{"id":9302,"date":"2020-09-21T08:18:55","date_gmt":"2020-09-21T08:18:55","guid":{"rendered":"https:\/\/263host.co.zw\/projects\/firstmutual\/?page_id=9302"},"modified":"2020-09-21T08:37:39","modified_gmt":"2020-09-21T08:37:39","slug":"nicoz-private-motor-proposal-form","status":"publish","type":"page","link":"https:\/\/263host.co.zw\/projects\/firstmutual\/nicoz-diamond-products\/nicoz-motor-claims-from\/nicoz-private-motor-proposal-form\/","title":{"rendered":"Nicoz PRIVATE MOTOR PROPOSAL FORM"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9302\" class=\"elementor elementor-9302\" 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-boxed elementor-section-height-default elementor-section-height-default\" 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\">PRIVATE MOTOR PROPOSAL 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-1569ce9 elementor-widget elementor-widget-text-editor\" data-id=\"1569ce9\" 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><strong>Head Office, Insurance Centre, 30 Samora Machel Avenue, P.O. Box 1256, Harare, Zimbabwe<\/strong><br \/><strong>Tel: 263-4-701133, 704911-4, 700346, Fax: 263-4-704134, 700083\u00a0<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-144c97f elementor-widget elementor-widget-text-editor\" data-id=\"144c97f\" 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-9301\"><form id=\"wpforms-form-9301\" class=\"wpforms-validate wpforms-form\" data-formid=\"9301\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9302\"><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=\"#ec1f27\" 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 3<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:33.333333333333%;background-color:#ec1f27;\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \"><div id=\"wpforms-9301-field_20-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"20\"><\/div><div id=\"wpforms-9301-field_1-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_1\">SURNAME and FIRST NAME<\/label><input type=\"text\" id=\"wpforms-9301-field_1\" class=\"wpforms-field-large\" name=\"wpforms[fields][1]\" ><\/div><div id=\"wpforms-9301-field_2-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-list-inline\" data-field-id=\"2\"><ul id=\"wpforms-9301-field_2\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_2_1\" name=\"wpforms[fields][2]\" value=\" Mr\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_2_1\"> Mr<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_2_2\" name=\"wpforms[fields][2]\" value=\"Mrs\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_2_2\">Mrs<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_2_3\" name=\"wpforms[fields][2]\" value=\"Dr\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_2_3\">Dr<\/label><\/li><\/ul><\/div><div id=\"wpforms-9301-field_4-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_4\">DATE OF BIRTH:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-9301-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"d\/m\/Y\" data-input=\"true\" name=\"wpforms[fields][4][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-9301-field_3-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_3\">OCCUPATION<\/label><input type=\"text\" id=\"wpforms-9301-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\" ><\/div><div id=\"wpforms-9301-field_5-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_5\">ID NUMBER<\/label><input type=\"text\" id=\"wpforms-9301-field_5\" class=\"wpforms-field-large\" name=\"wpforms[fields][5]\" ><\/div><div id=\"wpforms-9301-field_6-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_6\">E-MAIL ADDRESS <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-9301-field_6\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-9301-field_8-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third wpforms-first\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_8\">TELEPHONE: HOME<\/label><input type=\"tel\" id=\"wpforms-9301-field_8\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][8]\" ><\/div><div id=\"wpforms-9301-field_9-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_9\">WORK <\/label><input type=\"tel\" id=\"wpforms-9301-field_9\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][9]\" ><\/div><div id=\"wpforms-9301-field_10-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_10\">CELL<\/label><input type=\"tel\" id=\"wpforms-9301-field_10\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-9301-field_11-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_11\">POSTAL ADDRESS<\/label><input type=\"text\" id=\"wpforms-9301-field_11\" class=\"wpforms-field-large\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-9301-field_12-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_12\">RESIDENTIAL ADDRESS<\/label><input type=\"text\" id=\"wpforms-9301-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-9301-field_13-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_13\">BANK DETAILS<\/label><input type=\"text\" id=\"wpforms-9301-field_13\" class=\"wpforms-field-large\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-9301-field_14-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_14\">BANK ACCOUNT NO<\/label><input type=\"text\" id=\"wpforms-9301-field_14\" class=\"wpforms-field-large\" name=\"wpforms[fields][14]\" ><\/div><div id=\"wpforms-9301-field_15-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"15\"><div id=\"wpforms-9301-field_15\"><h1 style=\"font-size:130%\">PERIOD OF INSURANCE<\/h1><\/div><\/div><div id=\"wpforms-9301-field_16-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_16\">From<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-9301-field_16\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-input=\"true\" name=\"wpforms[fields][16][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-9301-field_17-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_17\">To<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-9301-field_17\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-input=\"true\" name=\"wpforms[fields][17][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-9301-field_19-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"19\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"9301\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" style=\"display:none;\"><div id=\"wpforms-9301-field_18-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"18\"><div id=\"wpforms-9301-field_18\"><h1 style=\"font-size:130%\">DETAILS OF PROPOSER<\/h1><\/div><\/div><div id=\"wpforms-9301-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_22\">Are you fully licenced for this class of vehicle<\/label><ul id=\"wpforms-9301-field_22\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_22_1\" name=\"wpforms[fields][22]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_22_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-9301-field_24-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-third\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_24\">Date when licenced<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-9301-field_24\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"d\/m\/Y\" data-input=\"true\" name=\"wpforms[fields][24][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-9301-field_23-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-third wpforms-one-third wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_23\">Have you ever been denied or have insurance policy cancelled<\/label><ul id=\"wpforms-9301-field_23\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-9301-field_23_2\" name=\"wpforms[fields][23]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_23_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-9301-field_26-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_26\">If yes to the above , state the reason<\/label><input type=\"text\" id=\"wpforms-9301-field_26\" class=\"wpforms-field-large\" name=\"wpforms[fields][26]\" ><\/div><div id=\"wpforms-9301-field_27-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-one-half wpforms-first\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_27\">Name of previous insurer<\/label><input type=\"text\" id=\"wpforms-9301-field_27\" class=\"wpforms-field-large\" name=\"wpforms[fields][27]\" ><\/div><div id=\"wpforms-9301-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_28\">State any loss suffered for the past 3years and their monetary value<\/label><input type=\"text\" id=\"wpforms-9301-field_28\" class=\"wpforms-field-large\" name=\"wpforms[fields][28]\" ><\/div><div id=\"wpforms-9301-field_29-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"29\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"9301\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3 last \" style=\"display:none;\"><div id=\"wpforms-9301-field_40-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_40\">VEHICLE (S) DETAILS<\/label><ul id=\"wpforms-9301-field_40\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_1\" name=\"wpforms[fields][40][]\" value=\"Make\/Model\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_1\">Make\/Model<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_2\" name=\"wpforms[fields][40][]\" value=\"Engine &amp; Chassis No: \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_2\">Engine &amp; Chassis No: <\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_3\" name=\"wpforms[fields][40][]\" value=\"Year of make \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_3\">Year of make <\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_5\" name=\"wpforms[fields][40][]\" value=\"Reg No:\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_5\">Reg No:<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_6\" name=\"wpforms[fields][40][]\" value=\"Type of cover\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_6\">Type of cover<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-9301-field_40_4\" name=\"wpforms[fields][40][]\" value=\"Value To be insured(incl.accessories)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-9301-field_40_4\">Value To be insured(incl.accessories)<\/label><\/li><\/ul><\/div><div id=\"wpforms-9301-field_30-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_30\">Make\/Model<\/label><input type=\"text\" id=\"wpforms-9301-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-9301-field_31-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_31\">Engine &amp; Chassis No: <\/label><input type=\"text\" id=\"wpforms-9301-field_31\" class=\"wpforms-field-large\" name=\"wpforms[fields][31]\" ><\/div><div id=\"wpforms-9301-field_32-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_32\">Year of make <\/label><input type=\"text\" id=\"wpforms-9301-field_32\" class=\"wpforms-field-large\" name=\"wpforms[fields][32]\" ><\/div><div id=\"wpforms-9301-field_37-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_37\">2.Name<\/label><input type=\"text\" id=\"wpforms-9301-field_37\" class=\"wpforms-field-large\" name=\"wpforms[fields][37]\" ><\/div><div id=\"wpforms-9301-field_38-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_38\">2.Engine &amp; Chassis No: <\/label><input type=\"text\" id=\"wpforms-9301-field_38\" class=\"wpforms-field-large\" name=\"wpforms[fields][38]\" ><\/div><div id=\"wpforms-9301-field_39-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"39\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_39\">2.Year of make<\/label><input type=\"text\" id=\"wpforms-9301-field_39\" class=\"wpforms-field-large\" name=\"wpforms[fields][39]\" ><\/div><div id=\"wpforms-9301-field_33-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_33\">Reg No: <\/label><input type=\"text\" id=\"wpforms-9301-field_33\" class=\"wpforms-field-large\" name=\"wpforms[fields][33]\" ><\/div><div id=\"wpforms-9301-field_34-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_34\">Type of cover <\/label><input type=\"text\" id=\"wpforms-9301-field_34\" class=\"wpforms-field-large\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-9301-field_35-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_35\">Value To be insured(incl.accessories)<\/label><input type=\"text\" id=\"wpforms-9301-field_35\" class=\"wpforms-field-large\" name=\"wpforms[fields][35]\" ><\/div><div id=\"wpforms-9301-field_41-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_41\">2.Reg No:<\/label><input type=\"text\" id=\"wpforms-9301-field_41\" class=\"wpforms-field-large\" name=\"wpforms[fields][41]\" ><\/div><div id=\"wpforms-9301-field_42-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_42\">2.Type of cover<\/label><input type=\"text\" id=\"wpforms-9301-field_42\" class=\"wpforms-field-large\" name=\"wpforms[fields][42]\" ><\/div><div id=\"wpforms-9301-field_43-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-9301-field_43\">2.Value To be insured(incl.accessories)<\/label><input type=\"text\" id=\"wpforms-9301-field_43\" class=\"wpforms-field-large\" name=\"wpforms[fields][43]\" ><\/div><div id=\"wpforms-9301-field_21-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"21\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-9301-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-9301-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"9301\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"3\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-9301\" 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>PRIVATE MOTOR PROPOSAL FORM Head Office, Insurance Centre, 30 Samora Machel Avenue, P.O. Box 1256, Harare, ZimbabweTel: 263-4-701133, 704911-4, 700346, Fax: 263-4-704134, 700083\u00a0<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":9244,"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 center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-9302","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9302","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/comments?post=9302"}],"version-history":[{"count":2,"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9302\/revisions"}],"predecessor-version":[{"id":9304,"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9302\/revisions\/9304"}],"up":[{"embeddable":true,"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/pages\/9244"}],"wp:attachment":[{"href":"https:\/\/263host.co.zw\/projects\/firstmutual\/wp-json\/wp\/v2\/media?parent=9302"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}