{"id":55107,"date":"2026-04-27T11:28:46","date_gmt":"2026-04-27T11:28:46","guid":{"rendered":"https:\/\/afgbankgabon.com\/?page_id=55107"},"modified":"2026-04-28T08:35:51","modified_gmt":"2026-04-28T08:35:51","slug":"souscription-bancassurance","status":"publish","type":"page","link":"https:\/\/afgbankgabon.com\/en\/souscription-bancassurance\/","title":{"rendered":"(Fran\u00e7ais) Souscription Bancassurance"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"55107\" class=\"elementor elementor-55107\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-902b652 elementor-section-height-min-height elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"902b652\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;gradient&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-wide\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-a515520\" data-id=\"a515520\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a555ae9 elementor-widget-mobile__width-initial elementor-widget elementor-widget-image\" data-id=\"a555ae9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1000\" height=\"429\" src=\"https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-1000x429.png\" class=\"attachment-large size-large wp-image-37894\" alt=\"\" srcset=\"https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-1000x429.png 1000w, https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-700x300.png 700w, https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-768x330.png 768w, https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-1536x659.png 1536w, https:\/\/afgbankgabon.com\/wp-content\/uploads\/2024\/10\/Logo-AFG-BANK-BLANC-2048x879.png 2048w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-c6a7318\" data-id=\"c6a7318\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3b4f525 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"3b4f525\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Formulaire de souscription BANCASSURANCE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-eae61f5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"eae61f5\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-300efcb\" 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percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_17'>ID de souscription<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations du client<\/h3><\/div><div id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_46'>Num\u00e9ro de compte<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_43'>Nom (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='large' maxlength='50'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_44'>Pr\u00e9noms (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='large' maxlength='80'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_47\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-seven-twelfths field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Date de naissance<\/legend><div id='input_2_47' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_2_47_2_container'><label for='input_2_47_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_47[]' id='input_2_47_2'   aria-required='false'  ><option value=''>Jour<\/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><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_2_47_1_container'><label for='input_2_47_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_47[]' id='input_2_47_1'   aria-required='false'  ><option value=''>Mois<\/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><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_2_47_3_container'><label for='input_2_47_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_47[]' id='input_2_47_3'   aria-required='false'  ><option value=''>Ann\u00e9e<\/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><\/div><\/fieldset><div id=\"field_2_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-five-twelfths field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_2'>E-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_2_2' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible pcafe_sp_field\"  data-field-class=\"pcafe_sp_field\" ><label class='gfield_label gform-field-label' for='input_2_4'>T\u00e9l\u00e9phone (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><span class='spf-phone error-msg hide'><\/span><span class='spf-phone valid-msg hide'><\/span><input name='input_4' id='input_2_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_7'>Adresse (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_2_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_49' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-49' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Produit d\u2019assurance<\/h3><\/div><div id=\"field_2_53\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_53'>Nombre de produit<\/label><div class='ginput_container ginput_container_select'><select name='input_53' id='input_2_53' class='large gfield_select'     aria-invalid=\"false\" ><option value='0' >0<\/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><\/select><\/div><\/div><div id=\"field_2_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_9'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_2_9' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_18'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_2_18' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_31'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_72\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_72'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_72' id='input_2_72' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_94\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_94'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_94' id='input_2_94' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_109\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_109'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_2_109' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_70\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_70'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_2_70' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_95\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_95'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_95' id='input_2_95' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_110\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_110'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_2_110' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_71\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_71'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_2_71' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_96\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_96'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_2_96' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_111\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_111'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_111' id='input_2_111' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_69\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_69'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_2_69' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_97\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_97'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_2_97' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_113\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_113'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_2_113' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_68\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_68'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_68' id='input_2_68' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_98\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_98'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_2_98' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_112\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_112'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_112' id='input_2_112' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_67\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_67'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_67' id='input_2_67' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_99\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_99'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_2_99' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_114\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_114'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_2_114' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_66\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_66'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_2_66' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_100\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_100'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_2_100' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_115\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_115'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_2_115' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_65\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_65'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_2_65' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_101\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_101'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_101' id='input_2_101' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_116\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_116'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_116' id='input_2_116' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_64\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_64'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_2_64' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_102\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_102'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_102' id='input_2_102' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_117\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_117'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_2_117' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_63\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_63'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_63' id='input_2_63' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_103\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_103'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_103' id='input_2_103' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_118\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_118'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_2_118' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_62\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_62'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_2_62' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_104\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_104'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_104' id='input_2_104' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_119\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_119'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_2_119' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_61\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_61'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_2_61' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_105\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_105'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_105' id='input_2_105' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_120\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_120'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_120' id='input_2_120' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_60\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_60'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_60' id='input_2_60' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_106\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_106'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_106' id='input_2_106' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_121\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_121'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_2_121' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_59'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_2_59' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_107\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_107'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_107' id='input_2_107' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_122\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_122'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_122' id='input_2_122' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_58\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_58'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_58' id='input_2_58' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_108\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_108'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_108' id='input_2_108' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_123\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_123'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_123' id='input_2_123' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_57\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_57'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_57' id='input_2_57' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_91\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_91'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_91' id='input_2_91' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_124\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_124'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_124' id='input_2_124' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_56\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_56'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_56' id='input_2_56' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_89\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_89'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_89' id='input_2_89' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_125\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_125'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_125' id='input_2_125' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_55\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_55'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_2_55' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_88\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_88'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_88' id='input_2_88' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_126\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_126'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_2_126' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_54\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_54'>Le type d&#039;assurance souscrite (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_54' id='input_2_54' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='VIE' >VIE<\/option><option value='NON VIE' >NON VIE<\/option><\/select><\/div><\/div><div id=\"field_2_74\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_74'>Le produit d&#039;assurance (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_2_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ASSURANCE EMPRUNTEURS' >ASSURANCE EMPRUNTEURS<\/option><option value='ASSURANCE \u00c9PARGNE +' >ASSURANCE \u00c9PARGNE +<\/option><option value='ASSURANCE SUR BIENS LEASING' >ASSURANCE SUR BIENS LEASING<\/option><option value='ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP' >ASSURANCE MOYEN DE PAIEMENT SUR CARTES VIP<\/option><option value='ASSURANCE INCENDIE' >ASSURANCE INCENDIE<\/option><option value='ASSURANCE MOYEN DE PAIEMENT PACKAGES' >ASSURANCE MOYEN DE PAIEMENT PACKAGES<\/option><option value='ASSURANCE COMPTE PARRAIN\u00c9' >ASSURANCE COMPTE PARRAIN\u00c9<\/option><\/select><\/div><\/div><div id=\"field_2_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_93'>Montant de la prime (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_2_93' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_50' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_2_50' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations bancaires<\/h3><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>Zone d&#039;agence (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_2_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='ZONE-DEVENIR' >ZONE-DEVENIR<\/option><option value='ZONE-OLOUMI' >ZONE-OLOUMI<\/option><option value='ZONE-PRIMA' >ZONE-PRIMA<\/option><\/select><\/div><\/div><div id=\"field_2_33\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_33'>Agence (*)<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_2_33' class='large gfield_select'     aria-invalid=\"false\" ><option value='Choisir' >Choisir<\/option><option value='A.D.L' >A.D.L<\/option><option value='AGENCE CENTRALE' >AGENCE CENTRALE<\/option><option value='AFG BANK GABON CENTRE AFFAIRES SIEGE' >AFG BANK GABON CENTRE AFFAIRES SIEGE<\/option><option value='AFG BANK GABON DIRECTION GENERALE' >AFG BANK GABON DIRECTION GENERALE<\/option><option value='DEVENIR' >DEVENIR<\/option><option value='LOUIS' >LOUIS<\/option><option value='OKALA' >OKALA<\/option><option value='OYEM' >OYEM<\/option><option value='PRESTIGE' >PRESTIGE<\/option><option value='RR' >RR<\/option><option value='UNIVERSITE' >UNIVERSITE<\/option><option value='AFG BANK GABON PORT-GENTIL DELTA' >AFG BANK GABON PORT-GENTIL DELTA<\/option><option value='DAHU' >DAHU<\/option><option value='FIRST' >FIRST<\/option><option value='GAMBA' >GAMBA<\/option><option value='MOUILA' >MOUILA<\/option><option value='OLOUMI' >OLOUMI<\/option><option value='OWENDO' >OWENDO<\/option><option value='FRANCEVILLE' >FRANCEVILLE<\/option><option value='MOANDA' >MOANDA<\/option><option value='MONT-BOUET' >MONT-BOUET<\/option><option value='NZENG-AYONG' >NZENG-AYONG<\/option><option value='PRIMA' >PRIMA<\/option><\/select><\/div><\/div><div id=\"field_2_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_42'>Nom du vendeur (*)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_2_51' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-51' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Documents<\/h3><\/div><div id=\"field_2_15\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_2_15'>Documents<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_15'>Importez la documentation<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_2_15' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_2_15&quot;,&quot;container&quot;:&quot;gform_multifile_upload_2_15&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_2_15&quot;,&quot;filelist&quot;:&quot;gform_preview_2_15&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/afgbankgabon.com\\\/?gf_page=64d31e9f7057908&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/afgbankgabon.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/afgbankgabon.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf&quot;}],&quot;max_file_size&quot;:&quot;2122317824b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:2,&quot;field_id&quot;:15,&quot;_gform_file_upload_nonce_2_15&quot;:&quot;f106e74ac5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_2_15&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_2_15' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_2_15' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_2_15 gfield_description_2_15\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_15'>Accepted file types: pdf, Max. file size: 2 GB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_2_15'><\/ul> <div id='gform_preview_2_15' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_127' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_127' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Review Form'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page gform_review_page ' data-js='page-field-id-127' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_128\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Envoyer'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' 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