or passport)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_68' id='input_5_68' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_68\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_68'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_68'><\/div><\/div><\/div><div id=\"field_5_69\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_69\"><label class='gfield_label gform-field-label' for='input_5_69' >Proof of purchase (invoice)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_69' id='input_5_69' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_69\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_69'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_69'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_20' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"5\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"5\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_26\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_26\"><h2>Accept T&Cs<\/h2><\/div><div id=\"field_5_79\"  class=\"gfield gfield--type-section gsection gf_scroll_text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_79\"><h3 class=\"gsection_title\">Terms, Conditions and Policy Wording<\/h3><div class='gsection_description' id='gfield_description_5_79'><p>We confirm your device is covered.<\/p>\n<p>One of our consultants will be in contact with you within 72 hours (Monday-Friday) to confirm the cover and will forward your policy documents to you.<\/p>\n\n<p>Just a few Terms and Conditions that you need to be aware of:<\/p>\n<p>I declare that I have applied for insurance cover on my mobile device(s).<\/p>\n<p>This insurance is only available for items purchased from an authorised network retailer and my device is currently free from damage and in my possession.<\/p>\n<p>Insurance Regulations require that we have on file a copy of your ID document and a copy of your proof of purchase. If we do not have this, you agree to provide it to us upon request.<\/p>\n<p>All premiums must be successfully collected into Insurers bank account in order that your policy remains valid and that a claim can be entertained.<\/p>\n<p>I am aware of the first amount payable in the event of a claim and that any claim submitted within the first sixty days (60) of cover, is subject to an additional excess of 10% of the claim.<\/p>\n<p>Any failure to disclose material fact or any false disclosure could result in us not accepting your risk and\/or Insurers voiding your Policy.<\/p>\n<p>I understand that this declaration forms part of the policy of insurance.<\/p>\n<p>Administration Plus (Pty) Ltd does not and will not sell or provide personal information to third parties for independent use. We may, however, share personal information with our business partners if that information is required to provide the product, or service you have requested and where relevant recruitment purposes. However, our business partners will adhere to using your information only as directed by Administration Plus (Pty) Ltd.<\/p><\/div><\/div><fieldset id=\"field_5_18\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_18.1' id='input_5_18_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_18_1' >I have read and understood the policy wording and disclosure document accompanying this policy.<\/label><input type='hidden' name='input_18.2' value='I have read and understood the policy wording and disclosure document accompanying this policy.' class='gform_hidden' \/><input type='hidden' name='input_18.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_5_47\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full marketing-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_47\"><legend class='gfield_label gform-field-label'  >May we contact you for related additional products or services we think you may find useful?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_47'>\n\t\t\t<div class='gchoice gchoice_5_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='YES'  id='choice_5_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_47_0' id='label_5_47_0' class='gform-field-label gform-field-label--type-inline'>Yes please<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='NO'  id='choice_5_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_47_1' id='label_5_47_1' class='gform-field-label gform-field-label--type-inline'>No, I would not like to receive any related marketing communications<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_66' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"6\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"6\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_6' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_27\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_27\"><h2>Finish and Submit<\/h2><\/div><div id=\"field_5_21\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_21\"><p>Thank you for taking the time to fill in this application.<\/p>\n\n<p>If you've elected to take up cover and completed your application in full, once you hit 'Submit' below, we'll be in touch to finalise & confirm your policy has been accepted or rejected. We will send you further correspondence related to your insurance cover within 48 hours (Monday - Friday)<\/p><\/div><div id=\"field_5_31\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_31\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_31' >Client reference<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_5_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_33\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_33\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_33' >Item reference<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_5_33' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_32\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_32\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_32' >Policy reference<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_5_32' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_37\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_37\"><div class='ginput_container ginput_container_text'><input name='input_37' id='input_5_37' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/div><div id=\"field_5_80\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_80\"><label class='gfield_label gform-field-label' for='input_5_80' >Email<\/label><div class='ginput_container'><input name='input_80' id='input_5_80' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_80'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer left_label'><input type='submit' id='gform_previous_button_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_5\"]){return false;}  if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_5\"]){return false;} if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  jQuery(\"#gform_5\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_5' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_5\"]){return false;}  if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_5\"]){return false;} if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  jQuery(\"#gform_5\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='5' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_5' value='WyJ7XCI3NFwiOltcImM0MDVhYTM3MzljODFiNGI0OTQ2MjdhZjJmZGQwZDUyXCIsXCI5MzBhMzQyN2MwNzRjYTlmODg5NDdlZTEyODM3NGJiN1wiXSxcIjczXCI6W1wiZDczZjhmYmM5ZDRiM2Q3NTY5ZDhhNDZlYTQ0NmQxZGJcIl0sXCIxOC4xXCI6XCI1ZmZjNjAyMDZmOWU5YTJlZmNmNzlkYjA5MDQ4Y2VjMVwiLFwiMTguMlwiOlwiZWZlMzk1OTJmZTEzN2JjYjQ1YTFmYmFiNTY3NThhNGRcIixcIjE4LjNcIjpcIjQ4MGRhZGU2Y2RjOTQ5NTdhZTBkZjZlOWVmNzYzYjJhXCJ9IiwiMjliMzE5Y2ViOGE0N2QwYTYzY2JmZWNkYmY1NGJiOWUiXQ==' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 5, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_5').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_5');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_5').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_5').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_5').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_5').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_5').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_5').val();gformInitSpinner( 5, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [5, current_page]);window['gf_submitting_5'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_5').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_5').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [5]);window['gf_submitting_5'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_5').text());}, 50);}else{jQuery('#gform_5').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [5, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 5, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n<!-- [et_pb_line_break_holder] --><!-- <script type=\"text\/javascript\" src=\"https:\/\/form.jotform.com\/jsform\/60554393658970\"><\/script> -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='1' id='gform_wrapper_5' style='display:none'><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/tric\/wp-json\/wp\/v2\/pages\/1753#gf_5' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_5_1' class='gform_page ' data-js='page-field-id-79' >\n                                    <div class='gform_page_fields'><div id='gform_fields_5' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_23\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_23\"><h1><strong>12 Month Extended Warranty For Apple Devices<\/strong><\/h1>\nAny cell phone supplied by Cellucity or affiliate companies which has been approved for redistribution by TRIC is eligible to take up this extended warranty.<\/div><div id=\"field_5_46\"  class=\"gfield gfield--type-html error-message-old-purchase gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_46\">This insurance is only available for items purchased from an authorised network retailer. Devices can not be more than 60 days old in order to qualify for this insurance product.<\/div><fieldset id=\"field_5_2\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_2\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Your name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_2'>\n                            <span id='input_5_2_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_2.2' id='input_5_2_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Mr' >Mr<\/option><option value='Ms' >Ms<\/option><option value='Mrs' >Mrs<\/option><option value='Doctor' >Doctor<\/option><option value='Reverend' >Reverend<\/option><option value='Honorable' >Honorable<\/option><option value='Professor' >Professor<\/option>\n                      <\/select>\n                                                    <label for='input_5_2_2' class='gform-field-label gform-field-label--type-sub '>Title<\/label>\n                                                  <\/span>\n                            <span id='input_5_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_5_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_2_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_5_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_2_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_3\"  class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_3\"><label class='gfield_label gform-field-label' for='input_5_3' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_5_3' type='email' value='' class='medium'   placeholder='example@example.com'  aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_72\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_72\"><label class='gfield_label gform-field-label' for='input_5_72' >Date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_72' id='input_5_72' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_72_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_72_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_72' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_5_74\"  class=\"gfield gfield--type-select gfield--width-full calculated-age field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_74\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_74' >Calculated age<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_5_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='under-35' >Under 35<\/option><option value='over-35' >Over 35<\/option><\/select><\/div><\/div><div id=\"field_5_4\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_4\"><label class='gfield_label gform-field-label' for='input_5_4' >Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_5_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_48\"  class=\"gfield gfield--type-radio gfield--type-choice new-or-preowned gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_48\"><legend class='gfield_label gform-field-label'  >Please select either:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_48'>\n\t\t\t<div class='gchoice gchoice_5_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='contract' checked='checked' id='choice_5_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_48_0' id='label_5_48_0' class='gform-field-label gform-field-label--type-inline'>Contract<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='prepaid'  id='choice_5_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_48_1' id='label_5_48_1' class='gform-field-label gform-field-label--type-inline'>Prepaid<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_75\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full device-condition gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_75\"><legend class='gfield_label gform-field-label'  >Device condition<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_75'>\n\t\t\t<div class='gchoice gchoice_5_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='New' checked='checked' id='choice_5_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_75_0' id='label_5_75_0' class='gform-field-label gform-field-label--type-inline'>New<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Pre-owned'  id='choice_5_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_75_1' id='label_5_75_1' class='gform-field-label gform-field-label--type-inline'>Pre-owned<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_76\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full preowned-condition gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_76\"><legend class='gfield_label gform-field-label'  >Pre-owned condition<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_76'>\n\t\t\t<div class='gchoice gchoice_5_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Pre-owned Pristine' checked='checked' id='choice_5_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_76_0' id='label_5_76_0' class='gform-field-label gform-field-label--type-inline'>Pre-owned Pristine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Pre-owned Premium'  id='choice_5_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_76_1' id='label_5_76_1' class='gform-field-label gform-field-label--type-inline'>Pre-owned Premium<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_45\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-purchase gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_45\"><label class='gfield_label gform-field-label' for='input_5_45' >Date of Purchase<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_5_45' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_45_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_45_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_45' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_5_50' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_2' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_2' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_49\"  class=\"gfield gfield--type-select device-type gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_49\"><label class='gfield_label gform-field-label' for='input_5_49' >Device Make<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select data-current=\"\" name='input_49' id='input_5_49' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='APPLE' >APPLE<\/option><option value='CAT' >CAT<\/option><option value='HONOR' >HONOR<\/option><option value='HUAWEI' >HUAWEI<\/option><option value='OPPO' >OPPO<\/option><option value='SAMSUNG' >SAMSUNG<\/option><option value='TABLETS' >TABLETS<\/option><option value='VIVO' >VIVO<\/option><option value='WEARABLES' >WEARABLES<\/option><option value='XIAOMI' >XIAOMI<\/option><option value='Others' >Others<\/option><\/select><\/div><\/div><div id=\"field_5_73\"  class=\"gfield gfield--type-select gfield--width-full device-model gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_73\"><label class='gfield_label gform-field-label' for='input_5_73' >Device Model<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select data-current=\"\" name='input_73' id='input_5_73' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select Device Make<\/option><option value='' ><\/option><\/select><\/div><\/div><div id=\"field_5_62\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_62\"><label class='gfield_label gform-field-label' for='input_5_62' >Device Model<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_5_62' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_64\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_64\"><label class='gfield_label gform-field-label' for='input_5_64' >Purchase Price<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_64' id='input_5_64' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_6\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_6\"><div class=\"quotation-response\"><\/div><\/div><div id=\"field_5_65\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_65\">As your device is not on our list, one of our underwriting staff will contact you to obtain further details & finalise your application.<\/div><div id=\"field_5_24\"  class=\"gfield gfield--type-text gfield--width-full device-imei gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_24\"><label class='gfield_label gform-field-label' for='input_5_24' >IMEI Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_5_24' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_38\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full device-imei-na field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_5_38\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >IMEI Not Available<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_38'><div class='gchoice gchoice_5_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='1'  id='choice_5_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_38_1' id='label_5_38_1' class='gform-field-label gform-field-label--type-inline'>IMEI is not yet available<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_7' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"1\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"1\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_7' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_25\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_25\"><h2>Bank Details & Debit Authority<\/h2><\/div><fieldset id=\"field_5_11\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_11\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Postal Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_5_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_11_1' id='input_5_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_5_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_11_2' id='input_5_11_2_label' class='gform-field-label gform-field-label--type-sub '>Street Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_5_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_11_3' id='input_5_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_5_11_4' value=''      aria-required='true'    \/>\n                                        <label for='input_5_11_4' id='input_5_11_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_5_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_11_5' id='input_5_11_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_5_11_6' value='South Africa' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_12\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_12\"><label class='gfield_label gform-field-label' for='input_5_12' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_41\"  class=\"gfield gfield--type-select bank-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_41\"><label class='gfield_label gform-field-label' for='input_5_41' >Bank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_5_41' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option data-branch-code=\"632005\" value='ABSA BANK' >ABSA BANK<\/option><option data-branch-code=\"470010\" value='CAPITEC BANK' >CAPITEC BANK<\/option><option data-branch-code=\"250655\" value='FIRST NATIONAL BANK' >FIRST NATIONAL BANK<\/option><option data-branch-code=\"198765\" value='NEDBANK LIMITED' >NEDBANK LIMITED<\/option><option data-branch-code=\"051001\" value='STANDARD BANK' >STANDARD BANK<\/option><option data-branch-code=\"430000\" value='AFRICAN BANK' >AFRICAN BANK<\/option><option data-branch-code=\"800000\" value='ALBARAKA BANK' >ALBARAKA BANK<\/option><option data-branch-code=\"688000\" value='BNP PARIBAS' >BNP PARIBAS<\/option><option data-branch-code=\"888000\" value='BANK ZERO' >BANK ZERO<\/option><option data-branch-code=\"462005\" value='BIDVEST BANK' >BIDVEST BANK<\/option><option data-branch-code=\"350005\" value='CITIBANK' >CITIBANK<\/option><option data-branch-code=\"679000\" value='DISCOVERY BANK' >DISCOVERY BANK<\/option><option data-branch-code=\"589000\" value='FINBOND MUTUAL BANK' >FINBOND MUTUAL BANK<\/option><option data-branch-code=\"591000\" value='FINBOND EPE' >FINBOND EPE<\/option><option data-branch-code=\"410342\" value='GROBANK LTD' >GROBANK LTD<\/option><option data-branch-code=\"223626\" value='GRINDRODBANK' >GRINDRODBANK<\/option><option data-branch-code=\"570100\" value='HBZ BANK' >HBZ BANK<\/option><option data-branch-code=\"587000\" value='HSBC BANK' >HSBC BANK<\/option><option data-branch-code=\"700066\" value='HABIB OVERSEAS BANK' >HABIB OVERSEAS BANK<\/option><option data-branch-code=\"580105\" value='INVESTEC BANK' >INVESTEC BANK<\/option><option data-branch-code=\"757026\" value='ITHALA' >ITHALA<\/option><option data-branch-code=\"432000\" value='JP MORGAN CHASE' >JP MORGAN CHASE<\/option><option data-branch-code=\"450105\" value='MERCANTILE BANK' >MERCANTILE BANK<\/option><option data-branch-code=\"261251\" value='RAND MERCHANT BANK' >RAND MERCHANT BANK<\/option><option data-branch-code=\"585001\" value='OLYMPUS MOBILE' >OLYMPUS MOBILE<\/option><option data-branch-code=\"720026\" value='PEOPLES BANK LTD INC NBS' >PEOPLES BANK LTD INC NBS<\/option><option data-branch-code=\"460005\" value='POSTBANK' >POSTBANK<\/option><option data-branch-code=\"900145\" value='S.A. RESERVE BANK' >S.A. RESERVE BANK<\/option><option data-branch-code=\"683000\" value='SASFIN BANK' >SASFIN BANK<\/option><option data-branch-code=\"351005\" value='SOCIETE GENERAL' >SOCIETE GENERAL<\/option><option data-branch-code=\"730020\" value='STANDARD CHARTERED BANK' >STANDARD CHARTERED BANK<\/option><option data-branch-code=\"801000\" value='STATE BANK OF INDIA' >STATE BANK OF INDIA<\/option><option data-branch-code=\"678910\" value='TYMEBANK' >TYMEBANK<\/option><option data-branch-code=\"431010\" value='UBANK LIMITED' >UBANK LIMITED<\/option><option data-branch-code=\"790005\" value='UNIBANK' >UNIBANK<\/option><option data-branch-code=\"588000\" value='VBS MUTUAL BANK' >VBS MUTUAL BANK<\/option><\/select><\/div><\/div><div id=\"field_5_14\"  class=\"gfield gfield--type-text bank-branch-code gf_readonly gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_14\"><label class='gfield_label gform-field-label' for='input_5_14' >Branch Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_5_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_42\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_42\"><label class='gfield_label gform-field-label' for='input_5_42' >Account Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_5_42' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Savings' >Savings<\/option><option value='Current' >Current<\/option><option value='Cheque' >Cheque<\/option><\/select><\/div><\/div><div id=\"field_5_13\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_13\"><label class='gfield_label gform-field-label' for='input_5_13' >Bank Account Holder&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_34\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_34\"><label class='gfield_label gform-field-label' for='input_5_34' >Account Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_5_34' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_17\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_17\"><label class='gfield_label gform-field-label' for='input_5_17' >Debit Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_5_17' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1st' >1st<\/option><option value='7th' >7th<\/option><option value='15th' >15th<\/option><option value='25th' >25th<\/option><option value='27th' >27th<\/option><\/select><\/div><\/div><div id=\"field_5_10\"  class=\"gfield gfield--type-html client-declaration gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_10\"><ul style=\"font-size: 14px\">\n \t<li>I authorise\u00a0Renasa Insurance Company Ltd to draw against the above account, the amount necessary for payment of the monthly premium every month until this arrangement is cancelled in writing by either party.<\/li>\n \t<li>I accept that if the debit date falls on a weekend or public holiday, we will be debited on the following working day.<\/li>\n \t<li>I am the authorised signatory on the above banking account and am authorised to apply for insurance on behalf of the company.<\/li>\n \t<li>I declare that I have applied for insurance cover on our mobile devices.<\/li>\n \t<li>I am aware of the first amount payable in the event of a claim.<\/li>\n \t<li>I am aware\u00a0of the premium payable and that the premium will be deducted in the cover month via monthly debit order by Renasa Insurance Company Ltd.<\/li>\n \t<li>I understand that failure to pay the monthly premium will result in cover lapsing.<\/li>\n \t<li>I confirm that I am in possession of the mobile devices\u00a0stated in the schedule.<\/li>\n \t<li>I understand that this declaration forms part of the policy of insurance.<\/li>\n \t<br><strong>Broker Acknowledgement:<\/strong><li>I hereby acknowledge that Econorisk Broker Consultants (Pty) Limited is the broker on The Real Insurance Cover mobile device policy and appoint them as our broker with effect from the commencement date of the policy to act on all matters related to this insurance policy and keep me informed of any additional cover options related to it at no additional fees to me. For any further advice or escalation, please contact tric@econorisk.co.za<\/li>\n<li><strong>Your monthly bank debit order reference will contain 'RENASAINS'<\/strong><\/li>\n<\/ul><\/div><div id=\"field_5_58\"  class=\"gfield gfield--type-signature gfield--width-full client-declaration-signature field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_58\"><label class='gfield_label gform-field-label' for='input_5_58' >Client Signature<\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' style='display:-moz-inline-stack; display: inline-block; zoom: 1; *display: inline;'><div id='input_5_58_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_5_58_valid' id='input_5_58_valid' \/><canvas id='input_5_58' width='300' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_5_58_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_5_58_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#000000\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"2\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_19' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_67\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_67\"><h2>Documents Upload<\/h2><\/div><div id=\"field_5_68\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_68\"><label class='gfield_label gform-field-label' for='input_5_68' >Proof of identity (ID, drivers license, or passport)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_68' id='input_5_68' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_68\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_68'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_68'><\/div><\/div><\/div><div id=\"field_5_69\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_69\"><label class='gfield_label gform-field-label' for='input_5_69' >Proof of purchase (invoice)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_69' id='input_5_69' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_69\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_69'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_69'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"3\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_20' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"5\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"5\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_26\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_26\"><h2>Accept T&Cs<\/h2><\/div><div id=\"field_5_79\"  class=\"gfield gfield--type-section gsection gf_scroll_text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_79\"><h3 class=\"gsection_title\">Terms, Conditions and Policy Wording<\/h3><div class='gsection_description' id='gfield_description_5_79'><p>We confirm your device is covered.<\/p>\n<p>One of our consultants will be in contact with you within 72 hours (Monday-Friday) to confirm the cover and will forward your policy documents to you.<\/p>\n\n<p>Just a few Terms and Conditions that you need to be aware of:<\/p>\n<p>I declare that I have applied for insurance cover on my mobile device(s).<\/p>\n<p>This insurance is only available for items purchased from an authorised network retailer and my device is currently free from damage and in my possession.<\/p>\n<p>Insurance Regulations require that we have on file a copy of your ID document and a copy of your proof of purchase. If we do not have this, you agree to provide it to us upon request.<\/p>\n<p>All premiums must be successfully collected into Insurers bank account in order that your policy remains valid and that a claim can be entertained.<\/p>\n<p>I am aware of the first amount payable in the event of a claim and that any claim submitted within the first sixty days (60) of cover, is subject to an additional excess of 10% of the claim.<\/p>\n<p>Any failure to disclose material fact or any false disclosure could result in us not accepting your risk and\/or Insurers voiding your Policy.<\/p>\n<p>I understand that this declaration forms part of the policy of insurance.<\/p>\n<p>Administration Plus (Pty) Ltd does not and will not sell or provide personal information to third parties for independent use. We may, however, share personal information with our business partners if that information is required to provide the product, or service you have requested and where relevant recruitment purposes. However, our business partners will adhere to using your information only as directed by Administration Plus (Pty) Ltd.<\/p><\/div><\/div><fieldset id=\"field_5_18\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_18.1' id='input_5_18_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_18_1' >I have read and understood the policy wording and disclosure document accompanying this policy.<\/label><input type='hidden' name='input_18.2' value='I have read and understood the policy wording and disclosure document accompanying this policy.' class='gform_hidden' \/><input type='hidden' name='input_18.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_5_47\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full marketing-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_47\"><legend class='gfield_label gform-field-label'  >May we contact you for related additional products or services we think you may find useful?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_47'>\n\t\t\t<div class='gchoice gchoice_5_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='YES'  id='choice_5_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_47_0' id='label_5_47_0' class='gform-field-label gform-field-label--type-inline'>Yes please<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='NO'  id='choice_5_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_47_1' id='label_5_47_1' class='gform-field-label gform-field-label--type-inline'>No, I would not like to receive any related marketing communications<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_5_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"4\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_5_66' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_5\").val(\"6\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_5\").val(\"6\");  jQuery(\"#gform_5\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_6' class='gform_fields left_label form_sublabel_below description_below'><div id=\"field_5_27\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_27\"><h2>Finish and Submit<\/h2><\/div><div id=\"field_5_21\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_21\"><p>Thank you for taking the time to fill in this application.<\/p>\n\n<p>If you've elected to take up cover and completed your application in full, once you hit 'Submit' below, we'll be in touch to finalise & confirm your policy has been accepted or rejected. We will send you further correspondence related to your insurance cover within 48 hours (Monday - Friday)<\/p><\/div><div id=\"field_5_31\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_31\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_31' >Client reference<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_5_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_33\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_33\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_33' >Item reference<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_5_33' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_32\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_5_32\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_32' >Policy reference<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_5_32' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_37\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_37\"><div class='ginput_container ginput_container_text'><input name='input_37' id='input_5_37' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/div><div id=\"field_5_80\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_80\"><label class='gfield_label gform-field-label' for='input_5_80' >Email<\/label><div class='ginput_container'><input name='input_80' id='input_5_80' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_80'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer left_label'><input type='submit' id='gform_previous_button_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_5\"]){return false;}  if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_5\"]){return false;} if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  jQuery(\"#gform_5\").trigger(\"submit\",[true]); 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