{"id":8833,"date":"2024-05-31T17:47:21","date_gmt":"2024-05-31T15:47:21","guid":{"rendered":"https:\/\/www.buendiaseguros.es\/enrollment-4\/"},"modified":"2026-07-04T19:23:57","modified_gmt":"2026-07-04T17:23:57","slug":"enrollment-4","status":"publish","type":"page","link":"https:\/\/www.buendiaseguros.es\/en\/enrollment-4\/","title":{"rendered":"Enrollment 4"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-16ncd-b188611fc806967d5b1b9c689e86aa64\">\n.flex_column.av-16ncd-b188611fc806967d5b1b9c689e86aa64{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-16ncd-b188611fc806967d5b1b9c689e86aa64 av_one_full  avia-builder-el-0  el_before_av_textblock  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-k8vwtcsh-c1dcf62d85318620c44c3ad19899d1fe\">\n#top .av-special-heading.av-k8vwtcsh-c1dcf62d85318620c44c3ad19899d1fe{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-k8vwtcsh-c1dcf62d85318620c44c3ad19899d1fe .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-k8vwtcsh-c1dcf62d85318620c44c3ad19899d1fe .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-k8vwtcsh-c1dcf62d85318620c44c3ad19899d1fe av-special-heading-h3  avia-builder-el-1  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  >Online Contracting <\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n<section  class='av_textblock_section av-k8vwunmd-7d1519e4a3026840b97e2d43487fe083 '  ><div class='avia_textblock' ><div>\n<h4><span style=\"color: #98a92a;\"><strong>Welcome to the secure area for contracting DKV medical insurance. <\/strong><\/span><\/h4>\n<p>Complete your sign-up <strong>in 2 steps<\/strong> and <strong>you will be able to enjoy your insurance.<\/strong> We will support you throughout the process, indicating the information you need to provide in case you have any questions.<\/p>\n<\/div>\n<p>Fields marked with a red asterisk must be filled in.<\/p>\n<form class=\"c-form-calculadora u-mb+++@xs ng-pristine ng-valid ng-valid-maxlength ng-valid-required ng-valid-date\"><\/form>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-au3tx-80a160a7e0c8adeb1d10f03c2e276c3b\">\n.flex_column.av-au3tx-80a160a7e0c8adeb1d10f03c2e276c3b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-au3tx-80a160a7e0c8adeb1d10f03c2e276c3b av_one_full  avia-builder-el-3  el_after_av_textblock  avia-builder-el-last  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-7lm5p-ac994382df40b688c10177c2401c7821 '  ><div class='avia_textblock' ><style id=\"wpforms-css-vars-8830\">\n\t\t\t\t#wpforms-8830 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-8830\"><form id=\"wpforms-form-8830\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"8830\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/8833\" data-token=\"1054da4aea87cf60f09adcadec8a3cd6\" data-token-time=\"1785555537\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-8830-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">name of the policyholder <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-8830-field_0-error\" required><label for=\"wpforms-8830-field_0\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-8830-field_0-last-error\" required><label for=\"wpforms-8830-field_0-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8830-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_3\">Start date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-8830-field_3-error\" required><\/div><div id=\"wpforms-8830-field_4-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_4\">Insurance model <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-8830-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required=\"required\"><option value=\"Elite (Without Copayment)\"  class=\"choice-1 depth-1\"  >Elite (Without Copayment)<\/option><option value=\"Classic (Copayment from 3 \u20ac)\"  class=\"choice-2 depth-1\"  >Classic (Copayment from 3 \u20ac)<\/option><option value=\"Plus (Copayment from 6 \u20ac)\"  class=\"choice-3 depth-1\"  >Plus (Copayment from 6 \u20ac)<\/option><option value=\"Complet (Copayment from 13 \u20ac)\"  class=\"choice-8 depth-1\"  >Complet (Copayment from 13 \u20ac)<\/option><option value=\"DKV Selecci\u00f3n (Without copayment)\"  class=\"choice-7 depth-1\"  >DKV Selecci\u00f3n (Without copayment)<\/option><option value=\"DKV Visa (Without copayment)\"  class=\"choice-14 depth-1\"  >DKV Visa (Without copayment)<\/option><option value=\"Reimbursement Elite\"  class=\"choice-15 depth-1\"  >Reimbursement Elite<\/option><option value=\"Reimbursement Classic\"  class=\"choice-16 depth-1\"  >Reimbursement Classic<\/option><option value=\"Reimbursement Premium\"  class=\"choice-17 depth-1\"  >Reimbursement Premium<\/option><option value=\"Reimbursement Plus\"  class=\"choice-19 depth-1\"  >Reimbursement Plus<\/option><option value=\"Reimbursement Complet\"  class=\"choice-18 depth-1\"  >Reimbursement Complet<\/option><\/select><\/div><div id=\"wpforms-8830-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_5\">Policyholder&#039;s date of birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-8830-field_5-error\" required><\/div><div id=\"wpforms-8830-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_8\">DNI\/NIE\/Passport Policyholder <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-8830-field_8-error\" required><\/div><div id=\"wpforms-8830-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_9\">Policyholder&#039;s nationality <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-8830-field_9-error\" required><\/div><div id=\"wpforms-8830-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_10\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-8830-field_10-error\" required><\/div><div id=\"wpforms-8830-field_11-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_11\">Post Code <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-8830-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" step=\"any\" aria-errormessage=\"wpforms-8830-field_11-error\" required><\/div><div id=\"wpforms-8830-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-8830-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8830-field_1-error\" required><\/div><div id=\"wpforms-8830-field_6-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_6\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-8830-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" step=\"any\" aria-errormessage=\"wpforms-8830-field_6-error\" required><\/div><div id=\"wpforms-8830-field_26-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_26\">Payment period <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-8830-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required=\"required\"><option value=\"Monthly\"  class=\"choice-1 depth-1\"  >Monthly<\/option><option value=\"Quaterly\"  class=\"choice-2 depth-1\"  >Quaterly<\/option><option value=\"Biannual\"  class=\"choice-3 depth-1\"  >Biannual<\/option><option value=\"Annual\"  class=\"choice-4 depth-1\"  >Annual<\/option><\/select><\/div><div id=\"wpforms-8830-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_27\">Bank Account <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-8830-field_27-error\" required><\/div><div id=\"wpforms-8830-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Multiple options<\/legend><ul id=\"wpforms-8830-field_14\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_14_1\" name=\"wpforms[fields][14]\" value=\"The policyholder and Insured 1 are the same person (if selected, it is not necessary to refill the data for Insured 1)\" aria-errormessage=\"wpforms-8830-field_14_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_14_1\">The policyholder and Insured 1 are the same person (if selected, it is not necessary to refill the data for Insured 1)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_14_4\" name=\"wpforms[fields][14]\" value=\"Insured different from Policyholder\" aria-errormessage=\"wpforms-8830-field_14_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_14_4\">Insured different from Policyholder<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8830-field_13-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Name of Insured 1<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_13\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][13][first]\" aria-errormessage=\"wpforms-8830-field_13-error\" ><label for=\"wpforms-8830-field_13\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_13-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][13][last]\" aria-errormessage=\"wpforms-8830-field_13-last-error\" ><label for=\"wpforms-8830-field_13-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8830-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_15\">Date of birth of Insured 1<\/label><input type=\"text\" id=\"wpforms-8830-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-8830-field_15-error\" ><\/div><div id=\"wpforms-8830-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_16\">DNI\/NIE\/Passport Insured 1<\/label><input type=\"text\" id=\"wpforms-8830-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-8830-field_16-error\" ><\/div><div id=\"wpforms-8830-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_17\">nationality of Insured 1<\/label><input type=\"text\" id=\"wpforms-8830-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-8830-field_17-error\" ><\/div><div id=\"wpforms-8830-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_18\">Height of Insured 1 (cm) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-8830-field_18-error\" required><\/div><div id=\"wpforms-8830-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_38\">Weight of Insured 1 (kg)   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-8830-field_38-error\" required><\/div><div id=\"wpforms-8830-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_19\">1. Has or have had any disease, accident, congenital disorder, hereditary family disease, joint pain, or any other symptoms or pain, or do you have any metabolic pathology (cholesterol, blood pressure, sugar, thyroid)? (Specify answer and year) Insured 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-8830-field_19-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_20\">2. Have you received, or are pending to receive any type of surgical, medical, pharmacological, rehabilitation, or dietary treatment (e.g., Diet for Hypertension)? (Specify treatments, causes, and dates) Insured 1. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-8830-field_20-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_21\">3. Have you been hospitalized or undergone surgery, or are you pending hospitalization? (Specify causes and dates) Insured 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-8830-field_21-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_22-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_22\">4. Have any diagnostic tests been performed on you, or are any pending? (Specify type of test, reason, result, and date) Insured 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-8830-field_22-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_23\">Uses glasses. Indicate the diopters for Insured 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-8830-field_23-error\" required><\/div><div id=\"wpforms-8830-field_25-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Do you take any of the following substances?<\/legend><ul id=\"wpforms-8830-field_25\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_25_1\" name=\"wpforms[fields][25]\" value=\"Alcohol\" aria-errormessage=\"wpforms-8830-field_25_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_25_1\">Alcohol<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_25_2\" name=\"wpforms[fields][25]\" value=\"Tobacco\" aria-errormessage=\"wpforms-8830-field_25_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_25_2\">Tobacco<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_25_3\" name=\"wpforms[fields][25]\" value=\"Drugs\" aria-errormessage=\"wpforms-8830-field_25_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_25_3\">Drugs<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8830-field_29-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"29\"><fieldset><legend class=\"wpforms-field-label\">Name of Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_29\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][29][first]\" aria-errormessage=\"wpforms-8830-field_29-error\" required><label for=\"wpforms-8830-field_29\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_29-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][29][last]\" aria-errormessage=\"wpforms-8830-field_29-last-error\" required><label for=\"wpforms-8830-field_29-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8830-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_37\">Date of birth of Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-8830-field_37-error\" required><\/div><div id=\"wpforms-8830-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_36\">DNI\/NIE\/Passport Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-8830-field_36-error\" required><\/div><div id=\"wpforms-8830-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_40\">nationality of Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-8830-field_40-error\" required><\/div><div id=\"wpforms-8830-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_12\">Height of Insured 2 (cm) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-8830-field_12-error\" required><\/div><div id=\"wpforms-8830-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_39\">Weight of Insured 2 (kg) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_39\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-8830-field_39-error\" required><\/div><div id=\"wpforms-8830-field_35-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_35\">1. Has or have had any disease, accident, congenital disorder, hereditary family disease, joint pain, or any other symptoms or pain, or do you have any metabolic pathology (cholesterol, blood pressure, sugar, thyroid)? (Specify answer and year) Insured 2. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-8830-field_35-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_34\">2. Have you received, or are pending to receive any type of surgical, medical, pharmacological, rehabilitation, or dietary treatment (e.g., Diet for Hypertension)? (Specify treatments, causes, and dates) Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-8830-field_34-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_33-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_33\">3. Have you been hospitalized or undergone surgery, or are you pending hospitalization? (Specify causes and dates) Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-8830-field_33-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_32\">4. Have any diagnostic tests been performed on you, or are any pending? (Specify type of test, reason, result, and date) Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-8830-field_32-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_31\">Uses glasses. Indicate the diopters for Insured 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-8830-field_31-error\" required><\/div><div id=\"wpforms-8830-field_30-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">Do you take any of the following substances? Innsured 2<\/legend><ul id=\"wpforms-8830-field_30\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_30_1\" name=\"wpforms[fields][30]\" value=\"Alcohol\" aria-errormessage=\"wpforms-8830-field_30_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_30_1\">Alcohol<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_30_2\" name=\"wpforms[fields][30]\" value=\"Tobacco\" aria-errormessage=\"wpforms-8830-field_30_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_30_2\">Tobacco<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_30_3\" name=\"wpforms[fields][30]\" value=\"Drugs\" aria-errormessage=\"wpforms-8830-field_30_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_30_3\">Drugs<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8830-field_42-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">Name of Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_42\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][42][first]\" aria-errormessage=\"wpforms-8830-field_42-error\" required><label for=\"wpforms-8830-field_42\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_42-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][42][last]\" aria-errormessage=\"wpforms-8830-field_42-last-error\" required><label for=\"wpforms-8830-field_42-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8830-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_54\">Date of birth of Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_54\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-8830-field_54-error\" required><\/div><div id=\"wpforms-8830-field_52-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_52\">DNI\/NIE\/Passport Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_52\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][52]\" aria-errormessage=\"wpforms-8830-field_52-error\" required><\/div><div id=\"wpforms-8830-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_51\">nationality of Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-8830-field_51-error\" required><\/div><div id=\"wpforms-8830-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_49\">Height of Insured 3 (cm) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_49\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-8830-field_49-error\" required><\/div><div id=\"wpforms-8830-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_50\">Weight of Insured 3 (kg)  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_50\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-8830-field_50-error\" required><\/div><div id=\"wpforms-8830-field_48-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_48\">1. Has or have had any disease, accident, congenital disorder, hereditary family disease, joint pain, or any other symptoms or pain, or do you have any metabolic pathology (cholesterol, blood pressure, sugar, thyroid)? (Specify answer and year) Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_48\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][48]\" aria-errormessage=\"wpforms-8830-field_48-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_47\">2. Have you received, or are pending to receive any type of surgical, medical, pharmacological, rehabilitation, or dietary treatment (e.g., Diet for Hypertension)? (Specify treatments, causes, and dates) Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-8830-field_47-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_46\">3. Have you been hospitalized or undergone surgery, or are you pending hospitalization? (Specify causes and dates) Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" aria-errormessage=\"wpforms-8830-field_46-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_45-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_45\">4. Have any diagnostic tests been performed on you, or are any pending? (Specify type of test, reason, result, and date) Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_45\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-8830-field_45-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_44\">Uses glasses. Indicate the diopters for Insured 3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_44\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-8830-field_44-error\" required><\/div><div id=\"wpforms-8830-field_43-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">Do you take any of the following substances? Innsured 3<\/legend><ul id=\"wpforms-8830-field_43\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_43_1\" name=\"wpforms[fields][43]\" value=\"Alcohol\" aria-errormessage=\"wpforms-8830-field_43_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_43_1\">Alcohol<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_43_2\" name=\"wpforms[fields][43]\" value=\"Tobacco\" aria-errormessage=\"wpforms-8830-field_43_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_43_2\">Tobacco<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_43_3\" name=\"wpforms[fields][43]\" value=\"Drugs\" aria-errormessage=\"wpforms-8830-field_43_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_43_3\">Drugs<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8830-field_66-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">Name of Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_66\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][66][first]\" aria-errormessage=\"wpforms-8830-field_66-error\" required><label for=\"wpforms-8830-field_66\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8830-field_66-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][66][last]\" aria-errormessage=\"wpforms-8830-field_66-last-error\" required><label for=\"wpforms-8830-field_66-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8830-field_65-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_65\">Date of birth of Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_65\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][65]\" aria-errormessage=\"wpforms-8830-field_65-error\" required><\/div><div id=\"wpforms-8830-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_64\">DNI\/NIE\/Passport Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-8830-field_64-error\" required><\/div><div id=\"wpforms-8830-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_63\">nationality of Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_63\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][63]\" aria-errormessage=\"wpforms-8830-field_63-error\" required><\/div><div id=\"wpforms-8830-field_62-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_62\">Height of Insured 4 (cm)  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_62\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][62]\" aria-errormessage=\"wpforms-8830-field_62-error\" required><\/div><div id=\"wpforms-8830-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_61\">Weight of Insured 4 (kg)  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_61\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-8830-field_61-error\" required><\/div><div id=\"wpforms-8830-field_60-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_60\">1. Has or have had any disease, accident, congenital disorder, hereditary family disease, joint pain, or any other symptoms or pain, or do you have any metabolic pathology (cholesterol, blood pressure, sugar, thyroid)? (Specify answer and year) Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_60\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-8830-field_60-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_59-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_59\">2. Have you received, or are pending to receive any type of surgical, medical, pharmacological, rehabilitation, or dietary treatment (e.g., Diet for Hypertension)? (Specify treatments, causes, and dates) Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_59\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-8830-field_59-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_58\">3. Have you been hospitalized or undergone surgery, or are you pending hospitalization? (Specify causes and dates) Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_58\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-8830-field_58-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_57\">4. Have any diagnostic tests been performed on you, or are any pending? (Specify type of test, reason, result, and date) Insured 4 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-8830-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-8830-field_57-error\" required><\/textarea><\/div><div id=\"wpforms-8830-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-8830-field_56\">Uses glasses. Indicate the diopters for Insured 4  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8830-field_56\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-8830-field_56-error\" required><\/div><div id=\"wpforms-8830-field_55-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Do you take any of the following substances? Innsured 4<\/legend><ul id=\"wpforms-8830-field_55\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_55_1\" name=\"wpforms[fields][55]\" value=\"Alcohol\" aria-errormessage=\"wpforms-8830-field_55_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_55_1\">Alcohol<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_55_2\" name=\"wpforms[fields][55]\" value=\"Tobacco\" aria-errormessage=\"wpforms-8830-field_55_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_55_2\">Tobacco<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-8830-field_55_3\" name=\"wpforms[fields][55]\" value=\"Drugs\" aria-errormessage=\"wpforms-8830-field_55_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_55_3\">Drugs<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8830-field_41-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"41\"><label class=\"wpforms-field-label\">Acuerdo RGPD <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><ul id=\"wpforms-8830-field_41\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-8830-field_41_1\" name=\"wpforms[fields][41][]\" value=\"I have read and accept the &lt;a href=&quot;https:\/\/www.buendiaseguros.es\/en\/who-we-are\/legal-notice\/&quot;&gt; legal notice &lt;\/a&gt; and accept the &lt;a href=&quot;https:\/\/www.buendiaseguros.es\/en\/who-we-are\/policy-on-privacy\/&quot;&gt; Policy on privacy&lt;\/a&gt;.\" aria-errormessage=\"wpforms-8830-field_41_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8830-field_41_1\">I have read and accept the <a href=\"https:\/\/www.buendiaseguros.es\/en\/who-we-are\/legal-notice\/\"> legal notice <\/a> and accept the <a href=\"https:\/\/www.buendiaseguros.es\/en\/who-we-are\/policy-on-privacy\/\"> Policy on privacy<\/a>.<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"8830\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/pages\/8833\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-8830\" class=\"wpforms-submit\" data-alt-text=\"Form successfully submitted, we will send your documentation shortly.\" data-submit-text=\"Send\" aria-live=\"assertive\" value=\"wpforms-submit\">Send<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.buendiaseguros.es\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<\/div><\/section><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_joinchat":[],"footnotes":""},"class_list":["post-8833","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/pages\/8833","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/comments?post=8833"}],"version-history":[{"count":5,"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/pages\/8833\/revisions"}],"predecessor-version":[{"id":8839,"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/pages\/8833\/revisions\/8839"}],"wp:attachment":[{"href":"https:\/\/www.buendiaseguros.es\/en\/wp-json\/wp\/v2\/media?parent=8833"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}