{"id":7071,"date":"2021-06-08T11:35:02","date_gmt":"2021-06-08T09:35:02","guid":{"rendered":"https:\/\/www.chanasassurances.com\/online-claim-reporting\/"},"modified":"2022-09-20T11:20:56","modified_gmt":"2022-09-20T09:20:56","slug":"online-claim-reporting","status":"publish","type":"page","link":"https:\/\/www.chanasassurances.com\/en\/our-online-services\/online-claim-reporting\/","title":{"rendered":"Online claim reporting"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"max-width:1185.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-15079\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;\" data-form-id=\"15079\" 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v\\u00e9hicule&quot;,&quot;nombre_de_vehicule&quot;:&quot;Nombre de v\\u00e9hicule impliqu\\u00e9&quot;,&quot;nom_de_adversaire_01&quot;:&quot;Nom de l&#039;adversaire 01&quot;,&quot;immatriculation_01&quot;:&quot;Immatriculation 01&quot;,&quot;compagnie_dassurance_1&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 01&quot;,&quot;nom_a_2&quot;:&quot;Nom de l&#039;adversaire 01&quot;,&quot;immatriculation_02&quot;:&quot;Immatriculation 01&quot;,&quot;compagnie_dassurance_02&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 01&quot;,&quot;nom_a_2-2&quot;:&quot;Nom de l&#039;adversaire 02&quot;,&quot;immatriculation_02-1&quot;:&quot;Immatriculation 02&quot;,&quot;compagnie_dassurance_02-1&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 02&quot;,&quot;nom_a_3&quot;:&quot;Nom de l&#039;adversaire 01&quot;,&quot;immatriculation_03&quot;:&quot;Immatriculation 01&quot;,&quot;compagnie_dassurance_03&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 01&quot;,&quot;nom_a_3-1&quot;:&quot;Nom de l&#039;adversaire 02&quot;,&quot;immatriculation_03-1&quot;:&quot;Immatriculation 02&quot;,&quot;compagnie_dassurance_03-1&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 02&quot;,&quot;nom_a_3-2&quot;:&quot;Nom de l&#039;adversaire 03&quot;,&quot;immatriculation_03-2&quot;:&quot;Immatriculation 03&quot;,&quot;compagnie_dassurance_03-2&quot;:&quot;Compagnie d&#039;assurance \\\/ Adversaire 03&quot;,&quot;causes_&amp;_circonstance&quot;:&quot;Causes &amp; circonstances du sinistre&quot;,&quot;identifiant_vehicule__pieton_tiers_&quot;:&quot;Identifiant v\\u00e9hicule \\\/ pi\\u00e9ton tiers &quot;,&quot;veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour&quot;:&quot;Veuillez joindre les documents dont vous disposez \\u00e0 ce jour (proc\\u00e8s-verbal, photos ...) :&quot;},&quot;field_logics&quot;:{&quot;vous_etes:&quot;:&quot;&quot;,&quot;nom_entreprise&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;vous_etes:\\&quot;,\\&quot;value\\&quot;:\\&quot;Entreprise\\&quot;}]&quot;,&quot;nom_du_responsable&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;vous_etes:\\&quot;,\\&quot;value\\&quot;:\\&quot;Entreprise\\&quot;}]&quot;,&quot;email_du_responsable&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;vous_etes:\\&quot;,\\&quot;value\\&quot;:\\&quot;Entreprise\\&quot;}]&quot;,&quot;nom&quot;:&quot;&quot;,&quot;Prenom&quot;:&quot;&quot;,&quot;email&quot;:&quot;&quot;,&quot;telephone&quot;:&quot;&quot;,&quot;numero_du_contrat&quot;:&quot;&quot;,&quot;nature_du_sinistre&quot;:&quot;&quot;,&quot;date_du_sinistre&quot;:&quot;&quot;,&quot;immatriculation_de_votre_vehicule&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nature_du_sinistre\\&quot;,\\&quot;value\\&quot;:\\&quot;automobile\\&quot;}]&quot;,&quot;nombre_de_vehicule&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nature_du_sinistre\\&quot;,\\&quot;value\\&quot;:\\&quot;automobile\\&quot;}]&quot;,&quot;nom_de_adversaire_01&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;1\\&quot;}]&quot;,&quot;immatriculation_01&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;1\\&quot;}]&quot;,&quot;compagnie_dassurance_1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;1\\&quot;}]&quot;,&quot;nom_a_2&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;immatriculation_02&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;compagnie_dassurance_02&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;nom_a_2-2&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;immatriculation_02-1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;compagnie_dassurance_02-1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;2\\&quot;}]&quot;,&quot;nom_a_3&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;immatriculation_03&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;compagnie_dassurance_03&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;nom_a_3-1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;immatriculation_03-1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;compagnie_dassurance_03-1&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;nom_a_3-2&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;immatriculation_03-2&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;compagnie_dassurance_03-2&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nombre_de_vehicule\\&quot;,\\&quot;value\\&quot;:\\&quot;3\\&quot;}]&quot;,&quot;causes_&amp;_circonstance&quot;:&quot;&quot;,&quot;identifiant_vehicule__pieton_tiers_&quot;:&quot;[{\\&quot;operator\\&quot;:\\&quot;and\\&quot;,\\&quot;comparison\\&quot;:\\&quot;equal\\&quot;,\\&quot;field\\&quot;:\\&quot;nature_du_sinistre\\&quot;,\\&quot;value\\&quot;:\\&quot;automobile \\&quot;}]&quot;,&quot;veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour&quot;:&quot;&quot;,&quot;notice_1&quot;:&quot;&quot;,&quot;submit_1&quot;:&quot;&quot;},&quot;field_types&quot;:{&quot;vous_etes:&quot;:&quot;select&quot;,&quot;nom_entreprise&quot;:&quot;text&quot;,&quot;nom_du_responsable&quot;:&quot;text&quot;,&quot;email_du_responsable&quot;:&quot;email&quot;,&quot;nom&quot;:&quot;text&quot;,&quot;Prenom&quot;:&quot;text&quot;,&quot;email&quot;:&quot;email&quot;,&quot;telephone&quot;:&quot;phone_number&quot;,&quot;numero_du_contrat&quot;:&quot;text&quot;,&quot;nature_du_sinistre&quot;:&quot;select&quot;,&quot;date_du_sinistre&quot;:&quot;date&quot;,&quot;immatriculation_de_votre_vehicule&quot;:&quot;text&quot;,&quot;nombre_de_vehicule&quot;:&quot;select&quot;,&quot;nom_de_adversaire_01&quot;:&quot;text&quot;,&quot;immatriculation_01&quot;:&quot;text&quot;,&quot;compagnie_dassurance_1&quot;:&quot;text&quot;,&quot;nom_a_2&quot;:&quot;text&quot;,&quot;immatriculation_02&quot;:&quot;text&quot;,&quot;compagnie_dassurance_02&quot;:&quot;text&quot;,&quot;nom_a_2-2&quot;:&quot;text&quot;,&quot;immatriculation_02-1&quot;:&quot;text&quot;,&quot;compagnie_dassurance_02-1&quot;:&quot;text&quot;,&quot;nom_a_3&quot;:&quot;text&quot;,&quot;immatriculation_03&quot;:&quot;text&quot;,&quot;compagnie_dassurance_03&quot;:&quot;text&quot;,&quot;nom_a_3-1&quot;:&quot;text&quot;,&quot;immatriculation_03-1&quot;:&quot;text&quot;,&quot;compagnie_dassurance_03-1&quot;:&quot;text&quot;,&quot;nom_a_3-2&quot;:&quot;text&quot;,&quot;immatriculation_03-2&quot;:&quot;text&quot;,&quot;compagnie_dassurance_03-2&quot;:&quot;text&quot;,&quot;causes_&amp;_circonstance&quot;:&quot;textarea&quot;,&quot;identifiant_vehicule__pieton_tiers_&quot;:&quot;text&quot;,&quot;veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour&quot;:&quot;upload&quot;,&quot;notice_1&quot;:&quot;notice&quot;,&quot;submit_1&quot;:&quot;submit&quot;},&quot;nonce_method&quot;:&quot;ajax&quot;,&quot;form_views&quot;:&quot;ajax&quot;,&quot;form_views_counting&quot;:&quot;all&quot;}\"><form action=\"https:\/\/www.chanasassurances.com\/en\/our-online-services\/online-claim-reporting\/\" method=\"post\" class=\"fusion-form fusion-form-15079\" enctype=\"multipart\/form-data\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:2%;--awb-padding-bottom:2%;--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-stretch\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1px;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><label for=\"vous_etes:\">Vous \u00eates: <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"vous_etes:\" name=\"vous_etes:\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Particulier\" >Particulier<\/option><option value=\"Entreprise\" >Entreprise<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_1\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_entreprise\">Nom de l&#039;entreprise <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_entreprise\" id=\"nom_entreprise\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_2\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_du_responsable\">Nom du Responsable <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_du_responsable\" id=\"nom_du_responsable\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"email_1\"><div class=\"fusion-form-label-wrapper\"><label for=\"email_du_responsable\">Email du responsable <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"email_du_responsable\" id=\"email_du_responsable\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-0 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-color:#0033a0;--awb-bg-color-hover:#0033a0;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><h3 style=\"text-align: center; color: #ffffff;\">Donn\u00e9es personnelles<\/h3>\n<\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom\">Nom <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom\" id=\"nom\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-2 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div class=\"fusion-form-label-wrapper\"><label for=\"Prenom\">Pr\u00e9nom <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"Prenom\" id=\"Prenom\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div class=\"fusion-form-label-wrapper\"><label for=\"email\">Email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"email\" id=\"email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div class=\"fusion-form-label-wrapper\"><label for=\"telephone\">T\u00e9l\u00e9phone <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telephone\" id=\"telephone\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div class=\"fusion-form-label-wrapper\"><label for=\"numero_du_contrat\">Num\u00e9ro du contrat <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"numero_du_contrat\" id=\"numero_du_contrat\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"11\" maxlength=\"13\"\/><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-3 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-color:#0033a0;--awb-bg-color-hover:#0033a0;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-2\"><h3 style=\"text-align: center; color: #ffffff;\">Nature du sinistre<\/h3>\n<\/div><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><label for=\"nature_du_sinistre\">Nature du sinistre<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"nature_du_sinistre\" name=\"nature_du_sinistre\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"autre\" >autre<\/option><option value=\"Automobile\" >Automobile<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><label for=\"date_du_sinistre\">Date du sinistre <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"date_du_sinistre\" name=\"date_du_sinistre\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_6\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_de_votre_vehicule\">Immatriculation de votre v\u00e9hicule <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_de_votre_vehicule\" id=\"immatriculation_de_votre_vehicule\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"LT 0000 AA *\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"select_3\"><label for=\"nombre_de_vehicule\">Nombre de v\u00e9hicule impliqu\u00e9 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"nombre_de_vehicule\" name=\"nombre_de_vehicule\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"\" disabled selected>???<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-4 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-border-color:#0e3594;--awb-border-style:solid;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_7\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_de_adversaire_01\">Nom de l&#039;adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_de_adversaire_01\" id=\"nom_de_adversaire_01\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-5 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-border-color:#0e3594;--awb-border-style:solid;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_8\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_01\">Immatriculation 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_01\" id=\"immatriculation_01\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-6 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_9\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_1\">Compagnie d&#039;assurance \/ Adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_1\" id=\"compagnie_dassurance_1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-7 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_10\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_a_2\">Nom de l&#039;adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_a_2\" id=\"nom_a_2\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-8 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_11\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_02\">Immatriculation 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_02\" id=\"immatriculation_02\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-9 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_12\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_02\">Compagnie d&#039;assurance \/ Adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_02\" id=\"compagnie_dassurance_02\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-10 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_13\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_a_2-2\">Nom de l&#039;adversaire 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_a_2-2\" id=\"nom_a_2-2\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-11 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_14\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_02-1\">Immatriculation 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_02-1\" id=\"immatriculation_02-1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-12 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_15\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_02-1\">Compagnie d&#039;assurance \/ Adversaire 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_02-1\" id=\"compagnie_dassurance_02-1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-13 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_16\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_a_3\">Nom de l&#039;adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_a_3\" id=\"nom_a_3\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-14 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_17\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_03\">Immatriculation 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_03\" id=\"immatriculation_03\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-15 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_18\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_03\">Compagnie d&#039;assurance \/ Adversaire 01 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_03\" id=\"compagnie_dassurance_03\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-16 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_19\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_a_3-1\">Nom de l&#039;adversaire 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_a_3-1\" id=\"nom_a_3-1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-17 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_20\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_03-1\">Immatriculation 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_03-1\" id=\"immatriculation_03-1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-18 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_21\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_03-1\">Compagnie d&#039;assurance \/ Adversaire 02 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_03-1\" id=\"compagnie_dassurance_03-1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-19 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_22\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom_a_3-2\">Nom de l&#039;adversaire 03 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"nom_a_3-2\" id=\"nom_a_3-2\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-20 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_23\"><div class=\"fusion-form-label-wrapper\"><label for=\"immatriculation_03-2\">Immatriculation 03 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"immatriculation_03-2\" id=\"immatriculation_03-2\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-21 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_24\"><div class=\"fusion-form-label-wrapper\"><label for=\"compagnie_dassurance_03-2\">Compagnie d&#039;assurance \/ Adversaire 03 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"compagnie_dassurance_03-2\" id=\"compagnie_dassurance_03-2\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-textarea-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><label for=\"causes_&amp;_circonstance\">Causes &amp; circonstances du sinistre <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><textarea cols=\"40\" autocomplete=\"off\"  minlength=\"0\"  rows=\"4\" tabindex=\"\" id=\"causes_&amp;_circonstance\" name=\"causes_&amp;_circonstance\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><\/textarea><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"15079\" data-form-element-name=\"text_25\"><div class=\"fusion-form-label-wrapper\"><label for=\"identifiant_vehicule__pieton_tiers_\">Identifiant v\u00e9hicule \/ pi\u00e9ton tiers <\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"identifiant_vehicule__pieton_tiers_\" id=\"identifiant_vehicule__pieton_tiers_\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-22 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-color:#0033a0;--awb-bg-color-hover:#0033a0;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-3\"><h3 style=\"text-align: center; color: #ffffff;\">Pi\u00e8ce(s) \u00e0 fournir<\/h3>\n<\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:10px;margin-bottom:10px;width:100%;\"><\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"15079\"><label for=\"veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour\">Veuillez joindre les documents dont vous disposez \u00e0 ce jour (proc\u00e8s-verbal, photos ...) :<\/label><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour\" name=\"veuillez_joindre_les_documents_dont_vous_disposez_a_ce_jour[]\" value=\"\"  class=\"fusion-form-input\"accept=\".jpg, .png, .pdf, .docx,\" placeholder=\"Click or drag a file to this area to upload. \" data-size=\"5\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag a file to this area to upload.\">Click or drag a file to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"form-submission-notices data-notice_1\" id=\"fusion-notices-1\" data-instance=\"1\"><div class=\"fusion-alert alert success alert-success fusion-alert-center fusion-form-response fusion-form-response-success fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-check-circle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">Votre d\u00e9claration de sinistre a \u00e9t\u00e9 envoy\u00e9.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><div class=\"fusion-alert alert error alert-danger fusion-alert-center fusion-form-response fusion-form-response-error fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-exclamation-triangle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">Une erreur s'est produite lors de la tentative d'envoi de votre d\u00e9claration de sinistre. Veuillez r\u00e9essayer plus tard.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><\/div><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"15079\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-2 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"15079\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Envoyer <\/span><\/button><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:10px;margin-bottom:10px;width:100%;\"><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"--awb-flex-grow:0;--awb-flex-grow-medium:0;--awb-flex-grow-small:0;--awb-flex-shrink:0;--awb-flex-shrink-medium:0;--awb-flex-shrink-small:0;width:calc( 100% + 1px ) !important;max-width:calc( 100% + 1px ) !important;margin-left: calc(-1px \/ 2 );margin-right: calc(-1px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-23 fusion_builder_column_inner_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-top:2%;--awb-padding-right:2%;--awb-padding-bottom:2%;--awb-padding-left:2%;--awb-bg-color:#f6f6f6;--awb-bg-color-hover:#f6f6f6;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0.5px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0.5px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0.5px;--awb-spacing-left-medium:0.5px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0.5px;--awb-spacing-left-small:0.5px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-4\"><p><strong>Protection de vos donn\u00e9es personnelles :\u00a0<\/strong>PS <em>Conf\u00e8re le juridique<\/em><\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"fusion_privacy_expiration_interval\" value=\"48\"><input type=\"hidden\" name=\"privacy_expiration_action\" value=\"anonymize\"><\/form><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-padding-top:2%;--awb-padding-right:2%;--awb-padding-bottom:2%;--awb-padding-left:2%;--awb-bg-color:#f6f6f6;--awb-bg-color-hover:#f6f6f6;--awb-bg-size:cover;--awb-box-shadow:2px 3px 5px 0px ;;--awb-border-color:#ececec;--awb-border-top:2px;--awb-border-right:2px;--awb-border-bottom:2px;--awb-border-left:2px;--awb-border-style:solid;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-widget-area awb-widget-area-element fusion-widget-area-1 fusion-content-widget-area\" style=\"--awb-title-color:#0033a0;--awb-padding:0px 0px 0px 0px;\"><div id=\"search-7\" class=\"widget widget_search\" style=\"border-style: solid;border-color:transparent;border-width:0px;\"><div class=\"heading\"><h4 class=\"widget-title\">Search<\/h4><\/div>\t\t<form role=\"search\" class=\"searchform fusion-search-form  fusion-search-form-classic\" method=\"get\" action=\"https:\/\/www.chanasassurances.com\/en\/\">\n\t\t\t<div class=\"fusion-search-form-content\">\n\n\t\t\t\t\n\t\t\t\t<div class=\"fusion-search-field search-field\">\n\t\t\t\t\t<label><span class=\"screen-reader-text\">Search for:<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"search\" value=\"\" name=\"s\" class=\"s\" placeholder=\"Search...\" required aria-required=\"true\" aria-label=\"Search...\"\/>\n\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"fusion-search-button search-button\">\n\t\t\t\t\t<input type=\"submit\" class=\"fusion-search-submit searchsubmit\" aria-label=\"Search\" value=\"&#xf002;\" \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t<\/div>\n\n\n\t\t\t\n\t\t<\/form>\n\t\t<\/div><div id=\"custom_html-25\" class=\"widget_text widget widget_custom_html\" style=\"border-style: solid;border-color:transparent;border-width:0px;\"><div class=\"textwidget custom-html-widget\"><h4 style=\"text-align: center; color: #ffffff; background-color: #0e3594\"><strong><br>Liens utiles<br><\/strong><br><\/h4><\/div><\/div><div id=\"nav_menu-4\" class=\"widget widget_nav_menu\" style=\"margin: 10%;border-style: solid;border-color:transparent;border-width:0px;\"><div class=\"menu-chanas-assurances-footer-liens-utiles-menu-anglais-container\"><ul id=\"menu-chanas-assurances-footer-liens-utiles-menu-anglais\" class=\"menu\"><li id=\"menu-item-7695\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-7695\"><a href=\"https:\/\/www.chanasassurances.com\/devenir-agent-general-ou-collaborateur-commercial-dagence\/\">Apporteur Libre d\u2019affaire<\/a><\/li>\n<li id=\"menu-item-7693\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7693\"><a href=\"https:\/\/www.chanasassurances.com\/en\/my-customer-area\/\">My customer area<\/a><\/li>\n<li id=\"menu-item-7694\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7694\"><a href=\"https:\/\/www.chanasassurances.com\/en\/join-us\/\">Join us<\/a><\/li>\n<li id=\"menu-item-7696\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7696\"><a href=\"https:\/\/www.chanasassurances.com\/en\/approved-garages\/\">Approved garages<\/a><\/li>\n<li id=\"menu-item-7698\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7698\"><a href=\"https:\/\/www.chanasassurances.com\/en\/lexicon\/\">Lexicon<\/a><\/li>\n<\/ul><\/div><\/div><div class=\"fusion-additional-widget-content\"><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7367,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-7071","page","type-page","status-publish","hentry"],"acf":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/pages\/7071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/comments?post=7071"}],"version-history":[{"count":3,"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/pages\/7071\/revisions"}],"predecessor-version":[{"id":7684,"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/pages\/7071\/revisions\/7684"}],"up":[{"embeddable":true,"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/pages\/7367"}],"wp:attachment":[{"href":"https:\/\/www.chanasassurances.com\/en\/wp-json\/wp\/v2\/media?parent=7071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}