{"id":492,"date":"2019-02-27T13:30:25","date_gmt":"2019-02-27T11:30:25","guid":{"rendered":"http:\/\/secure.adminplus.co.za\/tric\/?page_id=492"},"modified":"2023-09-19T06:55:39","modified_gmt":"2023-09-19T04:55:39","slug":"individual-claims","status":"publish","type":"page","link":"https:\/\/secure.adminplus.co.za\/tric\/individual-claims\/","title":{"rendered":"Individual Claims"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;claim-form&#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 _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;on|on|on&#8221; _builder_version=&#8221;4.21.0&#8243; disabled=&#8221;on&#8221; 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 gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/tric\/wp-json\/wp\/v2\/pages\/492#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-47' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_34\"  class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_34\"><p style=\"text-align: center;\"><strong>NOTE:<\/strong>&nbsp;Our claims process starts with the completion of this form.<\/p>\n<p style=\"text-align: center;\">All lost\/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss.<\/p>\n<p style=\"text-align: center;\">This form must be completed and submitted within 30 days&nbsp;from the date of loss.<\/p><\/li><li id=\"field_2_31\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_31\"><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/li><li id=\"field_2_35\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_35\"><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/li><li id=\"field_2_25\"  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_2_25\"><label class='gfield_label gform-field-label' for='input_2_25' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\"><label class='gfield_label gform-field-label' for='input_2_6' >Cell Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_2_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_2_43' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_45\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\"><h2 class=\"gsection_title\">Policy devices<\/h2><\/li><li id=\"field_2_46\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\"><label class='gfield_label gform-field-label' for='input_2_46' >Select the device this claim pertains to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_2_46' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_2_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_44' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_8\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><h2 class=\"gsection_title\">Device Details<\/h2><\/li><li id=\"field_2_12\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\"><label class='gfield_label gform-field-label'  >Type of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Accidental Damage'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Accidental Damage<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft from Vehicle'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>Theft from Vehicle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='Lost Device'  id='choice_2_12_2'    \/>\n\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>Lost Device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft'  id='choice_2_12_3'    \/>\n\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>Theft<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_13\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-loss gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\"><label class='gfield_label gform-field-label' for='input_2_13' >Date of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_2_13' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_with_icon gdatepicker_with_icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_2_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_13_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_13' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_14\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\"><label class='gfield_label gform-field-label' for='input_2_14' >Place of Loss \/ Damage<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_15\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\"><label class='gfield_label gform-field-label' for='input_2_15' >Please provide a brief description of what happened in the space below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_2_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_36\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_36\"><h2 class=\"gsection_title\">Please upload any documents required for your claim submission<\/h2><\/li><li id=\"field_2_37\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\"><label class='gfield_label gform-field-label' for='input_2_37' >Copy of ID<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_37' id='input_2_37' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_37 gfield_description_2_37\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_37'>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_2_37'><\/div><\/div><div class='gfield_description' id='gfield_description_2_37'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_38\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_38\"><label class='gfield_label gform-field-label' for='input_2_38' >Affidavit<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_38' id='input_2_38' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_38 gfield_description_2_38\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_38'>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_2_38'><\/div><\/div><div class='gfield_description' id='gfield_description_2_38'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_39\"  class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\"><label class='gfield_label gform-field-label' for='input_2_39' >Other docs (Photo of phone box) and (iStore Statement)<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_39' id='input_2_39' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_39 gfield_description_2_39\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_39'>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_2_39'><\/div><\/div><div class='gfield_description' id='gfield_description_2_39'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\"><h2 class=\"gsection_title\">If the device was lost or stolen<\/h2><\/li><li id=\"field_2_17\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\"><label class='gfield_label gform-field-label' for='input_2_17' >ITC Reference No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_18\"><label class='gfield_label gform-field-label' for='input_2_18' >S.A.P Case No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_19\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_19\"><label class='gfield_label gform-field-label' for='input_2_19' >Name of Police Station where reported<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_2_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_20\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\"><h2 class=\"gsection_title\">If the device was stolen from a vehicle<\/h2><div class='gsection_description' id='gfield_description_2_20'>Fax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 \/ <a href=\"mailto:claims@adminplus.co.za\">claims@adminplus.co.za<\/a>.<\/div><\/li><li id=\"field_2_23\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\"><label class='gfield_label gform-field-label' for='input_2_23' >How was entry gained?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_26\"  class=\"gfield gfield--type-consent gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Claims Declaration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_2_26_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_26\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_26_1' >I hereby agree that:<\/label><input type='hidden' name='input_26.2' value='I hereby agree that:' class='gform_hidden' \/><input type='hidden' name='input_26.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_26'>I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof.<br \/>\n<br \/>\n(Please complete a separate form for each item being claimed.)<br \/>\n<br \/>\nI\/We hereby declare that all the information declared above is true in every respect and that I\/We have not withheld any relevant information and I\/We will assist with any additional information that is required to finalise this claim.<br \/>\n I\/We hereby authorise Adminplus\/the Insurer to carry out any checks required to validate my\/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information. <br \/>\nI understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. <br \/>\nI hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.<\/div><\/li><li id=\"field_2_47\"  class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_47\"><label class='gfield_label gform-field-label' for='input_2_47' >Insured Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/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_2_47_Container' class='gfield_signature_container ginput_container' style='height:180px; width:380px; ' ><input type='hidden' class='gform_hidden' name='input_2_47_valid' id='input_2_47_valid' \/><canvas id='input_2_47' width='380' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_2_47_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=\"#000\" 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_2_47_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=\"#000\" 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=\"#000\" 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 class='gfield_description' id='gfield_description_2_47'>You are signing in agreement to all the aforementioned conditions in the Claims Declaration<\/div><\/li><li id=\"field_2_40\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\"><h2 class=\"gsection_title\">Collection &amp; Delivery<\/h2><\/li><li id=\"field_2_41\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\"><label class='gfield_label gform-field-label' for='input_2_41' >Collection address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_2_41' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_42\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\"><label class='gfield_label gform-field-label' for='input_2_42' >Delivery address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_2_42' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_48\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\"><label class='gfield_label gform-field-label' for='input_2_48' >Name<\/label><div class='ginput_container'><input name='input_48' id='input_2_48' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_48'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer left_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='Finish and Send'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJ7XCIyNi4xXCI6XCI1ZmZjNjAyMDZmOWU5YTJlZmNmNzlkYjA5MDQ4Y2VjMVwiLFwiMjYuMlwiOlwiOWQ1Njg5NDBiYjRiYjdhMzE3MDk2OWM2ZWM1Zjc3ZGJcIixcIjI2LjNcIjpcImIyMTQ0MGFmM2UyMzI3Mjk1MzdkYjg5N2Q0MzdkZmMwXCJ9IiwiM2RhZTc4ODk5OGZlODJhZWExNTkwMGUwOTFiM2Y2NWIiXQ==' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' 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( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').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_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').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_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = 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_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [2, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 2, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n<!-- [et_pb_line_break_holder] --><!-- <script type=\"text\/javascript\" src=\"https:\/\/form.myjotform.com\/jsform\/73454313094555\"><\/script> -->[\/et_pb_code][et_pb_code _builder_version=&#8221;4.21.0&#8243; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='1' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/tric\/wp-json\/wp\/v2\/pages\/492#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-47' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_34\"  class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_34\"><p style=\"text-align: center;\"><strong>NOTE:<\/strong>&nbsp;Our claims process starts with the completion of this form.<\/p>\n<p style=\"text-align: center;\">All lost\/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss.<\/p>\n<p style=\"text-align: center;\">This form must be completed and submitted within 30 days&nbsp;from the date of loss.<\/p><\/li><li id=\"field_2_31\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_31\"><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/li><li id=\"field_2_35\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_35\"><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/li><li id=\"field_2_25\"  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_2_25\"><label class='gfield_label gform-field-label' for='input_2_25' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\"><label class='gfield_label gform-field-label' for='input_2_6' >Cell Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_2_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_2_43' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_45\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\"><h2 class=\"gsection_title\">Policy devices<\/h2><\/li><li id=\"field_2_46\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\"><label class='gfield_label gform-field-label' for='input_2_46' >Select the device this claim pertains to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_2_46' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_2_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_44' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_8\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><h2 class=\"gsection_title\">Device Details<\/h2><\/li><li id=\"field_2_12\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\"><label class='gfield_label gform-field-label'  >Type of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Accidental Damage'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Accidental Damage<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft from Vehicle'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>Theft from Vehicle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='Lost Device'  id='choice_2_12_2'    \/>\n\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>Lost Device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft'  id='choice_2_12_3'    \/>\n\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>Theft<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_13\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-loss gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\"><label class='gfield_label gform-field-label' for='input_2_13' >Date of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_2_13' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_with_icon gdatepicker_with_icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_2_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_13_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_13' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_14\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\"><label class='gfield_label gform-field-label' for='input_2_14' >Place of Loss \/ Damage<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_15\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\"><label class='gfield_label gform-field-label' for='input_2_15' >Please provide a brief description of what happened in the space below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_2_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_36\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_36\"><h2 class=\"gsection_title\">Please upload any documents required for your claim submission<\/h2><\/li><li id=\"field_2_37\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\"><label class='gfield_label gform-field-label' for='input_2_37' >Copy of ID<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_37' id='input_2_37' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_37 gfield_description_2_37\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_37'>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_2_37'><\/div><\/div><div class='gfield_description' id='gfield_description_2_37'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_38\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_38\"><label class='gfield_label gform-field-label' for='input_2_38' >Affidavit<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_38' id='input_2_38' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_38 gfield_description_2_38\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_38'>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_2_38'><\/div><\/div><div class='gfield_description' id='gfield_description_2_38'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_39\"  class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\"><label class='gfield_label gform-field-label' for='input_2_39' >Other docs (Photo of phone box) and (iStore Statement)<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_39' id='input_2_39' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_39 gfield_description_2_39\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_39'>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_2_39'><\/div><\/div><div class='gfield_description' id='gfield_description_2_39'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\"><h2 class=\"gsection_title\">If the device was lost or stolen<\/h2><\/li><li id=\"field_2_17\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\"><label class='gfield_label gform-field-label' for='input_2_17' >ITC Reference No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_18\"><label class='gfield_label gform-field-label' for='input_2_18' >S.A.P Case No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_19\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_19\"><label class='gfield_label gform-field-label' for='input_2_19' >Name of Police Station where reported<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_2_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_20\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\"><h2 class=\"gsection_title\">If the device was stolen from a vehicle<\/h2><div class='gsection_description' id='gfield_description_2_20'>Fax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 \/ <a href=\"mailto:claims@adminplus.co.za\">claims@adminplus.co.za<\/a>.<\/div><\/li><li id=\"field_2_23\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\"><label class='gfield_label gform-field-label' for='input_2_23' >How was entry gained?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_26\"  class=\"gfield gfield--type-consent gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Claims Declaration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_2_26_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_26\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_26_1' >I hereby agree that:<\/label><input type='hidden' name='input_26.2' value='I hereby agree that:' class='gform_hidden' \/><input type='hidden' name='input_26.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_26'>I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof.<br \/>\n<br \/>\n(Please complete a separate form for each item being claimed.)<br \/>\n<br \/>\nI\/We hereby declare that all the information declared above is true in every respect and that I\/We have not withheld any relevant information and I\/We will assist with any additional information that is required to finalise this claim.<br \/>\n I\/We hereby authorise Adminplus\/the Insurer to carry out any checks required to validate my\/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information. <br \/>\nI understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. <br \/>\nI hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.<\/div><\/li><li id=\"field_2_47\"  class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_47\"><label class='gfield_label gform-field-label' for='input_2_47' >Insured Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/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_2_47_Container' class='gfield_signature_container ginput_container' style='height:180px; width:380px; ' ><input type='hidden' class='gform_hidden' name='input_2_47_valid' id='input_2_47_valid' \/><canvas id='input_2_47' width='380' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_2_47_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=\"#000\" 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_2_47_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=\"#000\" 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=\"#000\" 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 class='gfield_description' id='gfield_description_2_47'>You are signing in agreement to all the aforementioned conditions in the Claims Declaration<\/div><\/li><li id=\"field_2_40\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\"><h2 class=\"gsection_title\">Collection &amp; Delivery<\/h2><\/li><li id=\"field_2_41\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\"><label class='gfield_label gform-field-label' for='input_2_41' >Collection address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_2_41' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_42\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\"><label class='gfield_label gform-field-label' for='input_2_42' >Delivery address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_2_42' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_48\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\"><label class='gfield_label gform-field-label' for='input_2_48' >Email<\/label><div class='ginput_container'><input name='input_48' id='input_2_48' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_48'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer left_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='Finish and Send'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJ7XCIyNi4xXCI6XCI1ZmZjNjAyMDZmOWU5YTJlZmNmNzlkYjA5MDQ4Y2VjMVwiLFwiMjYuMlwiOlwiOWQ1Njg5NDBiYjRiYjdhMzE3MDk2OWM2ZWM1Zjc3ZGJcIixcIjI2LjNcIjpcImIyMTQ0MGFmM2UyMzI3Mjk1MzdkYjg5N2Q0MzdkZmMwXCJ9IiwiM2RhZTc4ODk5OGZlODJhZWExNTkwMGUwOTFiM2Y2NWIiXQ==' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' 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( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').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_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').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_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = 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_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [2, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 2, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='2' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/tric\/wp-json\/wp\/v2\/pages\/492#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-47' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_34\"  class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_34\"><p style=\"text-align: center;\"><strong>NOTE:<\/strong>&nbsp;Our claims process starts with the completion of this form.<\/p>\n<p style=\"text-align: center;\">All lost\/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss.<\/p>\n<p style=\"text-align: center;\">This form must be completed and submitted within 30 days&nbsp;from the date of loss.<\/p><\/li><li id=\"field_2_31\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_31\"><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/li><li id=\"field_2_35\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_35\"><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/li><li id=\"field_2_25\"  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_2_25\"><label class='gfield_label gform-field-label' for='input_2_25' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\"><label class='gfield_label gform-field-label' for='input_2_6' >Cell Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_2_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_2_43' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_45\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\"><h2 class=\"gsection_title\">Policy devices<\/h2><\/li><li id=\"field_2_46\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\"><label class='gfield_label gform-field-label' for='input_2_46' >Select the device this claim pertains to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_2_46' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_2_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_44' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_8\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><h2 class=\"gsection_title\">Device Details<\/h2><\/li><li id=\"field_2_12\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\"><label class='gfield_label gform-field-label'  >Type of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Accidental Damage'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Accidental Damage<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft from Vehicle'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>Theft from Vehicle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='Lost Device'  id='choice_2_12_2'    \/>\n\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>Lost Device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft'  id='choice_2_12_3'    \/>\n\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>Theft<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_13\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-loss gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\"><label class='gfield_label gform-field-label' for='input_2_13' >Date of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_2_13' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_with_icon gdatepicker_with_icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_2_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_13_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_13' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_14\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\"><label class='gfield_label gform-field-label' for='input_2_14' >Place of Loss \/ Damage<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_15\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\"><label class='gfield_label gform-field-label' for='input_2_15' >Please provide a brief description of what happened in the space below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_2_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_36\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_36\"><h2 class=\"gsection_title\">Please upload any documents required for your claim submission<\/h2><\/li><li id=\"field_2_37\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\"><label class='gfield_label gform-field-label' for='input_2_37' >Copy of ID<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_37' id='input_2_37' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_37 gfield_description_2_37\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_37'>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_2_37'><\/div><\/div><div class='gfield_description' id='gfield_description_2_37'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_38\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_38\"><label class='gfield_label gform-field-label' for='input_2_38' >Affidavit<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_38' id='input_2_38' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_38 gfield_description_2_38\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_38'>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_2_38'><\/div><\/div><div class='gfield_description' id='gfield_description_2_38'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_39\"  class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\"><label class='gfield_label gform-field-label' for='input_2_39' >Other docs (Photo of phone box) and (iStore Statement)<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_39' id='input_2_39' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_39 gfield_description_2_39\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_39'>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_2_39'><\/div><\/div><div class='gfield_description' id='gfield_description_2_39'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\"><h2 class=\"gsection_title\">If the device was lost or stolen<\/h2><\/li><li id=\"field_2_17\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\"><label class='gfield_label gform-field-label' for='input_2_17' >ITC Reference No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_18\"><label class='gfield_label gform-field-label' for='input_2_18' >S.A.P Case No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_19\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_19\"><label class='gfield_label gform-field-label' for='input_2_19' >Name of Police Station where reported<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_2_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_20\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\"><h2 class=\"gsection_title\">If the device was stolen from a vehicle<\/h2><div class='gsection_description' id='gfield_description_2_20'>Fax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 \/ <a href=\"mailto:claims@adminplus.co.za\">claims@adminplus.co.za<\/a>.<\/div><\/li><li id=\"field_2_23\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\"><label class='gfield_label gform-field-label' for='input_2_23' >How was entry gained?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_26\"  class=\"gfield gfield--type-consent gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Claims Declaration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_2_26_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_26\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_26_1' >I hereby agree that:<\/label><input type='hidden' name='input_26.2' value='I hereby agree that:' class='gform_hidden' \/><input type='hidden' name='input_26.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_26'>I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof.<br \/>\n<br \/>\n(Please complete a separate form for each item being claimed.)<br \/>\n<br \/>\nI\/We hereby declare that all the information declared above is true in every respect and that I\/We have not withheld any relevant information and I\/We will assist with any additional information that is required to finalise this claim.<br \/>\n I\/We hereby authorise Adminplus\/the Insurer to carry out any checks required to validate my\/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information. <br \/>\nI understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. <br \/>\nI hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.<\/div><\/li><li id=\"field_2_47\"  class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_47\"><label class='gfield_label gform-field-label' for='input_2_47' >Insured Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/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_2_47_Container' class='gfield_signature_container ginput_container' style='height:180px; width:380px; ' ><input type='hidden' class='gform_hidden' name='input_2_47_valid' id='input_2_47_valid' \/><canvas id='input_2_47' width='380' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_2_47_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=\"#000\" 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_2_47_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=\"#000\" 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=\"#000\" 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 class='gfield_description' id='gfield_description_2_47'>You are signing in agreement to all the aforementioned conditions in the Claims Declaration<\/div><\/li><li id=\"field_2_40\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\"><h2 class=\"gsection_title\">Collection &amp; Delivery<\/h2><\/li><li id=\"field_2_41\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\"><label class='gfield_label gform-field-label' for='input_2_41' >Collection address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_2_41' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_42\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\"><label class='gfield_label gform-field-label' for='input_2_42' >Delivery address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_2_42' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_48\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\"><label class='gfield_label gform-field-label' for='input_2_48' >Email<\/label><div class='ginput_container'><input name='input_48' id='input_2_48' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_48'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer left_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='Finish and Send'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJ7XCIyNi4xXCI6XCI1ZmZjNjAyMDZmOWU5YTJlZmNmNzlkYjA5MDQ4Y2VjMVwiLFwiMjYuMlwiOlwiOWQ1Njg5NDBiYjRiYjdhMzE3MDk2OWM2ZWM1Zjc3ZGJcIixcIjI2LjNcIjpcImIyMTQ0MGFmM2UyMzI3Mjk1MzdkYjg5N2Q0MzdkZmMwXCJ9IiwiM2RhZTc4ODk5OGZlODJhZWExNTkwMGUwOTFiM2Y2NWIiXQ==' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' 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( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').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_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').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_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = 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_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [2, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 2, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='3' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/tric\/wp-json\/wp\/v2\/pages\/492#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-47' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_34\"  class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_34\"><p style=\"text-align: center;\"><strong>NOTE:<\/strong>&nbsp;Our claims process starts with the completion of this form.<\/p>\n<p style=\"text-align: center;\">All lost\/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss.<\/p>\n<p style=\"text-align: center;\">This form must be completed and submitted within 30 days&nbsp;from the date of loss.<\/p><\/li><li id=\"field_2_31\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_31\"><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/li><li id=\"field_2_35\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_35\"><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='unassigned' \/><\/div><\/li><li id=\"field_2_25\"  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_2_25\"><label class='gfield_label gform-field-label' for='input_2_25' >ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\"><label class='gfield_label gform-field-label' for='input_2_6' >Cell Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_2_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_2_43' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_45\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\"><h2 class=\"gsection_title\">Policy devices<\/h2><\/li><li id=\"field_2_46\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\"><label class='gfield_label gform-field-label' for='input_2_46' >Select the device this claim pertains to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_2_46' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_2_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_44' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_2_8\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><h2 class=\"gsection_title\">Device Details<\/h2><\/li><li id=\"field_2_12\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\"><label class='gfield_label gform-field-label'  >Type of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Accidental Damage'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Accidental Damage<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft from Vehicle'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>Theft from Vehicle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='Lost Device'  id='choice_2_12_2'    \/>\n\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>Lost Device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='Theft'  id='choice_2_12_3'    \/>\n\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>Theft<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_13\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon date-of-loss gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\"><label class='gfield_label gform-field-label' for='input_2_13' >Date of Loss \/ Damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_2_13' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_with_icon gdatepicker_with_icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_2_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_13_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_13' class='gform_hidden' value='https:\/\/secure.adminplus.co.za\/tric\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_14\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\"><label class='gfield_label gform-field-label' for='input_2_14' >Place of Loss \/ Damage<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_15\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\"><label class='gfield_label gform-field-label' for='input_2_15' >Please provide a brief description of what happened in the space below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_2_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_36\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_36\"><h2 class=\"gsection_title\">Please upload any documents required for your claim submission<\/h2><\/li><li id=\"field_2_37\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\"><label class='gfield_label gform-field-label' for='input_2_37' >Copy of ID<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_37' id='input_2_37' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_37 gfield_description_2_37\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_37'>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_2_37'><\/div><\/div><div class='gfield_description' id='gfield_description_2_37'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_38\"  class=\"gfield gfield--type-fileupload maybe-required-doc field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_38\"><label class='gfield_label gform-field-label' for='input_2_38' >Affidavit<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_38' id='input_2_38' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_38 gfield_description_2_38\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_38'>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_2_38'><\/div><\/div><div class='gfield_description' id='gfield_description_2_38'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_39\"  class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\"><label class='gfield_label gform-field-label' for='input_2_39' >Other docs (Photo of phone box) and (iStore Statement)<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_39' id='input_2_39' type='file' class='medium' aria-describedby=\"gfield_upload_rules_2_39 gfield_description_2_39\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_39'>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_2_39'><\/div><\/div><div class='gfield_description' id='gfield_description_2_39'>Allowed file types: jpg, jpeg, gif, png, pdf<\/div><\/li><li id=\"field_2_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\"><h2 class=\"gsection_title\">If the device was lost or stolen<\/h2><\/li><li id=\"field_2_17\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\"><label class='gfield_label gform-field-label' for='input_2_17' >ITC Reference No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_18\"><label class='gfield_label gform-field-label' for='input_2_18' >S.A.P Case No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_19\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_19\"><label class='gfield_label gform-field-label' for='input_2_19' >Name of Police Station where reported<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_2_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_20\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\"><h2 class=\"gsection_title\">If the device was stolen from a vehicle<\/h2><div class='gsection_description' id='gfield_description_2_20'>Fax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 \/ <a href=\"mailto:claims@adminplus.co.za\">claims@adminplus.co.za<\/a>.<\/div><\/li><li id=\"field_2_23\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\"><label class='gfield_label gform-field-label' for='input_2_23' >How was entry gained?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_26\"  class=\"gfield gfield--type-consent gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Claims Declaration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_2_26_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_26\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_26_1' >I hereby agree that:<\/label><input type='hidden' name='input_26.2' value='I hereby agree that:' class='gform_hidden' \/><input type='hidden' name='input_26.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_26'>I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof.<br \/>\n<br \/>\n(Please complete a separate form for each item being claimed.)<br \/>\n<br \/>\nI\/We hereby declare that all the information declared above is true in every respect and that I\/We have not withheld any relevant information and I\/We will assist with any additional information that is required to finalise this claim.<br \/>\n I\/We hereby authorise Adminplus\/the Insurer to carry out any checks required to validate my\/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information. <br \/>\nI understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. <br \/>\nI hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.<\/div><\/li><li id=\"field_2_47\"  class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_47\"><label class='gfield_label gform-field-label' for='input_2_47' >Insured Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/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_2_47_Container' class='gfield_signature_container ginput_container' style='height:180px; width:380px; ' ><input type='hidden' class='gform_hidden' name='input_2_47_valid' id='input_2_47_valid' \/><canvas id='input_2_47' width='380' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_2_47_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=\"#000\" 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_2_47_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=\"#000\" 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=\"#000\" 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 class='gfield_description' id='gfield_description_2_47'>You are signing in agreement to all the aforementioned conditions in the Claims Declaration<\/div><\/li><li id=\"field_2_40\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\"><h2 class=\"gsection_title\">Collection &amp; Delivery<\/h2><\/li><li id=\"field_2_41\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\"><label class='gfield_label gform-field-label' for='input_2_41' >Collection address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_2_41' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head Office<\/option><option value='Insu' >Insurance<\/option><option value='KENIL' >Kenilworth<\/option><option value='King' >King Shaka Airport<\/option><option value='MALL ' >Mall of Africa<\/option><option value='MELROSE' >Melrose Arch<\/option><option value='N1C' >N1 City<\/option><option value='NATRENT' >National Rentals<\/option><option value='ONL' >Online<\/option><option value='ONLS' >On Line Store<\/option><option value='ORT' >OR Tambo International<\/option><option value='PAVILLION' >Pavilion<\/option><option value='Sand' >Sandton<\/option><option value='Shes' >Shesha <\/option><option value='SME' >SME<\/option><option value='SOMER' >Somerset West<\/option><option value='Tech' >Technical\/Repairs<\/option><option value='THE BRIDGE' >The Bridge<\/option><option value='THE GROVE' >The Grove<\/option><option value='The Padd' >The Paddocks<\/option><option value='THE POINT' >The Point<\/option><option value='THE REAL' >The Real Repair Company<\/option><option value='TRRC' >TRRC Sandton<\/option><option value='Tyge' >Tygervalley<\/option><option value='Walm' >Walmer Park<\/option><option value='WAT' >Vodacomshop Waterfront<\/option><option value='WFR' >Waterfront<\/option><\/select><\/div><\/li><li id=\"field_2_42\"  class=\"gfield gfield--type-select gfield--width-full dropdown-stores field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\"><label class='gfield_label gform-field-label' for='input_2_42' >Delivery address\/Store<\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_2_42' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select store<\/option><option value='BAYW' >Bay West<\/option><option value='BEDFORD' >Bedford Centre<\/option><option value='Benm' >Benmore<\/option><option value='BLUE ROUTE' >Blue Route<\/option><option value='Cana' >Canal Walk Vodacom<\/option><option value='CANAL' >Canal Walk<\/option><option value='CapeD' >Cape Town Domestic<\/option><option value='CapeQ' >Cape Quarter<\/option><option value='CAV' >Cavendish<\/option><option value='CLEAR' >Clearwater<\/option><option value='CLUC HO' >Head Office<\/option><option value='Cons' >Constantia<\/option><option value='GALLERIA' >Galleria<\/option><option value='Gard' >Gardens<\/option><option value='GATE' >Gateway<\/option><option value='HEMMING' >Hemmingways<\/option><option value='InsHO' >Insurance Head 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