{"id":9006,"date":"2020-09-09T08:19:14","date_gmt":"2020-09-09T08:19:14","guid":{"rendered":"https:\/\/263host.co.zw\/projects\/firstmutual\/?page_id=9006"},"modified":"2020-09-09T08:40:21","modified_gmt":"2020-09-09T08:40:21","slug":"e-fml-alterations-forms","status":"publish","type":"page","link":"https:\/\/263host.co.zw\/projects\/firstmutual\/e-fml-alterations-forms\/","title":{"rendered":"e-FML Alterations Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9006\" class=\"elementor elementor-9006\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;,&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\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e5c4d50 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"e5c4d50\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-38de1be\" data-id=\"38de1be\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d5e179d elementor-widget elementor-widget-spacer\" data-id=\"d5e179d\" 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\t\t<div class=\"elementor-element elementor-element-1358368 elementor-widget elementor-widget-heading\" data-id=\"1358368\" 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\">e-FML Alteration Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a327b7 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"2a327b7\" 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<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-abeead2\" data-id=\"abeead2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6a280f4 elementor-section-stretched elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"6a280f4\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7c123f1\" data-id=\"7c123f1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-542787c elementor-widget elementor-widget-text-editor\" data-id=\"542787c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-2230\"><form id=\"wpforms-form-2230\" class=\"wpforms-validate wpforms-form\" data-formid=\"2230\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9006\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#72b239;\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \"><div id=\"wpforms-2230-field_14-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"14\"><\/div><div id=\"wpforms-2230-field_2-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_2\">Policy Number or Card Reference Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2230-field_2\" class=\"wpforms-field-large\" name=\"wpforms[fields][2]\" ><\/div><div id=\"wpforms-2230-field_3-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_3\">First Name  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2230-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-2230-field_4-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_4\">Surname <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2230-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-2230-field_5-container\" class=\"wpforms-field wpforms-field-email wpforms-one-third wpforms-first\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_5\">Address Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2230-field_5\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-2230-field_6-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_6\">Mobile Number<\/label><input type=\"tel\" id=\"wpforms-2230-field_6\" class=\"wpforms-field-large wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-2230-field_7-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_7\">National I.D Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2230-field_7\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-2230-field_8-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_8\">Date Of Birth <\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2230-field_8\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"d\/m\/Y\" data-input=\"true\" name=\"wpforms[fields][8][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2230-field_9-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_9\">Alteration Type<\/label><select id=\"wpforms-2230-field_9\" class=\"wpforms-field-large\" name=\"wpforms[fields][9]\"><option value=\"Upgrade or add dependents on my existing e - FML\" >Upgrade or add dependents on my existing e &#8211; FML<\/option><option value=\"Convert and upgrade my group funeral cash plan to e - FML\" >Convert and upgrade my group funeral cash plan to e &#8211; FML<\/option><\/select><\/div><div id=\"wpforms-2230-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_10\">New Sum Assured\/ Cover (For all lives covered)<\/label><input type=\"text\" id=\"wpforms-2230-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-2230-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_11\">Grocery Rider <\/label><input type=\"text\" id=\"wpforms-2230-field_11\" class=\"wpforms-field-large\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-2230-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_12\">Tombstone Rider <\/label><input type=\"text\" id=\"wpforms-2230-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-2230-field_13-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"13\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"2230\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" style=\"display:none;\"><div id=\"wpforms-2230-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_17\">Dependants 1<\/label><textarea id=\"wpforms-2230-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" ><\/textarea><\/div><div id=\"wpforms-2230-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_18\">Dependents 2<\/label><textarea id=\"wpforms-2230-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/textarea><\/div><div id=\"wpforms-2230-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_19\">Dependents 3<\/label><textarea id=\"wpforms-2230-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/textarea><\/div><div id=\"wpforms-2230-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_20\">Dependents 4<\/label><textarea id=\"wpforms-2230-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/textarea><\/div><div id=\"wpforms-2230-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_21\">Dependents 5<\/label><textarea id=\"wpforms-2230-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/textarea><\/div><div id=\"wpforms-2230-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_22\">Total Contract Premium<\/label><input type=\"text\" id=\"wpforms-2230-field_22\" class=\"wpforms-field-large\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-2230-field_23-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_23\">Payment Option<\/label><select id=\"wpforms-2230-field_23\" class=\"wpforms-field-large\" name=\"wpforms[fields][23]\"><option value=\"Ecocash: Biller Code 17123 e.g *151*2*1*17123*amount#\" >Ecocash: Biller Code 17123 e.g *151*2*1*17123*amount#<\/option><option value=\"One money: Biller Code 22085\" >One money: Biller Code 22085<\/option><option value=\"Telecash select option to pay insurance\" >Telecash select option to pay insurance<\/option><option value=\"Transfer - Standard Chartered Bank Account NO. 0100203178680\" >Transfer &#8211; Standard Chartered Bank Account NO. 0100203178680<\/option><option value=\"Stop orders (Please get in touch with FML on email FMLILB@firstmutual.co.zw\" >Stop orders (Please get in touch with FML on email FMLILB@firstmutual.co.zw<\/option><\/select><\/div><div id=\"wpforms-2230-field_24-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_24\">Payment Reference Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2230-field_24\" class=\"wpforms-field-large\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-2230-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-2230-field_25\">Signature of Main Life Assured or Premium Payer (name and surname)<\/label><input type=\"text\" id=\"wpforms-2230-field_25\" class=\"wpforms-field-large\" name=\"wpforms[fields][25]\" ><\/div><div id=\"wpforms-2230-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"16\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-2230-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-2230-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"2230\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"3\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-2230\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>e-FML Alteration Form<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"disabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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