{"id":55418,"date":"2024-08-26T21:55:41","date_gmt":"2024-08-26T19:55:41","guid":{"rendered":"https:\/\/abes.ch\/?page_id=55418"},"modified":"2024-08-31T10:08:01","modified_gmt":"2024-08-31T08:08:01","slug":"elementare-55418","status":"publish","type":"page","link":"https:\/\/abes.ch\/it\/offertanforderung-krankenkasse\/","title":{"rendered":"Richiesta di preventivo assicurazione sanitaria"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"55418\" class=\"elementor elementor-55418\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a440945 e-con-full e-flex e-con e-parent\" data-id=\"a440945\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a207dcd elementor-widget elementor-widget-heading\" data-id=\"a207dcd\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Krankenkassen Offerte<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-51a7589 e-con-full e-flex e-con e-parent\" data-id=\"51a7589\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-08403ba elementor-widget elementor-widget-wpforms\" data-id=\"08403ba\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" 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-08403ba\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-08403ba {\n\t\t\t\t--wpforms-button-size-font-size: 14px;\n--wpforms-button-size-height: 37px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 5px;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-55358\"><form id=\"wpforms-form-55358\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"55358\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/it\/wp-json\/wp\/v2\/pages\/55418?wpforms_form_id=55358\" data-token=\"483df0fc1ffa8ec7ca9dc3c9be7b8ee3\" data-token-time=\"1776350955\"><noscript class=\"wpforms-error-noscript\">Abilita JavaScript nel browser per completare questo modulo.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Abilita JavaScript nel browser per completare questo modulo.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-55358-field_5-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"5\"><div id=\"wpforms-55358-field_5-description\" class=\"wpforms-field-description\"><p style=\"font-size:20pt;margin-bottom:5pt;font-family:Calibri;margin-top:0pt;color:#1477ba;\"><strong style=\"font-size:18pt;\">Informationen zum Offert-Gesuchsteller<\/strong><\/p><\/div><\/div><div id=\"wpforms-55358-field_56-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_56\">Aufsichtsrechtliche Rolle des Offert-Gesuchstellers <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_56\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][56]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte w\u00e4hlen Sie Ihre aufsichtsrechtliche Rolle als Gesuchsteller der Offerte<\/option><option value=\"Ich\/Wir sind in der Rolle als reiner Adressvermittler resp. Zuf\u00fchrer t\u00e4tig und es besteht kein FINMA Register Eintrag\"  class=\"choice-1 depth-1\"  >Ich\/Wir sind in der Rolle als reiner Adressvermittler resp. Zuf\u00fchrer t\u00e4tig und es besteht kein FINMA Register Eintrag<\/option><option value=\"Ich\/Wir sind in der Rolle als FINMA registrierter Vermittler t\u00e4tig\"  class=\"choice-2 depth-1\"  >Ich\/Wir sind in der Rolle als FINMA registrierter Vermittler t\u00e4tig<\/option><\/select><\/div><div id=\"wpforms-55358-field_62-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"62\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_62\">Rolle im Beratungsprozess mit dem Kunden<\/label><select id=\"wpforms-55358-field_62\" class=\"wpforms-field-large choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][62]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte w\u00e4hlen Sie Ihre Rolle Im Beratungsgespr\u00e4ch mit dem Kunden<\/option><option value=\"Ich\/Wir f\u00fchren das Erst-Beratungsgespr\u00e4ch mit dem Kunden und begleiten danach die Finalisierung durch einen Spezialisten der ABES Group AG\"  class=\"choice-1 depth-1\"  >Ich\/Wir f\u00fchren das Erst-Beratungsgespr\u00e4ch mit dem Kunden und begleiten danach die Finalisierung durch einen Spezialisten der ABES Group AG<\/option><option value=\"Ich\/Wir f\u00fchren den Lead mit den Grundinformationen zur vollst\u00e4ndigen Beratung einem Spezialisten der ABES Group AG zu\"  class=\"choice-2 depth-1\"  >Ich\/Wir f\u00fchren den Lead mit den Grundinformationen zur vollst\u00e4ndigen Beratung einem Spezialisten der ABES Group AG zu<\/option><\/select><\/div><div id=\"wpforms-55358-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_12\">Name des Subbrokers oder der anfragenden Organisation<\/label><input type=\"text\" id=\"wpforms-55358-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-55358-field_12-error\" ><\/div><div id=\"wpforms-55358-field_6-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"6\"><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-55358-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_10\">Vorname des Offert-Gesuchstellers <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55358-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-55358-field_10-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_8\">E-Mail-Adresse des Offert-Gesuchstellers <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-55358-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" spellcheck=\"false\" aria-errormessage=\"wpforms-55358-field_8-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_11\">Name des Offert-Gesuchstellers <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55358-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-55358-field_11-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_9-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_9\">Priorit\u00e4re Telefonnummer f\u00fcr R\u00fcckfragen <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-55358-field_9\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][9]\" aria-label=\"Priorit\u00e4re Telefonnummer f\u00fcr R\u00fcckfragen\" aria-errormessage=\"wpforms-55358-field_9-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Gew\u00fcnschtes Abgabedatum der Offerte und bei Bedarf gew\u00fcnschte Zeit<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-date-type-dropdown\"><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][13][date][d]\" id=\"wpforms-55358-field_13-day\" class=\"wpforms-field-date-time-date-day\" aria-label=\"Giorno\" ><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][13][date][m]\" id=\"wpforms-55358-field_13-month\" class=\"wpforms-field-date-time-date-month\" aria-label=\"Mese\" ><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][13][date][y]\" id=\"wpforms-55358-field_13-year\" class=\"wpforms-field-date-time-date-year\" aria-label=\"Anno\" ><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><label  class=\"wpforms-field-sublabel after\">Data<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-55358-field_13-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"H:i\" data-step=\"30\" data-rule-time24h=\"true\" data-min-time=\"08:00\" data-max-time=\"17:00\" data-rule-time-limit=\"true\" name=\"wpforms[fields][13][time]\" aria-errormessage=\"wpforms-55358-field_13-time-error\" ><label for=\"wpforms-55358-field_13-time\" class=\"wpforms-field-sublabel after\">Ora<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-55358-field_58-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-type=\"checkbox\" data-field-id=\"58\"><fieldset><legend class=\"wpforms-field-label\">Welche Anbieter werden vom Kunden bevorzugt und sollten f\u00fcr eine Offerte am ehesten ber\u00fccksichtigt werden?<\/legend><ul id=\"wpforms-55358-field_58\"><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_5\" name=\"wpforms[fields][58][]\" value=\"Concordia\" aria-errormessage=\"wpforms-55358-field_58_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_5\">Concordia<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_6\" name=\"wpforms[fields][58][]\" value=\"CSS\" aria-errormessage=\"wpforms-55358-field_58_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_6\">CSS<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_3\" name=\"wpforms[fields][58][]\" value=\"Groupe Mutuel\" aria-errormessage=\"wpforms-55358-field_58_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_3\">Groupe Mutuel<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_4\" name=\"wpforms[fields][58][]\" value=\"Helsana\" aria-errormessage=\"wpforms-55358-field_58_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_4\">Helsana<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_2\" name=\"wpforms[fields][58][]\" value=\"Sanitas\" aria-errormessage=\"wpforms-55358-field_58_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_2\">Sanitas<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_58_1\" name=\"wpforms[fields][58][]\" value=\"Swica\" aria-errormessage=\"wpforms-55358-field_58_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_58_1\">Swica<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55358-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"16\"><div id=\"wpforms-55358-field_16-description\" class=\"wpforms-field-description\"><p style=\"font-size:20pt;margin-bottom:5pt;font-family:Calibri;margin-top:0pt;color:#1477ba;\"><strong style=\"font-size:18pt;\">Informationen zum Kunden<\/strong><\/p><\/div><\/div><div id=\"wpforms-55358-field_24-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_24\">Anrede <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_24\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][24]\" required=\"required\"><option value=\"Frau\"  class=\"choice-1 depth-1\"  >Frau<\/option><option value=\"Herr\"  class=\"choice-2 depth-1\"  >Herr<\/option><option value=\"Non Bin\u00e4r\"  class=\"choice-3 depth-1\"  >Non Bin\u00e4r<\/option><\/select><\/div><div id=\"wpforms-55358-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_25\">Titel<\/label><select id=\"wpforms-55358-field_25\" class=\"wpforms-field-small\" name=\"wpforms[fields][25]\"><option value=\"Keiner\"  class=\"choice-1 depth-1\"  >Keiner<\/option><option value=\"Dr.\"  class=\"choice-2 depth-1\"  >Dr.<\/option><option value=\"Professor\"  class=\"choice-3 depth-1\"  >Professor<\/option><option value=\"Professor Dr.\"  class=\"choice-4 depth-1\"  >Professor Dr.<\/option><\/select><\/div>\t\t<div id=\"wpforms-55358-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-55358-field_1\" >Gew\u00fcnschte Gew\u00fcnschte Soll<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-55358-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-55358-field_17-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_17\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][17][first]\" aria-errormessage=\"wpforms-55358-field_17-error\" required><label for=\"wpforms-55358-field_17\" class=\"wpforms-field-sublabel after\">Nome<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_17-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][17][last]\" aria-errormessage=\"wpforms-55358-field_17-last-error\" required><label for=\"wpforms-55358-field_17-last\" class=\"wpforms-field-sublabel after\">Cognome<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-55358-field_18-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Adresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-55358-field_18\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][18][address1]\" placeholder=\"Strasse und Hausnummer\" aria-errormessage=\"wpforms-55358-field_18-error\" required><label for=\"wpforms-55358-field_18\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Indirizzo (linea 1)<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-55358-field_18-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][18][city]\" placeholder=\"PLZ\" aria-errormessage=\"wpforms-55358-field_18-city-error\" required><label for=\"wpforms-55358-field_18-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Citt\u00e0<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_18-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][18][state]\" placeholder=\"Wohnort in der Schweiz\" aria-errormessage=\"wpforms-55358-field_18-state-error\" required><label for=\"wpforms-55358-field_18-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Stato \/ Provincia \/ Regione<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-55358-field_19-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"19\"><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-55358-field_21-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Geburtsdatum <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][21][date][d]\" id=\"wpforms-55358-field_21-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Giorno\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][21][date][m]\" id=\"wpforms-55358-field_21-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mese\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][21][date][y]\" id=\"wpforms-55358-field_21-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Anno\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_20-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_20\">Zivilstand <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" required=\"required\"><option value=\"Ledig\"  class=\"choice-1 depth-1\"  >Ledig<\/option><option value=\"Verheiratet\"  class=\"choice-2 depth-1\"  >Verheiratet<\/option><option value=\"Geschieden\"  class=\"choice-3 depth-1\"  >Geschieden<\/option><option value=\"Verwitwet\"  class=\"choice-4 depth-1\"  >Verwitwet<\/option><option value=\"Unverheiratet - in eingetragener Partnerschaf\"  class=\"choice-7 depth-1\"  >Unverheiratet - in eingetragener Partnerschaf<\/option><option value=\"Aufgel\u00f6ste Partnerschaft\"  class=\"choice-6 depth-1\"  >Aufgel\u00f6ste Partnerschaft<\/option><option value=\"Gerichtlich aufgel\u00f6ste Partnerschaft\"  class=\"choice-5 depth-1\"  >Gerichtlich aufgel\u00f6ste Partnerschaft<\/option><option value=\"Durch Tod aufgel\u00f6ste Partnerschaft\"  class=\"choice-10 depth-1\"  >Durch Tod aufgel\u00f6ste Partnerschaft<\/option><option value=\"Durch Verschollenerkl\u00e4rung aufgel\u00f6ste Partnerschaft\"  class=\"choice-9 depth-1\"  >Durch Verschollenerkl\u00e4rung aufgel\u00f6ste Partnerschaft<\/option><\/select><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_23-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_23\">Nationalit\u00e4t <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required=\"required\"><option value=\"Schweiz\"  selected='selected' class=\"choice-255 depth-1\"  >Schweiz<\/option><option value=\"Afghanistan\"  class=\"choice-5 depth-1\"  >Afghanistan<\/option><option value=\"Albanien\"  class=\"choice-6 depth-1\"  >Albanien<\/option><option value=\"Algerien\"  class=\"choice-7 depth-1\"  >Algerien<\/option><option value=\"Amerikanisch-Samoa\"  class=\"choice-8 depth-1\"  >Amerikanisch-Samoa<\/option><option value=\"Amerikanische Jungferninseln\"  class=\"choice-9 depth-1\"  >Amerikanische Jungferninseln<\/option><option value=\"Andorra\"  class=\"choice-10 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-11 depth-1\"  >Angola<\/option><option value=\"Anguilla\"  class=\"choice-12 depth-1\"  >Anguilla<\/option><option value=\"Antarktika\"  class=\"choice-13 depth-1\"  >Antarktika<\/option><option value=\"Antigua und Barbuda\"  class=\"choice-14 depth-1\"  >Antigua und Barbuda<\/option><option value=\"Argentinien\"  class=\"choice-15 depth-1\"  >Argentinien<\/option><option value=\"Armenien\"  class=\"choice-16 depth-1\"  >Armenien<\/option><option value=\"Aruba\"  class=\"choice-17 depth-1\"  >Aruba<\/option><option value=\"Aserbaidschan\"  class=\"choice-18 depth-1\"  >Aserbaidschan<\/option><option value=\"Australien\"  class=\"choice-19 depth-1\"  >Australien<\/option><option value=\"Bahamas\"  class=\"choice-20 depth-1\"  >Bahamas<\/option><option value=\"Bahrain\"  class=\"choice-21 depth-1\"  >Bahrain<\/option><option value=\"Bangladesh\"  class=\"choice-22 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-23 depth-1\"  >Barbados<\/option><option value=\"Belgien\"  class=\"choice-24 depth-1\"  >Belgien<\/option><option value=\"Belize\"  class=\"choice-25 depth-1\"  >Belize<\/option><option value=\"Benin\"  class=\"choice-26 depth-1\"  >Benin<\/option><option value=\"Bermuda\"  class=\"choice-27 depth-1\"  >Bermuda<\/option><option value=\"Bhutan\"  class=\"choice-28 depth-1\"  >Bhutan<\/option><option value=\"Bolivien (Plurinationaler Staat)\"  class=\"choice-29 depth-1\"  >Bolivien (Plurinationaler Staat)<\/option><option value=\"Bonaire, Sint Eustatius und Saba\"  class=\"choice-30 depth-1\"  >Bonaire, Sint Eustatius und Saba<\/option><option value=\"Bosnien und Herzegowina\"  class=\"choice-31 depth-1\"  >Bosnien und Herzegowina<\/option><option value=\"Botswana\"  class=\"choice-32 depth-1\"  >Botswana<\/option><option value=\"Bouvetinsel\"  class=\"choice-33 depth-1\"  >Bouvetinsel<\/option><option value=\"Brasilien\"  class=\"choice-34 depth-1\"  >Brasilien<\/option><option value=\"Britische Jungferninseln\"  class=\"choice-35 depth-1\"  >Britische Jungferninseln<\/option><option value=\"Britisches Territorium im Indischen Ozean\"  class=\"choice-36 depth-1\"  >Britisches Territorium im Indischen Ozean<\/option><option value=\"Brunei Darussalam\"  class=\"choice-37 depth-1\"  >Brunei Darussalam<\/option><option value=\"Bulgarien\"  class=\"choice-38 depth-1\"  >Bulgarien<\/option><option value=\"Burkina Faso\"  class=\"choice-39 depth-1\"  >Burkina Faso<\/option><option value=\"Burundi\"  class=\"choice-40 depth-1\"  >Burundi<\/option><option value=\"Cabo Verde\"  class=\"choice-41 depth-1\"  >Cabo Verde<\/option><option value=\"Chile\"  class=\"choice-42 depth-1\"  >Chile<\/option><option value=\"China\"  class=\"choice-43 depth-1\"  >China<\/option><option value=\"Cookinseln\"  class=\"choice-44 depth-1\"  >Cookinseln<\/option><option value=\"Costa Rica\"  class=\"choice-45 depth-1\"  >Costa Rica<\/option><option value=\"Cura\u00e7ao\"  class=\"choice-46 depth-1\"  >Cura\u00e7ao<\/option><option value=\"C\u00f4te d&#039;Ivoire\"  class=\"choice-47 depth-1\"  >C\u00f4te d'Ivoire<\/option><option value=\"Deutschland\"  class=\"choice-48 depth-1\"  >Deutschland<\/option><option value=\"Djibouti\"  class=\"choice-49 depth-1\"  >Djibouti<\/option><option value=\"Dominica\"  class=\"choice-50 depth-1\"  >Dominica<\/option><option value=\"Dominikanische Republik\"  class=\"choice-51 depth-1\"  >Dominikanische Republik<\/option><option value=\"D\u00e4nemark\"  class=\"choice-52 depth-1\"  >D\u00e4nemark<\/option><option value=\"Ecuador\"  class=\"choice-53 depth-1\"  >Ecuador<\/option><option value=\"El Salvador\"  class=\"choice-54 depth-1\"  >El Salvador<\/option><option value=\"Eritrea\"  class=\"choice-55 depth-1\"  >Eritrea<\/option><option value=\"Estland\"  class=\"choice-56 depth-1\"  >Estland<\/option><option value=\"Eswatini (K\u00f6nigreich)\"  class=\"choice-57 depth-1\"  >Eswatini (K\u00f6nigreich)<\/option><option value=\"Falklandinseln (Malwinen)\"  class=\"choice-58 depth-1\"  >Falklandinseln (Malwinen)<\/option><option value=\"Fidschi\"  class=\"choice-59 depth-1\"  >Fidschi<\/option><option value=\"Finnland\"  class=\"choice-60 depth-1\"  >Finnland<\/option><option value=\"Frankreich\"  class=\"choice-61 depth-1\"  >Frankreich<\/option><option value=\"Franz\u00f6sisch-Guayana\"  class=\"choice-62 depth-1\"  >Franz\u00f6sisch-Guayana<\/option><option value=\"Franz\u00f6sisch-Polynesien\"  class=\"choice-63 depth-1\"  >Franz\u00f6sisch-Polynesien<\/option><option value=\"Franz\u00f6sische S\u00fcd- und Antarktisgebiete\"  class=\"choice-64 depth-1\"  >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value=\"F\u00e4r\u00f6er-Inseln\"  class=\"choice-65 depth-1\"  >F\u00e4r\u00f6er-Inseln<\/option><option value=\"Gabun\"  class=\"choice-66 depth-1\"  >Gabun<\/option><option value=\"Gambia\"  class=\"choice-67 depth-1\"  >Gambia<\/option><option value=\"Georgia\"  class=\"choice-68 depth-1\"  >Georgia<\/option><option value=\"Ghana\"  class=\"choice-69 depth-1\"  >Ghana<\/option><option value=\"Gibraltar\"  class=\"choice-70 depth-1\"  >Gibraltar<\/option><option value=\"Grenada\"  class=\"choice-71 depth-1\"  >Grenada<\/option><option value=\"Griechenland\"  class=\"choice-72 depth-1\"  >Griechenland<\/option><option value=\"Gr\u00f6nland\"  class=\"choice-73 depth-1\"  >Gr\u00f6nland<\/option><option value=\"Guadeloupe\"  class=\"choice-74 depth-1\"  >Guadeloupe<\/option><option value=\"Guam\"  class=\"choice-75 depth-1\"  >Guam<\/option><option value=\"Guatemala\"  class=\"choice-76 depth-1\"  >Guatemala<\/option><option value=\"Guernsey\"  class=\"choice-77 depth-1\"  >Guernsey<\/option><option value=\"Guinea\"  class=\"choice-78 depth-1\"  >Guinea<\/option><option value=\"Guinea-Bissau\"  class=\"choice-79 depth-1\"  >Guinea-Bissau<\/option><option value=\"Guyana\"  class=\"choice-80 depth-1\"  >Guyana<\/option><option value=\"Haiti\"  class=\"choice-81 depth-1\"  >Haiti<\/option><option value=\"Heard- und McDonald-Inseln\"  class=\"choice-82 depth-1\"  >Heard- und McDonald-Inseln<\/option><option value=\"Honduras\"  class=\"choice-83 depth-1\"  >Honduras<\/option><option value=\"Hongkong\"  class=\"choice-84 depth-1\"  >Hongkong<\/option><option value=\"Indien\"  class=\"choice-85 depth-1\"  >Indien<\/option><option value=\"Indonesien\"  class=\"choice-86 depth-1\"  >Indonesien<\/option><option value=\"Irak\"  class=\"choice-87 depth-1\"  >Irak<\/option><option value=\"Iran (Islamische Republik)\"  class=\"choice-88 depth-1\"  >Iran (Islamische Republik)<\/option><option value=\"Irland\"  class=\"choice-89 depth-1\"  >Irland<\/option><option value=\"Island\"  class=\"choice-90 depth-1\"  >Island<\/option><option value=\"Isle of Man\"  class=\"choice-91 depth-1\"  >Isle of Man<\/option><option value=\"Israel\"  class=\"choice-92 depth-1\"  >Israel<\/option><option value=\"Italien\"  class=\"choice-93 depth-1\"  >Italien<\/option><option value=\"Jamaika\"  class=\"choice-94 depth-1\"  >Jamaika<\/option><option value=\"Japan\"  class=\"choice-95 depth-1\"  >Japan<\/option><option value=\"Jemen\"  class=\"choice-96 depth-1\"  >Jemen<\/option><option value=\"Jersey\"  class=\"choice-97 depth-1\"  >Jersey<\/option><option value=\"Jordanien\"  class=\"choice-98 depth-1\"  >Jordanien<\/option><option value=\"Kaimaninseln\"  class=\"choice-99 depth-1\"  >Kaimaninseln<\/option><option value=\"Kambodscha\"  class=\"choice-100 depth-1\"  >Kambodscha<\/option><option value=\"Kamerun\"  class=\"choice-101 depth-1\"  >Kamerun<\/option><option value=\"Kanada\"  class=\"choice-102 depth-1\"  >Kanada<\/option><option value=\"Kasachstan\"  class=\"choice-103 depth-1\"  >Kasachstan<\/option><option value=\"Katar\"  class=\"choice-104 depth-1\"  >Katar<\/option><option value=\"Kenia\"  class=\"choice-105 depth-1\"  >Kenia<\/option><option value=\"Kirgistan\"  class=\"choice-106 depth-1\"  >Kirgistan<\/option><option value=\"Kiribati\"  class=\"choice-107 depth-1\"  >Kiribati<\/option><option value=\"Kokosinseln (Keelinginseln)\"  class=\"choice-108 depth-1\"  >Kokosinseln (Keelinginseln)<\/option><option value=\"Kolumbien\"  class=\"choice-109 depth-1\"  >Kolumbien<\/option><option value=\"Komoren\"  class=\"choice-110 depth-1\"  >Komoren<\/option><option value=\"Kongo (Demokratische Republik)\"  class=\"choice-111 depth-1\"  >Kongo (Demokratische Republik)<\/option><option value=\"Kongo (Republik)\"  class=\"choice-112 depth-1\"  >Kongo (Republik)<\/option><option value=\"Korea (Demokratische Volksrepublik)\"  class=\"choice-113 depth-1\"  >Korea (Demokratische Volksrepublik)<\/option><option value=\"Korea (Republik)\"  class=\"choice-114 depth-1\"  >Korea (Republik)<\/option><option value=\"Kosovo\"  class=\"choice-115 depth-1\"  >Kosovo<\/option><option value=\"Kroatien\"  class=\"choice-116 depth-1\"  >Kroatien<\/option><option value=\"Kuba\"  class=\"choice-117 depth-1\"  >Kuba<\/option><option value=\"Kuwait\"  class=\"choice-118 depth-1\"  >Kuwait<\/option><option value=\"Laos (Demokratische Volksrepublik)\"  class=\"choice-119 depth-1\"  >Laos (Demokratische Volksrepublik)<\/option><option value=\"Lesotho\"  class=\"choice-120 depth-1\"  >Lesotho<\/option><option value=\"Lettland\"  class=\"choice-121 depth-1\"  >Lettland<\/option><option value=\"Libanon\"  class=\"choice-122 depth-1\"  >Libanon<\/option><option value=\"Liberia\"  class=\"choice-123 depth-1\"  >Liberia<\/option><option value=\"Libyen\"  class=\"choice-124 depth-1\"  >Libyen<\/option><option value=\"Liechtenstein\"  class=\"choice-125 depth-1\"  >Liechtenstein<\/option><option value=\"Litauen\"  class=\"choice-126 depth-1\"  >Litauen<\/option><option value=\"Luxemburg\"  class=\"choice-127 depth-1\"  >Luxemburg<\/option><option value=\"Macau\"  class=\"choice-128 depth-1\"  >Macau<\/option><option value=\"Madagaskar\"  class=\"choice-129 depth-1\"  >Madagaskar<\/option><option value=\"Malawi\"  class=\"choice-130 depth-1\"  >Malawi<\/option><option value=\"Malaysia\"  class=\"choice-131 depth-1\"  >Malaysia<\/option><option value=\"Malediven\"  class=\"choice-132 depth-1\"  >Malediven<\/option><option value=\"Mali\"  class=\"choice-133 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-134 depth-1\"  >Malta<\/option><option value=\"Marokko\"  class=\"choice-135 depth-1\"  >Marokko<\/option><option value=\"Marshall-Inseln\"  class=\"choice-136 depth-1\"  >Marshall-Inseln<\/option><option value=\"Martinique\"  class=\"choice-137 depth-1\"  >Martinique<\/option><option value=\"Mauretanien\"  class=\"choice-138 depth-1\"  >Mauretanien<\/option><option value=\"Mauritius\"  class=\"choice-139 depth-1\"  >Mauritius<\/option><option value=\"Mayotte\"  class=\"choice-140 depth-1\"  >Mayotte<\/option><option value=\"Mexiko\"  class=\"choice-141 depth-1\"  >Mexiko<\/option><option value=\"Mikronesien\"  class=\"choice-142 depth-1\"  >Mikronesien<\/option><option value=\"Moldau (Republik)\"  class=\"choice-143 depth-1\"  >Moldau (Republik)<\/option><option value=\"Monaco\"  class=\"choice-144 depth-1\"  >Monaco<\/option><option value=\"Mongolei\"  class=\"choice-145 depth-1\"  >Mongolei<\/option><option value=\"Montenegro\"  class=\"choice-146 depth-1\"  >Montenegro<\/option><option value=\"Montserrat\"  class=\"choice-147 depth-1\"  >Montserrat<\/option><option value=\"Mosambik\"  class=\"choice-148 depth-1\"  >Mosambik<\/option><option value=\"Myanmar\"  class=\"choice-149 depth-1\"  >Myanmar<\/option><option value=\"Namibia\"  class=\"choice-150 depth-1\"  >Namibia<\/option><option value=\"Nauru\"  class=\"choice-151 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-152 depth-1\"  >Nepal<\/option><option value=\"Neukaledonien\"  class=\"choice-153 depth-1\"  >Neukaledonien<\/option><option value=\"Neuseeland\"  class=\"choice-154 depth-1\"  >Neuseeland<\/option><option value=\"Nicaragua\"  class=\"choice-155 depth-1\"  >Nicaragua<\/option><option value=\"Niederlande\"  class=\"choice-156 depth-1\"  >Niederlande<\/option><option value=\"Niger\"  class=\"choice-157 depth-1\"  >Niger<\/option><option value=\"Nigeria\"  class=\"choice-158 depth-1\"  >Nigeria<\/option><option value=\"Niue\"  class=\"choice-159 depth-1\"  >Niue<\/option><option value=\"Nordmazedonien (Republik)\"  class=\"choice-160 depth-1\"  >Nordmazedonien (Republik)<\/option><option value=\"Norfolkinsel\"  class=\"choice-161 depth-1\"  >Norfolkinsel<\/option><option value=\"Norwegen\"  class=\"choice-162 depth-1\"  >Norwegen<\/option><option value=\"N\u00f6rdliche Marianen\"  class=\"choice-163 depth-1\"  >N\u00f6rdliche Marianen<\/option><option value=\"Oman\"  class=\"choice-164 depth-1\"  >Oman<\/option><option value=\"Osttimor\"  class=\"choice-165 depth-1\"  >Osttimor<\/option><option value=\"Pakistan\"  class=\"choice-166 depth-1\"  >Pakistan<\/option><option value=\"Palau\"  class=\"choice-167 depth-1\"  >Palau<\/option><option value=\"Pal\u00e4stina (Staat)\"  class=\"choice-168 depth-1\"  >Pal\u00e4stina (Staat)<\/option><option value=\"Panama\"  class=\"choice-169 depth-1\"  >Panama<\/option><option value=\"Papua-Neuguinea\"  class=\"choice-170 depth-1\"  >Papua-Neuguinea<\/option><option value=\"Paraguay\"  class=\"choice-171 depth-1\"  >Paraguay<\/option><option value=\"Peru\"  class=\"choice-172 depth-1\"  >Peru<\/option><option value=\"Philippinen\"  class=\"choice-173 depth-1\"  >Philippinen<\/option><option value=\"Pitcairninseln\"  class=\"choice-174 depth-1\"  >Pitcairninseln<\/option><option value=\"Polen\"  class=\"choice-175 depth-1\"  >Polen<\/option><option value=\"Portugal\"  class=\"choice-176 depth-1\"  >Portugal<\/option><option value=\"Puerto Rico\"  class=\"choice-177 depth-1\"  >Puerto Rico<\/option><option value=\"Ruanda\"  class=\"choice-178 depth-1\"  >Ruanda<\/option><option value=\"Rum\u00e4nien\"  class=\"choice-179 depth-1\"  >Rum\u00e4nien<\/option><option value=\"Russland\"  class=\"choice-180 depth-1\"  >Russland<\/option><option value=\"R\u00e9union\"  class=\"choice-181 depth-1\"  >R\u00e9union<\/option><option value=\"Saint-Barth\u00e9lemy\"  class=\"choice-182 depth-1\"  >Saint-Barth\u00e9lemy<\/option><option value=\"Saint-Pierre und Miquelon\"  class=\"choice-183 depth-1\"  >Saint-Pierre und Miquelon<\/option><option value=\"Salomonen\"  class=\"choice-184 depth-1\"  >Salomonen<\/option><option value=\"Sambia\"  class=\"choice-185 depth-1\"  >Sambia<\/option><option value=\"Samoa\"  class=\"choice-186 depth-1\"  >Samoa<\/option><option value=\"San Marino\"  class=\"choice-187 depth-1\"  >San Marino<\/option><option value=\"Saudi-Arabien\"  class=\"choice-188 depth-1\"  >Saudi-Arabien<\/option><option value=\"Schweden\"  class=\"choice-189 depth-1\"  >Schweden<\/option><option value=\"Senegal\"  class=\"choice-191 depth-1\"  >Senegal<\/option><option value=\"Serbien\"  class=\"choice-192 depth-1\"  >Serbien<\/option><option value=\"Seychellen\"  class=\"choice-193 depth-1\"  >Seychellen<\/option><option value=\"Sierra Leone\"  class=\"choice-194 depth-1\"  >Sierra Leone<\/option><option value=\"Simbabwe\"  class=\"choice-195 depth-1\"  >Simbabwe<\/option><option value=\"Singapur\"  class=\"choice-196 depth-1\"  >Singapur<\/option><option value=\"Sint Maarten\"  class=\"choice-197 depth-1\"  >Sint Maarten<\/option><option value=\"Slowakei\"  class=\"choice-198 depth-1\"  >Slowakei<\/option><option value=\"Slowenien\"  class=\"choice-199 depth-1\"  >Slowenien<\/option><option value=\"Somalia\"  class=\"choice-200 depth-1\"  >Somalia<\/option><option value=\"Spanien\"  class=\"choice-201 depth-1\"  >Spanien<\/option><option value=\"Spitzbergen\"  class=\"choice-202 depth-1\"  >Spitzbergen<\/option><option value=\"Sri Lanka\"  class=\"choice-203 depth-1\"  >Sri Lanka<\/option><option value=\"St. Helena, Ascension und Tristan da Cunha\"  class=\"choice-204 depth-1\"  >St. Helena, Ascension und Tristan da Cunha<\/option><option value=\"St. Kitts und Nevis\"  class=\"choice-205 depth-1\"  >St. Kitts und Nevis<\/option><option value=\"St. Lucia\"  class=\"choice-206 depth-1\"  >St. Lucia<\/option><option value=\"St. Martin (franz\u00f6sisch)\"  class=\"choice-207 depth-1\"  >St. Martin (franz\u00f6sisch)<\/option><option value=\"St. Vincent und die Grenadinen\"  class=\"choice-208 depth-1\"  >St. Vincent und die Grenadinen<\/option><option value=\"Sudan\"  class=\"choice-209 depth-1\"  >Sudan<\/option><option value=\"Surinam\"  class=\"choice-210 depth-1\"  >Surinam<\/option><option value=\"Syrien (Arabische Republik)\"  class=\"choice-211 depth-1\"  >Syrien (Arabische Republik)<\/option><option value=\"S\u00e3o Tom\u00e9 und Pr\u00edncipe\"  class=\"choice-212 depth-1\"  >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value=\"S\u00fcdafrika\"  class=\"choice-213 depth-1\"  >S\u00fcdafrika<\/option><option value=\"S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln\"  class=\"choice-214 depth-1\"  >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value=\"S\u00fcdsudan\"  class=\"choice-215 depth-1\"  >S\u00fcdsudan<\/option><option value=\"Tadschikistan\"  class=\"choice-216 depth-1\"  >Tadschikistan<\/option><option value=\"Taiwan, Republik China\"  class=\"choice-217 depth-1\"  >Taiwan, Republik China<\/option><option value=\"Tansania (Vereinigte Republik)\"  class=\"choice-218 depth-1\"  >Tansania (Vereinigte Republik)<\/option><option value=\"Thailand\"  class=\"choice-219 depth-1\"  >Thailand<\/option><option value=\"Togo\"  class=\"choice-220 depth-1\"  >Togo<\/option><option value=\"Tokelau\"  class=\"choice-221 depth-1\"  >Tokelau<\/option><option value=\"Tonga\"  class=\"choice-222 depth-1\"  >Tonga<\/option><option value=\"Trinidad und Tobago\"  class=\"choice-223 depth-1\"  >Trinidad und Tobago<\/option><option value=\"Tschad\"  class=\"choice-224 depth-1\"  >Tschad<\/option><option value=\"Tschechische Republik\"  class=\"choice-225 depth-1\"  >Tschechische Republik<\/option><option value=\"Tunesien\"  class=\"choice-226 depth-1\"  >Tunesien<\/option><option value=\"Turkmenistan\"  class=\"choice-227 depth-1\"  >Turkmenistan<\/option><option value=\"Turks- und Caicosinseln\"  class=\"choice-228 depth-1\"  >Turks- und Caicosinseln<\/option><option value=\"Tuvalu\"  class=\"choice-229 depth-1\"  >Tuvalu<\/option><option value=\"T\u00fcrkei\"  class=\"choice-230 depth-1\"  >T\u00fcrkei<\/option><option value=\"USA\"  class=\"choice-231 depth-1\"  >USA<\/option><option value=\"Uganda\"  class=\"choice-232 depth-1\"  >Uganda<\/option><option value=\"Ukraine\"  class=\"choice-233 depth-1\"  >Ukraine<\/option><option value=\"Ungarn\"  class=\"choice-234 depth-1\"  >Ungarn<\/option><option value=\"United States Minor Outlying Islands\"  class=\"choice-235 depth-1\"  >United States Minor Outlying Islands<\/option><option value=\"Uruguay\"  class=\"choice-236 depth-1\"  >Uruguay<\/option><option value=\"Usbekistan\"  class=\"choice-237 depth-1\"  >Usbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-238 depth-1\"  >Vanuatu<\/option><option value=\"Vatikanstadt (Staat)\"  class=\"choice-239 depth-1\"  >Vatikanstadt (Staat)<\/option><option value=\"Venezuela (Bolivarische Republik)\"  class=\"choice-240 depth-1\"  >Venezuela (Bolivarische Republik)<\/option><option value=\"Vereinigte Arabische Emirate\"  class=\"choice-241 depth-1\"  >Vereinigte Arabische Emirate<\/option><option value=\"Vereinigtes K\u00f6nigreich von Gro\u00dfbritannien und Nordirland\"  class=\"choice-242 depth-1\"  >Vereinigtes K\u00f6nigreich von Gro\u00dfbritannien und Nordirland<\/option><option value=\"Vietnam\"  class=\"choice-243 depth-1\"  >Vietnam<\/option><option value=\"Wallis und Futuna\"  class=\"choice-244 depth-1\"  >Wallis und Futuna<\/option><option value=\"Weihnachtsinsel\"  class=\"choice-245 depth-1\"  >Weihnachtsinsel<\/option><option value=\"Wei\u00dfrussland\"  class=\"choice-246 depth-1\"  >Wei\u00dfrussland<\/option><option value=\"Westsahara\"  class=\"choice-247 depth-1\"  >Westsahara<\/option><option value=\"Zentralafrikanische Republik\"  class=\"choice-248 depth-1\"  >Zentralafrikanische Republik<\/option><option value=\"Zypern\"  class=\"choice-249 depth-1\"  >Zypern<\/option><option value=\"\u00c4gypten\"  class=\"choice-250 depth-1\"  >\u00c4gypten<\/option><option value=\"\u00c4quatorialguinea\"  class=\"choice-251 depth-1\"  >\u00c4quatorialguinea<\/option><option value=\"\u00c4thopien\"  class=\"choice-252 depth-1\"  >\u00c4thopien<\/option><option value=\"\u00c5landinseln\"  class=\"choice-253 depth-1\"  >\u00c5landinseln<\/option><option value=\"\u00d6sterreich\"  class=\"choice-254 depth-1\"  >\u00d6sterreich<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_22\">Aufenthaltsbewilligung <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"Keine\"  class=\"choice-1 depth-1\"  >Keine<\/option><option value=\"Ausweis C (Niederlassungsbewilligung)\"  class=\"choice-2 depth-1\"  >Ausweis C (Niederlassungsbewilligung)<\/option><option value=\"Ausweis B (Aufenthaltsbewilligung)\"  class=\"choice-3 depth-1\"  >Ausweis B (Aufenthaltsbewilligung)<\/option><option value=\"Ausweis Ci (Aufenthaltsbewilligung mit Erwerbst\u00e4tigkeit f\u00fcr Drittstaatsangeh\u00f6rige)\"  class=\"choice-4 depth-1\"  >Ausweis Ci (Aufenthaltsbewilligung mit Erwerbst\u00e4tigkeit f\u00fcr Drittstaatsangeh\u00f6rige)<\/option><option value=\"Ausweis G (Grenzg\u00e4ngerbewilligung)\"  class=\"choice-5 depth-1\"  >Ausweis G (Grenzg\u00e4ngerbewilligung)<\/option><option value=\"Ausweis L (Kurzaufenthaltsbewilligung)\"  class=\"choice-6 depth-1\"  >Ausweis L (Kurzaufenthaltsbewilligung)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_27-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"27\"><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-55358-field_28-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_28\">Soll der Partner mitversichert werden?<\/label><select id=\"wpforms-55358-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte beantworten Sie die Frage<\/option><option value=\"Ja\"  class=\"choice-1 depth-1\"  >Ja<\/option><option value=\"Nein\"  class=\"choice-2 depth-1\"  >Nein<\/option><option value=\"Ich \u00fcberlasse die Antwort dem Spezialisten\"  class=\"choice-3 depth-1\"  >Ich \u00fcberlasse die Antwort dem Spezialisten<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_29-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_29\">Sind Kinder vorhanden, welche mitversichert werden sollen?<\/label><select id=\"wpforms-55358-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte beantworten Sie die Frage<\/option><option value=\"Ja\"  class=\"choice-1 depth-1\"  >Ja<\/option><option value=\"Nein\"  class=\"choice-3 depth-1\"  >Nein<\/option><option value=\"Ich \u00fcberlasse die Antwort dem Spezialisten\"  class=\"choice-4 depth-1\"  >Ich \u00fcberlasse die Antwort dem Spezialisten<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_26-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"26\" style=\"display:none;\"><div id=\"wpforms-55358-field_26-description\" class=\"wpforms-field-description\"><p style=\"font-size:20pt;margin-bottom:5pt;font-family:Calibri;margin-top:0pt;color:#1477ba;\"><strong style=\"font-size:18pt;\">Informationen zu Mitversicherten<\/strong><\/p><\/div><\/div><div id=\"wpforms-55358-field_30-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"30\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_30\">Anrede des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_30\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][30]\" required=\"required\"><option value=\"Frau\"  class=\"choice-1 depth-1\"  >Frau<\/option><option value=\"Herr\"  class=\"choice-2 depth-1\"  >Herr<\/option><option value=\"Non Bin\u00e4r\"  class=\"choice-3 depth-1\"  >Non Bin\u00e4r<\/option><\/select><\/div><div id=\"wpforms-55358-field_31-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_31\">Titel des Partners<\/label><select id=\"wpforms-55358-field_31\" class=\"wpforms-field-small\" name=\"wpforms[fields][31]\"><option value=\"Keiner\"  class=\"choice-1 depth-1\"  >Keiner<\/option><option value=\"Dr.\"  class=\"choice-2 depth-1\"  >Dr.<\/option><option value=\"Professor\"  class=\"choice-3 depth-1\"  >Professor<\/option><option value=\"Professor Dr.\"  class=\"choice-4 depth-1\"  >Professor Dr.<\/option><\/select><\/div><div id=\"wpforms-55358-field_32-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"32\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Name des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_32\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][32][first]\" aria-errormessage=\"wpforms-55358-field_32-error\" required><label for=\"wpforms-55358-field_32\" class=\"wpforms-field-sublabel after\">Nome<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_32-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][32][last]\" aria-errormessage=\"wpforms-55358-field_32-last-error\" required><label for=\"wpforms-55358-field_32-last\" class=\"wpforms-field-sublabel after\">Cognome<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-55358-field_33-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"33\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Adresse des Partners wenn abweichende Adresse zum Kunden<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-55358-field_33\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][33][address1]\" placeholder=\"Strasse und Hausnummer\" aria-errormessage=\"wpforms-55358-field_33-error\" ><label for=\"wpforms-55358-field_33\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Indirizzo (linea 1)<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-55358-field_33-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][33][city]\" placeholder=\"PLZ\" aria-errormessage=\"wpforms-55358-field_33-city-error\" ><label for=\"wpforms-55358-field_33-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Citt\u00e0<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-55358-field_33-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][33][state]\" placeholder=\"Wohnort in der Schweiz\" aria-errormessage=\"wpforms-55358-field_33-state-error\" ><label for=\"wpforms-55358-field_33-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Stato \/ Provincia \/ Regione<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-55358-field_34-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"34\" style=\"display:none;\"><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-55358-field_35-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"35\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Geburtsdatum des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][35][date][d]\" id=\"wpforms-55358-field_35-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Giorno\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][35][date][m]\" id=\"wpforms-55358-field_35-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mese\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][35][date][y]\" id=\"wpforms-55358-field_35-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Anno\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_37\">Zivilstand des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" required=\"required\"><option value=\"Verheiratet\"  class=\"choice-1 depth-1\"  >Verheiratet<\/option><option value=\"Verheiratet\"  class=\"choice-2 depth-1\"  >Verheiratet<\/option><option value=\"Geschieden\"  class=\"choice-3 depth-1\"  >Geschieden<\/option><option value=\"Verwitwet\"  class=\"choice-4 depth-1\"  >Verwitwet<\/option><option value=\"Unverheiratet - in eingetragener Partnerschaf\"  class=\"choice-7 depth-1\"  >Unverheiratet - in eingetragener Partnerschaf<\/option><option value=\"Aufgel\u00f6ste Partnerschaft\"  class=\"choice-6 depth-1\"  >Aufgel\u00f6ste Partnerschaft<\/option><option value=\"Gerichtlich aufgel\u00f6ste Partnerschaft\"  class=\"choice-5 depth-1\"  >Gerichtlich aufgel\u00f6ste Partnerschaft<\/option><option value=\"Durch Tod aufgel\u00f6ste Partnerschaft\"  class=\"choice-10 depth-1\"  >Durch Tod aufgel\u00f6ste Partnerschaft<\/option><option value=\"Durch Verschollenerkl\u00e4rung aufgel\u00f6ste Partnerschaft\"  class=\"choice-9 depth-1\"  >Durch Verschollenerkl\u00e4rung aufgel\u00f6ste Partnerschaft<\/option><\/select><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_36-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"36\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_36\">Nationalit\u00e4t des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" required=\"required\"><option value=\"Schweiz\"  selected='selected' class=\"choice-255 depth-1\"  >Schweiz<\/option><option value=\"Afghanistan\"  class=\"choice-5 depth-1\"  >Afghanistan<\/option><option value=\"Albanien\"  class=\"choice-6 depth-1\"  >Albanien<\/option><option value=\"Algerien\"  class=\"choice-7 depth-1\"  >Algerien<\/option><option value=\"Amerikanisch-Samoa\"  class=\"choice-8 depth-1\"  >Amerikanisch-Samoa<\/option><option value=\"Amerikanische Jungferninseln\"  class=\"choice-9 depth-1\"  >Amerikanische Jungferninseln<\/option><option value=\"Andorra\"  class=\"choice-10 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-11 depth-1\"  >Angola<\/option><option value=\"Anguilla\"  class=\"choice-12 depth-1\"  >Anguilla<\/option><option value=\"Antarktika\"  class=\"choice-13 depth-1\"  >Antarktika<\/option><option value=\"Antigua und Barbuda\"  class=\"choice-14 depth-1\"  >Antigua und Barbuda<\/option><option value=\"Argentinien\"  class=\"choice-15 depth-1\"  >Argentinien<\/option><option value=\"Armenien\"  class=\"choice-16 depth-1\"  >Armenien<\/option><option value=\"Aruba\"  class=\"choice-17 depth-1\"  >Aruba<\/option><option value=\"Aserbaidschan\"  class=\"choice-18 depth-1\"  >Aserbaidschan<\/option><option value=\"Australien\"  class=\"choice-19 depth-1\"  >Australien<\/option><option value=\"Bahamas\"  class=\"choice-20 depth-1\"  >Bahamas<\/option><option value=\"Bahrain\"  class=\"choice-21 depth-1\"  >Bahrain<\/option><option value=\"Bangladesh\"  class=\"choice-22 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-23 depth-1\"  >Barbados<\/option><option value=\"Belgien\"  class=\"choice-24 depth-1\"  >Belgien<\/option><option value=\"Belize\"  class=\"choice-25 depth-1\"  >Belize<\/option><option value=\"Benin\"  class=\"choice-26 depth-1\"  >Benin<\/option><option value=\"Bermuda\"  class=\"choice-27 depth-1\"  >Bermuda<\/option><option value=\"Bhutan\"  class=\"choice-28 depth-1\"  >Bhutan<\/option><option value=\"Bolivien (Plurinationaler Staat)\"  class=\"choice-29 depth-1\"  >Bolivien (Plurinationaler Staat)<\/option><option value=\"Bonaire, Sint Eustatius und Saba\"  class=\"choice-30 depth-1\"  >Bonaire, Sint Eustatius und Saba<\/option><option value=\"Bosnien und Herzegowina\"  class=\"choice-31 depth-1\"  >Bosnien und Herzegowina<\/option><option value=\"Botswana\"  class=\"choice-32 depth-1\"  >Botswana<\/option><option value=\"Bouvetinsel\"  class=\"choice-33 depth-1\"  >Bouvetinsel<\/option><option value=\"Brasilien\"  class=\"choice-34 depth-1\"  >Brasilien<\/option><option value=\"Britische Jungferninseln\"  class=\"choice-35 depth-1\"  >Britische Jungferninseln<\/option><option value=\"Britisches Territorium im Indischen Ozean\"  class=\"choice-36 depth-1\"  >Britisches Territorium im Indischen Ozean<\/option><option value=\"Brunei Darussalam\"  class=\"choice-37 depth-1\"  >Brunei Darussalam<\/option><option value=\"Bulgarien\"  class=\"choice-38 depth-1\"  >Bulgarien<\/option><option value=\"Burkina Faso\"  class=\"choice-39 depth-1\"  >Burkina Faso<\/option><option value=\"Burundi\"  class=\"choice-40 depth-1\"  >Burundi<\/option><option value=\"Cabo Verde\"  class=\"choice-41 depth-1\"  >Cabo Verde<\/option><option value=\"Chile\"  class=\"choice-42 depth-1\"  >Chile<\/option><option value=\"China\"  class=\"choice-43 depth-1\"  >China<\/option><option value=\"Cookinseln\"  class=\"choice-44 depth-1\"  >Cookinseln<\/option><option value=\"Costa Rica\"  class=\"choice-45 depth-1\"  >Costa Rica<\/option><option value=\"Cura\u00e7ao\"  class=\"choice-46 depth-1\"  >Cura\u00e7ao<\/option><option value=\"C\u00f4te d&#039;Ivoire\"  class=\"choice-47 depth-1\"  >C\u00f4te d'Ivoire<\/option><option value=\"Deutschland\"  class=\"choice-48 depth-1\"  >Deutschland<\/option><option value=\"Djibouti\"  class=\"choice-49 depth-1\"  >Djibouti<\/option><option value=\"Dominica\"  class=\"choice-50 depth-1\"  >Dominica<\/option><option value=\"Dominikanische Republik\"  class=\"choice-51 depth-1\"  >Dominikanische Republik<\/option><option value=\"D\u00e4nemark\"  class=\"choice-52 depth-1\"  >D\u00e4nemark<\/option><option value=\"Ecuador\"  class=\"choice-53 depth-1\"  >Ecuador<\/option><option value=\"El Salvador\"  class=\"choice-54 depth-1\"  >El Salvador<\/option><option value=\"Eritrea\"  class=\"choice-55 depth-1\"  >Eritrea<\/option><option value=\"Estland\"  class=\"choice-56 depth-1\"  >Estland<\/option><option value=\"Eswatini (K\u00f6nigreich)\"  class=\"choice-57 depth-1\"  >Eswatini (K\u00f6nigreich)<\/option><option value=\"Falklandinseln (Malwinen)\"  class=\"choice-58 depth-1\"  >Falklandinseln (Malwinen)<\/option><option value=\"Fidschi\"  class=\"choice-59 depth-1\"  >Fidschi<\/option><option value=\"Finnland\"  class=\"choice-60 depth-1\"  >Finnland<\/option><option value=\"Frankreich\"  class=\"choice-61 depth-1\"  >Frankreich<\/option><option value=\"Franz\u00f6sisch-Guayana\"  class=\"choice-62 depth-1\"  >Franz\u00f6sisch-Guayana<\/option><option value=\"Franz\u00f6sisch-Polynesien\"  class=\"choice-63 depth-1\"  >Franz\u00f6sisch-Polynesien<\/option><option value=\"Franz\u00f6sische S\u00fcd- und Antarktisgebiete\"  class=\"choice-64 depth-1\"  >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value=\"F\u00e4r\u00f6er-Inseln\"  class=\"choice-65 depth-1\"  >F\u00e4r\u00f6er-Inseln<\/option><option value=\"Gabun\"  class=\"choice-66 depth-1\"  >Gabun<\/option><option value=\"Gambia\"  class=\"choice-67 depth-1\"  >Gambia<\/option><option value=\"Georgia\"  class=\"choice-68 depth-1\"  >Georgia<\/option><option value=\"Ghana\"  class=\"choice-69 depth-1\"  >Ghana<\/option><option value=\"Gibraltar\"  class=\"choice-70 depth-1\"  >Gibraltar<\/option><option value=\"Grenada\"  class=\"choice-71 depth-1\"  >Grenada<\/option><option value=\"Griechenland\"  class=\"choice-72 depth-1\"  >Griechenland<\/option><option value=\"Gr\u00f6nland\"  class=\"choice-73 depth-1\"  >Gr\u00f6nland<\/option><option value=\"Guadeloupe\"  class=\"choice-74 depth-1\"  >Guadeloupe<\/option><option value=\"Guam\"  class=\"choice-75 depth-1\"  >Guam<\/option><option value=\"Guatemala\"  class=\"choice-76 depth-1\"  >Guatemala<\/option><option value=\"Guernsey\"  class=\"choice-77 depth-1\"  >Guernsey<\/option><option value=\"Guinea\"  class=\"choice-78 depth-1\"  >Guinea<\/option><option value=\"Guinea-Bissau\"  class=\"choice-79 depth-1\"  >Guinea-Bissau<\/option><option value=\"Guyana\"  class=\"choice-80 depth-1\"  >Guyana<\/option><option value=\"Haiti\"  class=\"choice-81 depth-1\"  >Haiti<\/option><option value=\"Heard- und McDonald-Inseln\"  class=\"choice-82 depth-1\"  >Heard- und McDonald-Inseln<\/option><option value=\"Honduras\"  class=\"choice-83 depth-1\"  >Honduras<\/option><option value=\"Hongkong\"  class=\"choice-84 depth-1\"  >Hongkong<\/option><option value=\"Indien\"  class=\"choice-85 depth-1\"  >Indien<\/option><option value=\"Indonesien\"  class=\"choice-86 depth-1\"  >Indonesien<\/option><option value=\"Irak\"  class=\"choice-87 depth-1\"  >Irak<\/option><option value=\"Iran (Islamische Republik)\"  class=\"choice-88 depth-1\"  >Iran (Islamische Republik)<\/option><option value=\"Irland\"  class=\"choice-89 depth-1\"  >Irland<\/option><option value=\"Island\"  class=\"choice-90 depth-1\"  >Island<\/option><option value=\"Isle of Man\"  class=\"choice-91 depth-1\"  >Isle of Man<\/option><option value=\"Israel\"  class=\"choice-92 depth-1\"  >Israel<\/option><option value=\"Italien\"  class=\"choice-93 depth-1\"  >Italien<\/option><option value=\"Jamaika\"  class=\"choice-94 depth-1\"  >Jamaika<\/option><option value=\"Japan\"  class=\"choice-95 depth-1\"  >Japan<\/option><option value=\"Jemen\"  class=\"choice-96 depth-1\"  >Jemen<\/option><option value=\"Jersey\"  class=\"choice-97 depth-1\"  >Jersey<\/option><option value=\"Jordanien\"  class=\"choice-98 depth-1\"  >Jordanien<\/option><option value=\"Kaimaninseln\"  class=\"choice-99 depth-1\"  >Kaimaninseln<\/option><option value=\"Kambodscha\"  class=\"choice-100 depth-1\"  >Kambodscha<\/option><option value=\"Kamerun\"  class=\"choice-101 depth-1\"  >Kamerun<\/option><option value=\"Kanada\"  class=\"choice-102 depth-1\"  >Kanada<\/option><option value=\"Kasachstan\"  class=\"choice-103 depth-1\"  >Kasachstan<\/option><option value=\"Katar\"  class=\"choice-104 depth-1\"  >Katar<\/option><option value=\"Kenia\"  class=\"choice-105 depth-1\"  >Kenia<\/option><option value=\"Kirgistan\"  class=\"choice-106 depth-1\"  >Kirgistan<\/option><option value=\"Kiribati\"  class=\"choice-107 depth-1\"  >Kiribati<\/option><option value=\"Kokosinseln (Keelinginseln)\"  class=\"choice-108 depth-1\"  >Kokosinseln (Keelinginseln)<\/option><option value=\"Kolumbien\"  class=\"choice-109 depth-1\"  >Kolumbien<\/option><option value=\"Komoren\"  class=\"choice-110 depth-1\"  >Komoren<\/option><option value=\"Kongo (Demokratische Republik)\"  class=\"choice-111 depth-1\"  >Kongo (Demokratische Republik)<\/option><option value=\"Kongo (Republik)\"  class=\"choice-112 depth-1\"  >Kongo (Republik)<\/option><option value=\"Korea (Demokratische Volksrepublik)\"  class=\"choice-113 depth-1\"  >Korea (Demokratische Volksrepublik)<\/option><option value=\"Korea (Republik)\"  class=\"choice-114 depth-1\"  >Korea (Republik)<\/option><option value=\"Kosovo\"  class=\"choice-115 depth-1\"  >Kosovo<\/option><option value=\"Kroatien\"  class=\"choice-116 depth-1\"  >Kroatien<\/option><option value=\"Kuba\"  class=\"choice-117 depth-1\"  >Kuba<\/option><option value=\"Kuwait\"  class=\"choice-118 depth-1\"  >Kuwait<\/option><option value=\"Laos (Demokratische Volksrepublik)\"  class=\"choice-119 depth-1\"  >Laos (Demokratische Volksrepublik)<\/option><option value=\"Lesotho\"  class=\"choice-120 depth-1\"  >Lesotho<\/option><option value=\"Lettland\"  class=\"choice-121 depth-1\"  >Lettland<\/option><option value=\"Libanon\"  class=\"choice-122 depth-1\"  >Libanon<\/option><option value=\"Liberia\"  class=\"choice-123 depth-1\"  >Liberia<\/option><option value=\"Libyen\"  class=\"choice-124 depth-1\"  >Libyen<\/option><option value=\"Liechtenstein\"  class=\"choice-125 depth-1\"  >Liechtenstein<\/option><option value=\"Litauen\"  class=\"choice-126 depth-1\"  >Litauen<\/option><option value=\"Luxemburg\"  class=\"choice-127 depth-1\"  >Luxemburg<\/option><option value=\"Macau\"  class=\"choice-128 depth-1\"  >Macau<\/option><option value=\"Madagaskar\"  class=\"choice-129 depth-1\"  >Madagaskar<\/option><option value=\"Malawi\"  class=\"choice-130 depth-1\"  >Malawi<\/option><option value=\"Malaysia\"  class=\"choice-131 depth-1\"  >Malaysia<\/option><option value=\"Malediven\"  class=\"choice-132 depth-1\"  >Malediven<\/option><option value=\"Mali\"  class=\"choice-133 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-134 depth-1\"  >Malta<\/option><option value=\"Marokko\"  class=\"choice-135 depth-1\"  >Marokko<\/option><option value=\"Marshall-Inseln\"  class=\"choice-136 depth-1\"  >Marshall-Inseln<\/option><option value=\"Martinique\"  class=\"choice-137 depth-1\"  >Martinique<\/option><option value=\"Mauretanien\"  class=\"choice-138 depth-1\"  >Mauretanien<\/option><option value=\"Mauritius\"  class=\"choice-139 depth-1\"  >Mauritius<\/option><option value=\"Mayotte\"  class=\"choice-140 depth-1\"  >Mayotte<\/option><option value=\"Mexiko\"  class=\"choice-141 depth-1\"  >Mexiko<\/option><option value=\"Mikronesien\"  class=\"choice-142 depth-1\"  >Mikronesien<\/option><option value=\"Moldau (Republik)\"  class=\"choice-143 depth-1\"  >Moldau (Republik)<\/option><option value=\"Monaco\"  class=\"choice-144 depth-1\"  >Monaco<\/option><option value=\"Mongolei\"  class=\"choice-145 depth-1\"  >Mongolei<\/option><option value=\"Montenegro\"  class=\"choice-146 depth-1\"  >Montenegro<\/option><option value=\"Montserrat\"  class=\"choice-147 depth-1\"  >Montserrat<\/option><option value=\"Mosambik\"  class=\"choice-148 depth-1\"  >Mosambik<\/option><option value=\"Myanmar\"  class=\"choice-149 depth-1\"  >Myanmar<\/option><option value=\"Namibia\"  class=\"choice-150 depth-1\"  >Namibia<\/option><option value=\"Nauru\"  class=\"choice-151 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-152 depth-1\"  >Nepal<\/option><option value=\"Neukaledonien\"  class=\"choice-153 depth-1\"  >Neukaledonien<\/option><option value=\"Neuseeland\"  class=\"choice-154 depth-1\"  >Neuseeland<\/option><option value=\"Nicaragua\"  class=\"choice-155 depth-1\"  >Nicaragua<\/option><option value=\"Niederlande\"  class=\"choice-156 depth-1\"  >Niederlande<\/option><option value=\"Niger\"  class=\"choice-157 depth-1\"  >Niger<\/option><option value=\"Nigeria\"  class=\"choice-158 depth-1\"  >Nigeria<\/option><option value=\"Niue\"  class=\"choice-159 depth-1\"  >Niue<\/option><option value=\"Nordmazedonien (Republik)\"  class=\"choice-160 depth-1\"  >Nordmazedonien (Republik)<\/option><option value=\"Norfolkinsel\"  class=\"choice-161 depth-1\"  >Norfolkinsel<\/option><option value=\"Norwegen\"  class=\"choice-162 depth-1\"  >Norwegen<\/option><option value=\"N\u00f6rdliche Marianen\"  class=\"choice-163 depth-1\"  >N\u00f6rdliche Marianen<\/option><option value=\"Oman\"  class=\"choice-164 depth-1\"  >Oman<\/option><option value=\"Osttimor\"  class=\"choice-165 depth-1\"  >Osttimor<\/option><option value=\"Pakistan\"  class=\"choice-166 depth-1\"  >Pakistan<\/option><option value=\"Palau\"  class=\"choice-167 depth-1\"  >Palau<\/option><option value=\"Pal\u00e4stina (Staat)\"  class=\"choice-168 depth-1\"  >Pal\u00e4stina (Staat)<\/option><option value=\"Panama\"  class=\"choice-169 depth-1\"  >Panama<\/option><option value=\"Papua-Neuguinea\"  class=\"choice-170 depth-1\"  >Papua-Neuguinea<\/option><option value=\"Paraguay\"  class=\"choice-171 depth-1\"  >Paraguay<\/option><option value=\"Peru\"  class=\"choice-172 depth-1\"  >Peru<\/option><option value=\"Philippinen\"  class=\"choice-173 depth-1\"  >Philippinen<\/option><option value=\"Pitcairninseln\"  class=\"choice-174 depth-1\"  >Pitcairninseln<\/option><option value=\"Polen\"  class=\"choice-175 depth-1\"  >Polen<\/option><option value=\"Portugal\"  class=\"choice-176 depth-1\"  >Portugal<\/option><option value=\"Puerto Rico\"  class=\"choice-177 depth-1\"  >Puerto Rico<\/option><option value=\"Ruanda\"  class=\"choice-178 depth-1\"  >Ruanda<\/option><option value=\"Rum\u00e4nien\"  class=\"choice-179 depth-1\"  >Rum\u00e4nien<\/option><option value=\"Russland\"  class=\"choice-180 depth-1\"  >Russland<\/option><option value=\"R\u00e9union\"  class=\"choice-181 depth-1\"  >R\u00e9union<\/option><option value=\"Saint-Barth\u00e9lemy\"  class=\"choice-182 depth-1\"  >Saint-Barth\u00e9lemy<\/option><option value=\"Saint-Pierre und Miquelon\"  class=\"choice-183 depth-1\"  >Saint-Pierre und Miquelon<\/option><option value=\"Salomonen\"  class=\"choice-184 depth-1\"  >Salomonen<\/option><option value=\"Sambia\"  class=\"choice-185 depth-1\"  >Sambia<\/option><option value=\"Samoa\"  class=\"choice-186 depth-1\"  >Samoa<\/option><option value=\"San Marino\"  class=\"choice-187 depth-1\"  >San Marino<\/option><option value=\"Saudi-Arabien\"  class=\"choice-188 depth-1\"  >Saudi-Arabien<\/option><option value=\"Schweden\"  class=\"choice-189 depth-1\"  >Schweden<\/option><option value=\"Senegal\"  class=\"choice-191 depth-1\"  >Senegal<\/option><option value=\"Serbien\"  class=\"choice-192 depth-1\"  >Serbien<\/option><option value=\"Seychellen\"  class=\"choice-193 depth-1\"  >Seychellen<\/option><option value=\"Sierra Leone\"  class=\"choice-194 depth-1\"  >Sierra Leone<\/option><option value=\"Simbabwe\"  class=\"choice-195 depth-1\"  >Simbabwe<\/option><option value=\"Singapur\"  class=\"choice-196 depth-1\"  >Singapur<\/option><option value=\"Sint Maarten\"  class=\"choice-197 depth-1\"  >Sint Maarten<\/option><option value=\"Slowakei\"  class=\"choice-198 depth-1\"  >Slowakei<\/option><option value=\"Slowenien\"  class=\"choice-199 depth-1\"  >Slowenien<\/option><option value=\"Somalia\"  class=\"choice-200 depth-1\"  >Somalia<\/option><option value=\"Spanien\"  class=\"choice-201 depth-1\"  >Spanien<\/option><option value=\"Spitzbergen\"  class=\"choice-202 depth-1\"  >Spitzbergen<\/option><option value=\"Sri Lanka\"  class=\"choice-203 depth-1\"  >Sri Lanka<\/option><option value=\"St. Helena, Ascension und Tristan da Cunha\"  class=\"choice-204 depth-1\"  >St. Helena, Ascension und Tristan da Cunha<\/option><option value=\"St. Kitts und Nevis\"  class=\"choice-205 depth-1\"  >St. Kitts und Nevis<\/option><option value=\"St. Lucia\"  class=\"choice-206 depth-1\"  >St. Lucia<\/option><option value=\"St. Martin (franz\u00f6sisch)\"  class=\"choice-207 depth-1\"  >St. Martin (franz\u00f6sisch)<\/option><option value=\"St. Vincent und die Grenadinen\"  class=\"choice-208 depth-1\"  >St. Vincent und die Grenadinen<\/option><option value=\"Sudan\"  class=\"choice-209 depth-1\"  >Sudan<\/option><option value=\"Surinam\"  class=\"choice-210 depth-1\"  >Surinam<\/option><option value=\"Syrien (Arabische Republik)\"  class=\"choice-211 depth-1\"  >Syrien (Arabische Republik)<\/option><option value=\"S\u00e3o Tom\u00e9 und Pr\u00edncipe\"  class=\"choice-212 depth-1\"  >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value=\"S\u00fcdafrika\"  class=\"choice-213 depth-1\"  >S\u00fcdafrika<\/option><option value=\"S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln\"  class=\"choice-214 depth-1\"  >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value=\"S\u00fcdsudan\"  class=\"choice-215 depth-1\"  >S\u00fcdsudan<\/option><option value=\"Tadschikistan\"  class=\"choice-216 depth-1\"  >Tadschikistan<\/option><option value=\"Taiwan, Republik China\"  class=\"choice-217 depth-1\"  >Taiwan, Republik China<\/option><option value=\"Tansania (Vereinigte Republik)\"  class=\"choice-218 depth-1\"  >Tansania (Vereinigte Republik)<\/option><option value=\"Thailand\"  class=\"choice-219 depth-1\"  >Thailand<\/option><option value=\"Togo\"  class=\"choice-220 depth-1\"  >Togo<\/option><option value=\"Tokelau\"  class=\"choice-221 depth-1\"  >Tokelau<\/option><option value=\"Tonga\"  class=\"choice-222 depth-1\"  >Tonga<\/option><option value=\"Trinidad und Tobago\"  class=\"choice-223 depth-1\"  >Trinidad und Tobago<\/option><option value=\"Tschad\"  class=\"choice-224 depth-1\"  >Tschad<\/option><option value=\"Tschechische Republik\"  class=\"choice-225 depth-1\"  >Tschechische Republik<\/option><option value=\"Tunesien\"  class=\"choice-226 depth-1\"  >Tunesien<\/option><option value=\"Turkmenistan\"  class=\"choice-227 depth-1\"  >Turkmenistan<\/option><option value=\"Turks- und Caicosinseln\"  class=\"choice-228 depth-1\"  >Turks- und Caicosinseln<\/option><option value=\"Tuvalu\"  class=\"choice-229 depth-1\"  >Tuvalu<\/option><option value=\"T\u00fcrkei\"  class=\"choice-230 depth-1\"  >T\u00fcrkei<\/option><option value=\"USA\"  class=\"choice-231 depth-1\"  >USA<\/option><option value=\"Uganda\"  class=\"choice-232 depth-1\"  >Uganda<\/option><option value=\"Ukraine\"  class=\"choice-233 depth-1\"  >Ukraine<\/option><option value=\"Ungarn\"  class=\"choice-234 depth-1\"  >Ungarn<\/option><option value=\"United States Minor Outlying Islands\"  class=\"choice-235 depth-1\"  >United States Minor Outlying Islands<\/option><option value=\"Uruguay\"  class=\"choice-236 depth-1\"  >Uruguay<\/option><option value=\"Usbekistan\"  class=\"choice-237 depth-1\"  >Usbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-238 depth-1\"  >Vanuatu<\/option><option value=\"Vatikanstadt (Staat)\"  class=\"choice-239 depth-1\"  >Vatikanstadt (Staat)<\/option><option value=\"Venezuela (Bolivarische Republik)\"  class=\"choice-240 depth-1\"  >Venezuela (Bolivarische Republik)<\/option><option value=\"Vereinigte Arabische Emirate\"  class=\"choice-241 depth-1\"  >Vereinigte Arabische Emirate<\/option><option value=\"Vereinigtes K\u00f6nigreich von Gro\u00dfbritannien und Nordirland\"  class=\"choice-242 depth-1\"  >Vereinigtes K\u00f6nigreich von Gro\u00dfbritannien und Nordirland<\/option><option value=\"Vietnam\"  class=\"choice-243 depth-1\"  >Vietnam<\/option><option value=\"Wallis und Futuna\"  class=\"choice-244 depth-1\"  >Wallis und Futuna<\/option><option value=\"Weihnachtsinsel\"  class=\"choice-245 depth-1\"  >Weihnachtsinsel<\/option><option value=\"Wei\u00dfrussland\"  class=\"choice-246 depth-1\"  >Wei\u00dfrussland<\/option><option value=\"Westsahara\"  class=\"choice-247 depth-1\"  >Westsahara<\/option><option value=\"Zentralafrikanische Republik\"  class=\"choice-248 depth-1\"  >Zentralafrikanische Republik<\/option><option value=\"Zypern\"  class=\"choice-249 depth-1\"  >Zypern<\/option><option value=\"\u00c4gypten\"  class=\"choice-250 depth-1\"  >\u00c4gypten<\/option><option value=\"\u00c4quatorialguinea\"  class=\"choice-251 depth-1\"  >\u00c4quatorialguinea<\/option><option value=\"\u00c4thopien\"  class=\"choice-252 depth-1\"  >\u00c4thopien<\/option><option value=\"\u00c5landinseln\"  class=\"choice-253 depth-1\"  >\u00c5landinseln<\/option><option value=\"\u00d6sterreich\"  class=\"choice-254 depth-1\"  >\u00d6sterreich<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_38-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_38\">Aufenthaltsbewilligung des Partners <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" required=\"required\"><option value=\"Keine\"  selected='selected' class=\"choice-1 depth-1\"  >Keine<\/option><option value=\"Ausweis C (Niederlassungsbewilligung)\"  class=\"choice-2 depth-1\"  >Ausweis C (Niederlassungsbewilligung)<\/option><option value=\"Ausweis B (Aufenthaltsbewilligung)\"  class=\"choice-3 depth-1\"  >Ausweis B (Aufenthaltsbewilligung)<\/option><option value=\"Ausweis Ci (Aufenthaltsbewilligung mit Erwerbst\u00e4tigkeit f\u00fcr Drittstaatsangeh\u00f6rige)\"  class=\"choice-4 depth-1\"  >Ausweis Ci (Aufenthaltsbewilligung mit Erwerbst\u00e4tigkeit f\u00fcr Drittstaatsangeh\u00f6rige)<\/option><option value=\"Ausweis G (Grenzg\u00e4ngerbewilligung)\"  class=\"choice-5 depth-1\"  >Ausweis G (Grenzg\u00e4ngerbewilligung)<\/option><option value=\"Ausweis L (Kurzaufenthaltsbewilligung)\"  class=\"choice-6 depth-1\"  >Ausweis L (Kurzaufenthaltsbewilligung)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_39-container\" class=\"wpforms-field wpforms-field-repeater wpforms-conditional-field wpforms-conditional-show wpforms-field-repeater-display-rows\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"39\" style=\"display:none;\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tKinder des VN\n\t\t\t<\/h3><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][39][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-39-55358\"><div id=\"wpforms-55358-repeater-field_39-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<div class=\"wpforms-field-layout-rows wpforms-field-medium wpforms-field-repeater-display-rows wpforms-field-repeater-preset-50-50\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_41_{CLONE}-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"41_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_41_{CLONE}\">Name des Kindes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55358-field_41_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][41_{CLONE}]\" aria-errormessage=\"wpforms-55358-field_41_{CLONE}-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_42_{CLONE}-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"42_{CLONE}\"><fieldset><legend class=\"wpforms-field-label\">Geburtsdatum des Kindes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][42_{CLONE}][date][d]\" id=\"wpforms-55358-field_42_{CLONE}-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Giorno\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][42_{CLONE}][date][m]\" id=\"wpforms-55358-field_42_{CLONE}-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mese\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][42_{CLONE}][date][y]\" id=\"wpforms-55358-field_42_{CLONE}-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Anno\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Hinzuf\u00fcgen\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Entfernen\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-medium wpforms-field-repeater-display-rows wpforms-field-repeater-preset-50-50\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_41\">Name des Kindes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55358-field_41\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-55358-field_41-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_42-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">Geburtsdatum des Kindes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][42][date][d]\" id=\"wpforms-55358-field_42-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Giorno\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][42][date][m]\" id=\"wpforms-55358-field_42-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mese\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][42][date][y]\" id=\"wpforms-55358-field_42-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Anno\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Hinzuf\u00fcgen\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Entfernen\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_44-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"44\" style=\"display:none;\"><div id=\"wpforms-55358-field_44-description\" class=\"wpforms-field-description\"><p style=\"font-size:20pt;margin-bottom:5pt;font-family:Calibri;margin-top:0pt;color:#1477ba;\"><strong style=\"font-size:18pt;\">Informationen zu gew\u00fcnschten Leistungen und Deckungen<\/strong><\/p><\/div><\/div><div id=\"wpforms-55358-field_50-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"50\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gew\u00fcnschte Grundversicherung  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55358-field_50\" class=\"wpforms-field-required wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_50_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M224 24V80H168c-13.3 0-24 10.7-24 24v48c0 13.3 10.7 24 24 24h56v56c0 13.3 10.7 24 24 24h48c13.3 0 24-10.7 24-24V176h56c13.3 0 24-10.7 24-24V104c0-13.3-10.7-24-24-24H320V24c0-13.3-10.7-24-24-24H248c-13.3 0-24 10.7-24 24zM559.7 392.2c17.8-13.1 21.6-38.1 8.5-55.9s-38.1-21.6-55.9-8.5L392.6 416H272c-8.8 0-16-7.2-16-16s7.2-16 16-16h16 64c17.7 0 32-14.3 32-32s-14.3-32-32-32H288 272 193.7c-29.1 0-57.3 9.9-80 28L68.8 384H32c-17.7 0-32 14.3-32 32v64c0 17.7 14.3 32 32 32H192 352.5c29 0 57.3-9.3 80.7-26.5l126.6-93.3zm-367-8.2l.9 0 0 0c-.3 0-.6 0-.9 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_50_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Freie Arztwahl\" aria-errormessage=\"wpforms-55358-field_50_1-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Freie Arztwahl<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_50_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M184 48H328c4.4 0 8 3.6 8 8V96H176V56c0-4.4 3.6-8 8-8zm-56 8V96H64C28.7 96 0 124.7 0 160V416c0 35.3 28.7 64 64 64H448c35.3 0 64-28.7 64-64V160c0-35.3-28.7-64-64-64H384V56c0-30.9-25.1-56-56-56H184c-30.9 0-56 25.1-56 56zm96 152c0-8.8 7.2-16 16-16h32c8.8 0 16 7.2 16 16v48h48c8.8 0 16 7.2 16 16v32c0 8.8-7.2 16-16 16H288v48c0 8.8-7.2 16-16 16H240c-8.8 0-16-7.2-16-16V320H176c-8.8 0-16-7.2-16-16V272c0-8.8 7.2-16 16-16h48V208z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_50_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Hausarztmodell\" aria-errormessage=\"wpforms-55358-field_50_2-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Hausarztmodell<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_50_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M280 0C408.1 0 512 103.9 512 232c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-101.6-82.4-184-184-184c-13.3 0-24-10.7-24-24s10.7-24 24-24zm8 192a32 32 0 1 1 0 64 32 32 0 1 1 0-64zm-32-72c0-13.3 10.7-24 24-24c75.1 0 136 60.9 136 136c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-48.6-39.4-88-88-88c-13.3 0-24-10.7-24-24zM117.5 1.4c19.4-5.3 39.7 4.6 47.4 23.2l40 96c6.8 16.3 2.1 35.2-11.6 46.3L144 207.3c33.3 70.4 90.3 127.4 160.7 160.7L345 318.7c11.2-13.7 30-18.4 46.3-11.6l96 40c18.6 7.7 28.5 28 23.2 47.4l-24 88C481.8 499.9 466 512 448 512C200.6 512 0 311.4 0 64C0 46 12.1 30.2 29.5 25.4l88-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_50_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Telefonmodell\" aria-errormessage=\"wpforms-55358-field_50_3-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Telefonmodell<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-4 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_50_4\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M543.8 287.6c17 0 32-14 32-32.1c1-9-3-17-11-24L309.5 7c-6-5-14-7-21-7s-15 1-22 8L10 231.5c-7 7-10 15-10 24c0 18 14 32.1 32 32.1h32V448c0 35.3 28.7 64 64 64H448.5c35.5 0 64.2-28.8 64-64.3l-.7-160.2h32zM256 208c0-8.8 7.2-16 16-16h32c8.8 0 16 7.2 16 16v48h48c8.8 0 16 7.2 16 16v32c0 8.8-7.2 16-16 16H320v48c0 8.8-7.2 16-16 16H272c-8.8 0-16-7.2-16-16V320H208c-8.8 0-16-7.2-16-16V272c0-8.8 7.2-16 16-16h48V208z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_50_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"HMO Modell\" aria-errormessage=\"wpforms-55358-field_50_4-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">HMO Modell<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55358-field_53-container\" class=\"wpforms-field wpforms-field-likert_scale wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"likert_scale\" data-field-id=\"53\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gew\u00fcnschte Franchise Grundversicherung <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend>\n\t\t<table class=\"wpforms-field-large modern\">\n\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<th style=\"width:20%;\"><\/th><th style=\"width:13%;\">2&#039;500<\/th><th style=\"width:13%;\">2&#039;000<\/th><th style=\"width:13%;\">1&#039;500<\/th><th style=\"width:13%;\">1&#039;000<\/th><th style=\"width:13%;\">500<\/th><th style=\"width:13%;\">300<\/th>\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t<tbody>\n\t\t\t\t<tr><th>Gew\u00fcnschte Franchise<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">2&#039;500<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"1\" aria-errormessage=\"wpforms-55358-field_53_1_1-error\" required><label for=\"wpforms-55358-field_53_1_1\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 2&#039;500<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">2&#039;000<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"2\" aria-errormessage=\"wpforms-55358-field_53_1_2-error\" required><label for=\"wpforms-55358-field_53_1_2\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 2&#039;000<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">1&#039;500<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"3\" aria-errormessage=\"wpforms-55358-field_53_1_3-error\" required><label for=\"wpforms-55358-field_53_1_3\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 1&#039;500<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">1&#039;000<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"4\" aria-errormessage=\"wpforms-55358-field_53_1_4-error\" required><label for=\"wpforms-55358-field_53_1_4\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 1&#039;000<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">500<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"5\" aria-errormessage=\"wpforms-55358-field_53_1_5-error\" required><label for=\"wpforms-55358-field_53_1_5\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 500<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">300<\/span><input type=\"radio\" id=\"wpforms-55358-field_53_1_6\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][53][1]\" value=\"6\" aria-errormessage=\"wpforms-55358-field_53_1_6-error\" required><label for=\"wpforms-55358-field_53_1_6\"><span class=\"wpforms-screen-reader-element\">Gew\u00fcnschte Franchise 300<\/span><\/label><\/div><\/td><\/tr>\t\t\t<\/tbody>\n\t\t<\/table>\n\t\t<\/fieldset><\/div><div id=\"wpforms-55358-field_68-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"68\"><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-55358-field_67-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"67\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_67\">Einschluss Unfallversicherung <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_67\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][67]\" required=\"required\"><option value=\"Nein\"  class=\"choice-2 depth-1\"  >Nein<\/option><option value=\"Ja\"  class=\"choice-1 depth-1\"  >Ja<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-55358-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"69\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_69\">4.\tAuswahlm\u00f6glichkeit f\u00fcr Station\u00e4ren Aufenthalt im Spital: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55358-field_69\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][69]\" required=\"required\"><option value=\"Allgemein\"  class=\"choice-2 depth-1\"  >Allgemein<\/option><option value=\"Halbprivat\"  class=\"choice-1 depth-1\"  >Halbprivat<\/option><option value=\"Privat\"  class=\"choice-5 depth-1\"  >Privat<\/option><option value=\"Flex\"  class=\"choice-4 depth-1\"  >Flex<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55358-field_51-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"51\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Worauf legt der Kunde besonderen Wert <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55358-field_51\" class=\"wpforms-field-required wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 544 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M113.7 256c0 121.8 83.9 222.8 193.5 241.1-18.7 4.5-38.2 6.9-58.2 6.9C111.4 504 0 393 0 256S111.4 8 248.9 8c20.1 0 39.6 2.4 58.2 6.9C197.5 33.2 113.7 134.2 113.7 256m297.4 100.3c-77.7 55.4-179.6 47.5-240.4-14.6 5.5 14.1 12.7 27.7 21.7 40.5 61.6 88.2 182.4 109.3 269.7 47 87.3-62.3 108.1-184.3 46.5-272.6-9-12.9-19.3-24.3-30.5-34.2 37.4 78.8 10.7 178.5-67 233.9m-218.8-244c-1.4 1-2.7 2.1-4 3.1 64.3-17.8 135.9 4 178.9 60.5 35.7 47 42.9 106.6 24.4 158 56.7-56.2 67.6-142.1 22.3-201.8-50-65.5-149.1-74.4-221.6-19.8M296 224c-4.4 0-8-3.6-8-8v-40c0-4.4-3.6-8-8-8h-48c-4.4 0-8 3.6-8 8v40c0 4.4-3.6 8-8 8h-40c-4.4 0-8 3.6-8 8v48c0 4.4 3.6 8 8 8h40c4.4 0 8 3.6 8 8v40c0 4.4 3.6 8 8 8h48c4.4 0 8-3.6 8-8v-40c0-4.4 3.6-8 8-8h40c4.4 0 8-3.6 8-8v-48c0-4.4-3.6-8-8-8h-40z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Alternativ- Komplement\u00e4rmedizin\" aria-errormessage=\"wpforms-55358-field_51_1-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Alternativ- Komplement\u00e4rmedizin<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 448 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M186.1 52.1C169.3 39.1 148.7 32 127.5 32C74.7 32 32 74.7 32 127.5v6.2c0 15.8 3.7 31.3 10.7 45.5l23.5 47.1c4.5 8.9 7.6 18.4 9.4 28.2l36.7 205.8c2 11.2 11.6 19.4 22.9 19.8s21.4-7.4 24-18.4l28.9-121.3C192.2 323.7 207 312 224 312s31.8 11.7 35.8 28.3l28.9 121.3c2.6 11.1 12.7 18.8 24 18.4s20.9-8.6 22.9-19.8l36.7-205.8c1.8-9.8 4.9-19.3 9.4-28.2l23.5-47.1c7.1-14.1 10.7-29.7 10.7-45.5v-2.1c0-55-44.6-99.6-99.6-99.6c-24.1 0-47.4 8.8-65.6 24.6l-3.2 2.8 19.5 15.2c7 5.4 8.2 15.5 2.8 22.5s-15.5 8.2-22.5 2.8l-24.4-19-37-28.8z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Zahnfehlstellung\/Kieferorthop\u00e4die\" aria-errormessage=\"wpforms-55358-field_51_2-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Zahnfehlstellung\/Kieferorthop\u00e4die<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M482.3 192c34.2 0 93.7 29 93.7 64c0 36-59.5 64-93.7 64l-116.6 0L265.2 495.9c-5.7 10-16.3 16.1-27.8 16.1l-56.2 0c-10.6 0-18.3-10.2-15.4-20.4l49-171.6L112 320 68.8 377.6c-3 4-7.8 6.4-12.8 6.4l-42 0c-7.8 0-14-6.3-14-14c0-1.3 .2-2.6 .5-3.9L32 256 .5 145.9c-.4-1.3-.5-2.6-.5-3.9c0-7.8 6.3-14 14-14l42 0c5 0 9.8 2.4 12.8 6.4L112 192l102.9 0-49-171.6C162.9 10.2 170.6 0 181.2 0l56.2 0c11.5 0 22.1 6.2 27.8 16.1L365.7 192l116.6 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"geplante Auslandbehandlungen\" aria-errormessage=\"wpforms-55358-field_51_3-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">geplante Auslandbehandlungen<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-4 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_4\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M0 48C0 21.5 21.5 0 48 0H368c26.5 0 48 21.5 48 48V96h50.7c17 0 33.3 6.7 45.3 18.7L589.3 192c12 12 18.7 28.3 18.7 45.3V256v32 64c17.7 0 32 14.3 32 32s-14.3 32-32 32H576c0 53-43 96-96 96s-96-43-96-96H256c0 53-43 96-96 96s-96-43-96-96H48c-26.5 0-48-21.5-48-48V48zM416 256H544V237.3L466.7 160H416v96zM160 464a48 48 0 1 0 0-96 48 48 0 1 0 0 96zm368-48a48 48 0 1 0 -96 0 48 48 0 1 0 96 0zM176 80v48l-48 0c-8.8 0-16 7.2-16 16v32c0 8.8 7.2 16 16 16h48v48c0 8.8 7.2 16 16 16h32c8.8 0 16-7.2 16-16V192h48c8.8 0 16-7.2 16-16V144c0-8.8-7.2-16-16-16H240V80c0-8.8-7.2-16-16-16H192c-8.8 0-16 7.2-16 16z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Transportkosten\" aria-errormessage=\"wpforms-55358-field_51_4-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Transportkosten<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-5 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_5\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M118.6 80c-11.5 0-21.4 7.9-24 19.1L57 260.3c20.5-6.2 48.3-12.3 78.7-12.3c32.3 0 61.8 6.9 82.8 13.5c10.6 3.3 19.3 6.7 25.4 9.2c3.1 1.3 5.5 2.4 7.3 3.2c.9 .4 1.6 .7 2.1 1l.6 .3 .2 .1 .1 0 0 0 0 0s0 0-6.3 12.7h0l6.3-12.7c5.8 2.9 10.4 7.3 13.5 12.7h40.6c3.1-5.3 7.7-9.8 13.5-12.7l6.3 12.7h0c-6.3-12.7-6.3-12.7-6.3-12.7l0 0 0 0 .1 0 .2-.1 .6-.3c.5-.2 1.2-.6 2.1-1c1.8-.8 4.2-1.9 7.3-3.2c6.1-2.6 14.8-5.9 25.4-9.2c21-6.6 50.4-13.5 82.8-13.5c30.4 0 58.2 6.1 78.7 12.3L481.4 99.1c-2.6-11.2-12.6-19.1-24-19.1c-3.1 0-6.2 .6-9.2 1.8L416.9 94.3c-12.3 4.9-26.3-1.1-31.2-13.4s1.1-26.3 13.4-31.2l31.3-12.5c8.6-3.4 17.7-5.2 27-5.2c33.8 0 63.1 23.3 70.8 56.2l43.9 188c1.7 7.3 2.9 14.7 3.5 22.1c.3 1.9 .5 3.8 .5 5.7v6.7V352v16c0 61.9-50.1 112-112 112H419.7c-59.4 0-108.5-46.4-111.8-105.8L306.6 352H269.4l-1.2 22.2C264.9 433.6 215.8 480 156.3 480H112C50.1 480 0 429.9 0 368V352 310.7 304c0-1.9 .2-3.8 .5-5.7c.6-7.4 1.8-14.8 3.5-22.1l43.9-188C55.5 55.3 84.8 32 118.6 32c9.2 0 18.4 1.8 27 5.2l31.3 12.5c12.3 4.9 18.3 18.9 13.4 31.2s-18.9 18.3-31.2 13.4L127.8 81.8c-2.9-1.2-6-1.8-9.2-1.8zM64 325.4V368c0 26.5 21.5 48 48 48h44.3c25.5 0 46.5-19.9 47.9-45.3l2.5-45.6c-2.3-.8-4.9-1.7-7.5-2.5c-17.2-5.4-39.9-10.5-63.6-10.5c-23.7 0-46.2 5.1-63.2 10.5c-3.1 1-5.9 1.9-8.5 2.9zM512 368V325.4c-2.6-.9-5.5-1.9-8.5-2.9c-17-5.4-39.5-10.5-63.2-10.5c-23.7 0-46.4 5.1-63.6 10.5c-2.7 .8-5.2 1.7-7.5 2.5l2.5 45.6c1.4 25.4 22.5 45.3 47.9 45.3H464c26.5 0 48-21.5 48-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Brillen und Kontaktlinsen\" aria-errormessage=\"wpforms-55358-field_51_5-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Brillen und Kontaktlinsen<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-6 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_51_6\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M312 32c-13.3 0-24 10.7-24 24s10.7 24 24 24h25.7l34.6 64H222.9l-27.4-38C191 99.7 183.7 96 176 96H120c-13.3 0-24 10.7-24 24s10.7 24 24 24h43.7l22.1 30.7-26.6 53.1c-10-2.5-20.5-3.8-31.2-3.8C57.3 224 0 281.3 0 352s57.3 128 128 128c65.3 0 119.1-48.9 127-112h49c8.5 0 16.3-4.5 20.7-11.8l84.8-143.5 21.7 40.1C402.4 276.3 384 312 384 352c0 70.7 57.3 128 128 128s128-57.3 128-128s-57.3-128-128-128c-13.5 0-26.5 2.1-38.7 6L375.4 48.8C369.8 38.4 359 32 347.2 32H312zM458.6 303.7l32.3 59.7c6.3 11.7 20.9 16 32.5 9.7s16-20.9 9.7-32.5l-32.3-59.7c3.6-.6 7.4-.9 11.2-.9c39.8 0 72 32.2 72 72s-32.2 72-72 72s-72-32.2-72-72c0-18.6 7-35.5 18.6-48.3zM133.2 368h65c-7.3 32.1-36 56-70.2 56c-39.8 0-72-32.2-72-72s32.2-72 72-72c1.7 0 3.4 .1 5.1 .2l-24.2 48.5c-9 18.1 4.1 39.4 24.3 39.4zm33.7-48l50.7-101.3 72.9 101.2-.1 .1H166.8zm90.6-128H365.9L317 274.8 257.4 192z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-55358-field_51_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Fitnessbeitr\u00e4ge\" aria-errormessage=\"wpforms-55358-field_51_6-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Fitnessbeitr\u00e4ge<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55358-field_66-container\" class=\"wpforms-field wpforms-field-likert_scale wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"likert_scale\" data-field-id=\"66\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gew\u00fcnschte Versicherungssumme <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend>\n\t\t<table class=\"wpforms-field-large modern\">\n\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<th style=\"width:20%;\"><\/th><th style=\"width:20%;\">Light \u2013 Ohne Zahnarzt Attest<\/th><th style=\"width:20%;\">1000<\/th><th style=\"width:20%;\">2000<\/th><th style=\"width:20%;\">3000<\/th>\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t<tbody>\n\t\t\t\t<tr><th>Versicherungsumme<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Light \u2013 Ohne Zahnarzt Attest<\/span><input type=\"radio\" id=\"wpforms-55358-field_66_1_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"1\" aria-errormessage=\"wpforms-55358-field_66_1_1-error\" required><label for=\"wpforms-55358-field_66_1_1\"><span class=\"wpforms-screen-reader-element\">Versicherungsumme Light \u2013 Ohne Zahnarzt Attest<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">1000<\/span><input type=\"radio\" id=\"wpforms-55358-field_66_1_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"2\" aria-errormessage=\"wpforms-55358-field_66_1_2-error\" required><label for=\"wpforms-55358-field_66_1_2\"><span class=\"wpforms-screen-reader-element\">Versicherungsumme 1000<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">2000<\/span><input type=\"radio\" id=\"wpforms-55358-field_66_1_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"3\" aria-errormessage=\"wpforms-55358-field_66_1_3-error\" required><label for=\"wpforms-55358-field_66_1_3\"><span class=\"wpforms-screen-reader-element\">Versicherungsumme 2000<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">3000<\/span><input type=\"radio\" id=\"wpforms-55358-field_66_1_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"4\" aria-errormessage=\"wpforms-55358-field_66_1_4-error\" required><label for=\"wpforms-55358-field_66_1_4\"><span class=\"wpforms-screen-reader-element\">Versicherungsumme 3000<\/span><\/label><\/div><\/td><\/tr>\t\t\t<\/tbody>\n\t\t<\/table>\n\t\t<\/fieldset><\/div><div id=\"wpforms-55358-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_45\">Wer ist der heutige Krankenkassen Versicherer?<\/label><input type=\"text\" id=\"wpforms-55358-field_45\" class=\"wpforms-field-large\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-55358-field_45-error\" ><\/div><div id=\"wpforms-55358-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_15\">Erg\u00e4nzungen und Bemerkungen<\/label><textarea id=\"wpforms-55358-field_15\" class=\"wpforms-field-large\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-55358-field_15-error\" ><\/textarea><\/div><div id=\"wpforms-55358-field_48-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-55358-field_48\">Laden Sie hier Daten wie z.B. bisherige Krankenkassen Vertr\u00e4ge<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"48\"\n\t\tdata-form-id=\"55358\"\n\t\tdata-input-name=\"wpforms_55358_48\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,json\"\n\t\tdata-max-size=\"314572800\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"314572800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">Puoi caricare fino a 5 file.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-55358-field_48\"\n\t\tname=\"wpforms_55358_48\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-55358-field_63-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"63\"><div id=\"wpforms-55358-field_63-description\" class=\"wpforms-field-description\"><p style=\"font-size:20pt;margin-bottom:5pt;font-family:Calibri;margin-top:0pt;color:#1477ba;\"><strong style=\"font-size:18pt;\">Nutzungsbedingungen<\/strong><\/p><\/div><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-55358-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Nutzungsbedingungen <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55358-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_14_1\" name=\"wpforms[fields][14][]\" value=\"Ich akzeptiere die Nutzungsbedingungen\" aria-errormessage=\"wpforms-55358-field_14_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_14_1\">Ich akzeptiere die Nutzungsbedingungen<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-55358-field_64-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"64\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Einwilligung zur Beratung durch ABES Group AG <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55358-field_64\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55358-field_64_1\" name=\"wpforms[fields][64][]\" value=\"Ich best\u00e4tige sicher zu stellen, dass der Spezialist der ABES Group AG mit dem Kunden das Beratungsgespr\u00e4ch f\u00fchren wird.\" aria-errormessage=\"wpforms-55358-field_64_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55358-field_64_1\">Ich best\u00e4tige sicher zu stellen, dass der Spezialist der ABES Group AG mit dem Kunden das Beratungsgespr\u00e4ch f\u00fchren wird.<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-55358-field_65-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"65\"><div id=\"wpforms-55358-field_65\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-55358-field_65-error\"><p>Die Nutzung dieses Formulars dient der Offertanforderung von Krankenkassen Offerten bei der ABES Group AG. Es wird nur nach elektronischer Registrierung und Erfassung eines User-Benutzerkontos f\u00fcr den Offert-Gesuchsteller zur Verf\u00fcgung gestellt. Die Registrierung als User dient ausschliesslich zum Zwecke der Nachvollziehbarkeit und aus Gr\u00fcnden des Datenschutzes. Ein User erh\u00e4lt keine weiteren Nachrichten der ABES Group AG. Der Versand des Formulars erfordert den Namen und eine g\u00fcltige E-Mail-Adresse eines registrierten Offert-Gesuchstellers.<br \/>\nABES Group AG stellt gest\u00fctzt auf das vorliegen des vollst\u00e4ndig ausgef\u00fcllten Offertformulars situativ die allf\u00e4llig gew\u00fcnschten Offerten und m\u00f6glicherweise auch Flyer oder Factsheets sowie eigene Erl\u00e4uterungen und Erkl\u00e4rungen zum Zwecke der Vervollst\u00e4ndigung und Illustration zu. Diese Inhalte entsprechen dem Marketingmaterial und dienen ausschliesslich zu Informationszwecken. Massgebend sind einzig die jeweiligen Offerten und Angebote zu Krankenkassenprodukten der genannten Anbieter. Unsere eigenen Dienstleistungen stellen weder ein Angebot noch eine Aufforderung zu einer bestimmten Handelsstrategie dar.<br \/>\nDer Offert-Gesuchsteller best\u00e4tigt, dass er ein registrierter Partner der ABES Group AG ist und das Offertformular wahrheitsgem\u00e4ss ausgef\u00fcllt hat.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-55358-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-55358-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-55358-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"55358\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/abes.ch\/it\/wp-json\/wp\/v2\/pages\/55418\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-55358\" class=\"wpforms-submit\" data-alt-text=\"Wird gesendet\u00a0\u2026\" data-submit-text=\"Absenden\" aria-live=\"assertive\" value=\"wpforms-submit\">Absenden<\/button><img decoding=\"async\" src=\"https:\/\/abes.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Caricamento\"><\/div><input type=\"hidden\" id=\"ct_checkjs_wpforms_428fca9bc1921c25c5121f9da7815cde\" name=\"ct_checkjs_wpforms\" value=\"0\" \/><script>setTimeout(function(){var ct_input_name = \"ct_checkjs_wpforms_428fca9bc1921c25c5121f9da7815cde\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '372296269');}}, 1000);<\/script><input\n                    class=\"apbct_special_field apbct_email_id__wp_wpforms\"\n                    name=\"apbct__email_id__wp_wpforms\"\n                    aria-label=\"apbct__label_id__wp_wpforms\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Krankenkassen Offerte Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.Informationen zum Offert-GesuchstellerAufsichtsrechtliche Rolle des Offert-Gesuchstellers *Bitte w\u00e4hlen Sie Ihre aufsichtsrechtliche Rolle als Gesuchsteller der OfferteIch\/Wir sind in der Rolle als reiner Adressvermittler resp. Zuf\u00fchrer t\u00e4tig und es besteht kein FINMA Register EintragIch\/Wir sind in [&hellip;]<\/p>\n","protected":false},"author":108,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","footnotes":""},"class_list":["post-55418","page","type-page","status-publish","hentry"],"coauthors":[],"author_meta":{"author_link":"https:\/\/abes.ch\/it\/author\/supervisor\/","display_name":"Supervisor"},"relative_dates":{"created":"Pubblicato 2 anni fa","modified":"Aggiornato 2 anni fa"},"absolute_dates":{"created":"Pubblicato il 26. Agosto 2024","modified":"Aggiornato il 31. Agosto 2024"},"absolute_dates_time":{"created":"Pubblicato il 26. Agosto 2024 21:55","modified":"Aggiornato il 31. 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