{"id":632,"date":"2025-05-13T17:10:57","date_gmt":"2025-05-13T21:10:57","guid":{"rendered":"https:\/\/assurancecamionneur.com\/?page_id=632"},"modified":"2025-05-13T19:56:04","modified_gmt":"2025-05-13T23:56:04","slug":"form_newplan","status":"publish","type":"page","link":"https:\/\/assurancecamionneur.com\/en\/form_newplan\/","title":{"rendered":"Application form"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"632\" class=\"elementor elementor-632\" data-elementor-settings=\"{&quot;element_pack_global_tooltip_width&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true}}\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-d3b77c2 e-flex e-con-boxed e-con e-parent\" data-id=\"d3b77c2\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-997b630 elementor-widget elementor-widget-spacer\" data-id=\"997b630\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-5bfeda2 e-con-full e-flex e-con e-child\" data-id=\"5bfeda2\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4112d30 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"4112d30\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-alt\" viewbox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M224 136V0H24C10.7 0 0 10.7 0 24v464c0 13.3 10.7 24 24 24h336c13.3 0 24-10.7 24-24V160H248c-13.2 0-24-10.8-24-24zm64 236c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-8c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12v8zm0-64c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-8c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12v8zm0-72v8c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-8c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm96-114.1v6.1H256V0h6.1c6.4 0 12.5 2.5 17 7l97.9 98c4.5 4.5 7 10.6 7 16.9z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f511e5d elementor-widget elementor-widget-heading\" data-id=\"f511e5d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Application form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f88c3b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"6f88c3b\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-87948cc e-flex e-con-boxed e-con e-parent\" data-id=\"87948cc\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4741016 elementor-widget elementor-widget-wpforms\" data-id=\"4741016\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-4741016\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-4741016 {\n\t\t\t\t--wpforms-button-background-color: #02477E;\n--wpforms-field-border-color: #02477E;\n--wpforms-field-border-color-spare: #02477E;\n--wpforms-label-color: #000000;\n--wpforms-button-border-radius: 0px;\n--wpforms-field-size-input-height: 31px;\n--wpforms-field-size-input-spacing: 10px;\n--wpforms-field-size-font-size: 14px;\n--wpforms-field-size-line-height: 17px;\n--wpforms-field-size-padding-h: 9px;\n--wpforms-field-size-checkbox-size: 14px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 0.75;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\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\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-660\"><form id=\"wpforms-form-660\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"660\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/632\" data-token=\"2b07bee60ba5fe5888da8c57ce02593a\" data-token-time=\"1776294384\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/632\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-660-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_4\">Full Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-660-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-660-field_4-error\" required><\/div><div id=\"wpforms-660-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"5\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_7\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-660-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" aria-errormessage=\"wpforms-660-field_7-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_6-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_6\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-660-field_6\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][6]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-660-field_6-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_8-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_8\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-660-field_8\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"F j, Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][8][date]\" aria-errormessage=\"wpforms-660-field_8-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_10\">City <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-660-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-660-field_10-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Sex <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-660-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_11_1\" name=\"wpforms[fields][11]\" value=\"Homme\" aria-errormessage=\"wpforms-660-field_11_1-error\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_11_1\">Man<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_11_2\" name=\"wpforms[fields][11]\" value=\"Femme\" aria-errormessage=\"wpforms-660-field_11_2-error\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_11_2\">Woman<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-660-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Smoking <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-660-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_12_1\" name=\"wpforms[fields][12]\" value=\"Oui\" aria-errormessage=\"wpforms-660-field_12_1-error\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_12_2\" name=\"wpforms[fields][12]\" value=\"Non\" aria-errormessage=\"wpforms-660-field_12_2-error\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_12_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-660-field_13-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"13\"><\/div><div id=\"wpforms-660-field_15-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"15\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-660-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_16\">Full name - Spouse<\/label><input type=\"text\" id=\"wpforms-660-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-660-field_16-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-660-field_17-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_17\">Date of Birth Spouse(e)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-660-field_17\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][17][date]\" aria-errormessage=\"wpforms-660-field_17-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-660-field_18-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"18\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-660-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Sex - Spouse<\/legend><ul id=\"wpforms-660-field_19\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_19_1\" name=\"wpforms[fields][19]\" value=\"Homme\" aria-errormessage=\"wpforms-660-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_19_1\">Man<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_19_2\" name=\"wpforms[fields][19]\" value=\"Femme\" aria-errormessage=\"wpforms-660-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_19_2\">Woman<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-660-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Smoking - Spouse<\/legend><ul id=\"wpforms-660-field_20\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_20_1\" name=\"wpforms[fields][20]\" value=\"Oui\" aria-errormessage=\"wpforms-660-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_20_2\" name=\"wpforms[fields][20]\" value=\"Non\" aria-errormessage=\"wpforms-660-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-660-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Dependent children<\/legend><ul id=\"wpforms-660-field_21\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_21_1\" name=\"wpforms[fields][21]\" value=\"Oui\" aria-errormessage=\"wpforms-660-field_21_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-660-field_21_2\" name=\"wpforms[fields][21]\" value=\"Non\" aria-errormessage=\"wpforms-660-field_21_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-660-field_21_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-660-field_14-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"14\"><\/div><div id=\"wpforms-660-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_22\">Job title <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-660-field_22\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled selected='selected'><\/option><option value=\"Salari\u00e9\" >Salari\u00e9<\/option><option value=\"Travailleur autonome\" >Travailleur autonome<\/option><option value=\"Propri\u00e9taire\" >Propri\u00e9taire<\/option><\/select><\/div><div id=\"wpforms-660-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-660-field_3\">Choose your Plan <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-660-field_3\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"1\" name=\"wpforms[fields][3]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled selected='selected'><\/option><option value=\"PLAN ESSENTIEL - 30 ANS - 78,41$\" >PLAN ESSENTIEL - 30 ANS - 78,41$<\/option><option value=\"PLAN ESSENTIEL - 40 ANS - 80,41$\" >PLAN ESSENTIEL - 40 ANS - 80,41$<\/option><option value=\"PLAN ESSENTIEL - 50 ANS - 89,14$\" >PLAN ESSENTIEL - 50 ANS - 89,14$<\/option><option value=\"PLAN ESSENTIEL - 60 ANS - 129,37$\" >PLAN ESSENTIEL - 60 ANS - 129,37$<\/option><option value=\"PLAN SUP\u00c9RIEUR - 30 ANS - 86,80$\" >PLAN SUP\u00c9RIEUR - 30 ANS - 86,80$<\/option><option value=\"PLAN SUP\u00c9RIEUR - 40 ANS - 92,95$\" >PLAN SUP\u00c9RIEUR - 40 ANS - 92,95$<\/option><option value=\"PLAN SUP\u00c9RIEUR - 50 ANS - 125,49$\" >PLAN SUP\u00c9RIEUR - 50 ANS - 125,49$<\/option><option value=\"PLAN SUP\u00c9RIEUR - 60 ANS - 237,39$\" >PLAN SUP\u00c9RIEUR - 60 ANS - 237,39$<\/option><option value=\"PLAN \u00c9LITE - 30 ANS - 110,43$\" >PLAN \u00c9LITE - 30 ANS - 110,43$<\/option><option value=\"PLAN \u00c9LITE - 40 ANS - 123,37$\" >PLAN \u00c9LITE - 40 ANS - 123,37$<\/option><option value=\"PLAN \u00c9LITE - 50 ANS - 179,66$\" >PLAN \u00c9LITE - 50 ANS - 179,66$<\/option><option value=\"PLAN \u00c9LITE - 60 ANS - 286,79$\" >PLAN \u00c9LITE - 60 ANS - 286,79$<\/option><option value=\"PLAN PRO - 30 ANS - 160,53$\" >PLAN PRO - 30 ANS - 160,53$<\/option><option value=\"PLAN PRO - 40 ANS - 167,80$\" >PLAN PRO - 40 ANS - 167,80$<\/option><option value=\"PLAN PRO - 50 ANS - 252,37$\" >PLAN PRO - 50 ANS - 252,37$<\/option><option value=\"PLAN PRO - 60 ANS - 306,43$\" >PLAN PRO - 60 ANS - 306,43$<\/option><\/select><\/div><\/div><!-- 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-->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Formulaire de Demande Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Nom Complet *Courriel *T\u00e9l\u00e9phone * Date de Naissance *Ville * Sexe * Homme Femme Fumeur * Oui Non Nom Complet &#8211; Conjoint(e)Date de Naissance &#8211; Conjoint(e) Sexe &#8211; Conjoint(e) Homme Femme Fumeur &#8211; Conjoint(e) 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