{"id":1902,"date":"2023-06-14T08:55:55","date_gmt":"2023-06-14T06:55:55","guid":{"rendered":"https:\/\/cfverzekeringen.com\/?page_id=1902"},"modified":"2024-07-25T12:25:15","modified_gmt":"2024-07-25T10:25:15","slug":"request-form","status":"publish","type":"page","link":"https:\/\/cfverzekeringen.com\/en\/request-form\/","title":{"rendered":"Request form"},"content":{"rendered":"<div class=\"section--header-intro wf-section\">\n    <div class=\"container no--padding w-container\">\n        <div class=\"header-intro__background-container extended-page--both\">\n            <img decoding=\"async\" data-src=\"https:\/\/cfverzekeringen.com\/wp-content\/themes\/vallonic-cfverzekeringen\/dist\/images\/Vallonic__CF-Verzekeringen__home__intro__background2x_288cf0c1.png\" loading=\"lazy\" alt=\"\" class=\"header-intro__background-img lazyload\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\"><noscript><img decoding=\"async\" src=\"https:\/\/cfverzekeringen.com\/wp-content\/themes\/vallonic-cfverzekeringen\/dist\/images\/Vallonic__CF-Verzekeringen__home__intro__background2x_288cf0c1.png\" loading=\"lazy\" alt=\"\" class=\"header-intro__background-img\"><\/noscript>\n        <\/div>\n                <div class=\"header-intro__title-container  \">\n                            <h1 class=\"header-intro__title \">\n                    Request information\n                    <!-- Wij laten u onbezorgd<br>genieten<br> -->\n                <\/h1>\n                                            <\/div>\n                    <\/div>\n    <\/div>\n\n\n\n<div class=\"section--contact-form wf-section\">\n    <div class=\"container w-container\">\n        <div class=\"contact-form__inner\">\n            <h2 class=\"contact-form__title\">\n                \n                \n            <\/h2>\n            <p class=\"contact-form__p\">\n                \n                \n            <\/p>\n        <\/div>\n        <div class=\"w-layout-grid contact__grid\">\n            <div id=\"w-node-d81f4440-b545-267b-621b-c54e47e52a60-74ac8bb6\" class=\"contact-grid__form\">\n                <div class=\"forminator-ui forminator-custom-form forminator-custom-form-1953 forminator-design--flat forminator-custom forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1953\" data-uid=\"6766d354b6ec3\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1953\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1953 forminator-design--flat forminator-custom forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1953\"\n\t\t\t\t\n\t\t\t\tdata-design=\"flat\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"custom\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6766d354b6ec3\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6766d354b6ec3-label\"><span id=\"forminator-checkbox-group-6766d354b6ec3-label\" class=\"forminator-label\">I would like to request a quote without obligation:<\/span><label id=\"forminator-field-checkbox-1-1-6766d354b6ec3-label\" for=\"forminator-field-checkbox-1-1-6766d354b6ec3\" class=\"forminator-checkbox\" title=\"Car insurance\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6766d354b6ec3\" aria-labelledby=\"forminator-field-checkbox-1-1-6766d354b6ec3-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Car insurance<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6766d354b6ec3-label\" for=\"forminator-field-checkbox-1-2-6766d354b6ec3\" class=\"forminator-checkbox\" title=\"Home insurance\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6766d354b6ec3\" aria-labelledby=\"forminator-field-checkbox-1-2-6766d354b6ec3-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Home insurance<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6766d354b6ec3-label\" for=\"forminator-field-checkbox-1-3-6766d354b6ec3\" class=\"forminator-checkbox\" title=\"Contents insurance\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Inboedelverzekering\" id=\"forminator-field-checkbox-1-3-6766d354b6ec3\" aria-labelledby=\"forminator-field-checkbox-1-3-6766d354b6ec3-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Contents insurance<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Car insurance<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Do you have an extra car?&quot;,&quot;remove_text&quot;:&quot;Remove extra car&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6766d354b6ec3\" id=\"forminator-field-text-1_6766d354b6ec3-label\" class=\"forminator-label\">Make \/ Model \/ Type<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6766d354b6ec3\" id=\"forminator-field-text-2_6766d354b6ec3-label\" class=\"forminator-label\">Year built<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6766d354b6ec3\" id=\"forminator-field-text-4_6766d354b6ec3-label\" class=\"forminator-label\">No-claim history (years)<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6766d354b6ec3\" id=\"forminator-field-text-3_6766d354b6ec3-label\" class=\"forminator-label\">Coverage<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Do you have an extra car?\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove extra car\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Home insurance<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6766d354b6ec3\" id=\"forminator-field-address-1-street_address_6766d354b6ec3-label\" class=\"forminator-label\">Address<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_6766d354b6ec3\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6766d354b6ec3\" id=\"forminator-field-text-5_6766d354b6ec3-label\" class=\"forminator-label\">Rebuild value<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6766d354b6ec3-label\"><span id=\"forminator-radiogroup-6766d354b6ec3-label\" class=\"forminator-label\">Use<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6766d354b6ec3\" class=\"forminator-radio\" title=\"Permanent\"><input type=\"radio\" name=\"radio-1\" value=\"permanent\" id=\"forminator-field-radio-1-1-6766d354b6ec3\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Permanent<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6766d354b6ec3\" class=\"forminator-radio\" title=\"Holiday home without rental\"><input type=\"radio\" name=\"radio-1\" value=\"holiday-home-without-rental\" id=\"forminator-field-radio-1-2-6766d354b6ec3\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Holiday home without rental<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6766d354b6ec3\" class=\"forminator-radio\" title=\"Holiday home and\/or long\/short term rental\"><input type=\"radio\" name=\"radio-1\" value=\"holiday-home-and-or-long-short-term-rental\" id=\"forminator-field-radio-1-3-6766d354b6ec3\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Holiday home and\/or long\/short term rental<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Contents insurance<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add Item&quot;,&quot;remove_text&quot;:&quot;Remove Item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-2-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-street_address_6766d354b6ec3\" id=\"forminator-field-address-2-street_address_6766d354b6ec3-label\" class=\"forminator-label\">Address<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"\" id=\"forminator-field-address-2-street_address_6766d354b6ec3\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6766d354b6ec3\" id=\"forminator-field-text-6_6766d354b6ec3-label\" class=\"forminator-label\">Insured amount<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6766d354b6ec3-label\"><span id=\"forminator-radiogroup-6766d354b6ec3-label\" class=\"forminator-label\">Rental?<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6766d354b6ec3\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"yes\" id=\"forminator-field-radio-2-1-6766d354b6ec3\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6766d354b6ec3\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"no\" id=\"forminator-field-radio-2-2-6766d354b6ec3\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add Item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove Item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6766d354b6ec3\" id=\"forminator-field-name-1_6766d354b6ec3-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6766d354b6ec3\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6766d354b6ec3\" id=\"forminator-field-email-1_6766d354b6ec3-label\" class=\"forminator-label\">E-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6766d354b6ec3\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6766d354b6ec3\" id=\"forminator-field-phone-1_6766d354b6ec3-label\" class=\"forminator-label\">Phonenumber <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6766d354b6ec3\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"inline\" data-sitekey=\"6Ldrv_wfAAAAANj0cywLlAxmKcJIzIJQSYX-xf23\" data-size=\"invisible\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"183c6deeef\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/1902\/\" \/><input type=\"hidden\" name=\"form_id\" value=\"1953\"><input type=\"hidden\" name=\"page_id\" value=\"1902\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/cfverzekeringen.com\/en\/request-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_18\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_18\" type=\"text\" name=\"input_18\" value=\"\" autocomplete=\"off\"><\/label><\/form>\n            <\/div>\n\n                        \n                    <\/div>\n        <div class=\"spacer-90\">\n        <\/div>\n    <\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-1902","page","type-page","status-publish","hentry"],"acf":[],"rankMath":{"parentDomain":"cfverzekeringen.com","noFollowDomains":[],"noFollowExcludeDomains":[],"noFollowExternalLinks":false,"featuredImageNotice":"The featured image should be at least 200 by 200 pixels to be picked up by Facebook and other social media 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