[hidden lang default:get]
[hidden temp_password-hidden]
[hidden delta-hidden]
[hidden max_diff-hidden "90"]
[hidden num_contrat]
[hidden apporteur default:get]
[hidden date_souscription]
<div class="declenche-devis ml-4 mr-4">
<div class="row">
<div class="col-12 error"></div>
<div class="col-12 ml-2 mr-4">
<h2>WorldWide Travel Insurance</h2>
<div class="row">
<div class="col">
    <fieldset>
     <label class="text-uppercase" for="duration_date">Travel Period</label>
     <div class="input-group daterange"><label id="daterange-start-label">Departure Date</label>[text date-depart id:duration_date class:form-control class:daterange-start readonly default:get]<label id="daterange-end-label">Return Date</label>[text date-fin class:form-control class:daterange-end readonly default:get]<span class="input-group-append" role="right-icon"><button class="btn-transparent" type="button"><i class="fa fa-calendar"></i></button></span>
                        </div>
                    </fieldset>
                </div>
            </div>
[diffdate resultatDuree date1:date-depart date2:date-fin get:d]

    <div class="row"><div class="col pl-2"><small class="date-difference" style="opacity: 0.73;"></small></div></div>

    [hidden provenance_pays-zone ""]
    <div class="row">
    <div class="col-6">
         <fieldset><label class="text-uppercase">Provenance</label><div class="input-group mt-1">[select_pays* provenance_pays class:combobox class:w-100 class:swisscare-style no-display:schengen default:get]</div></fieldset>
      
</div>
    <div class="col-6">
         <fieldset><label>DESTINATION</label><div class="input-group mt-1">[select_pays* destination_pays class:combobox class:w-100 class:swisscare-style no-display:blacklist default:get]</div></fieldset></div>
</div>

 
    [hidden number-pers defaut:get]
    [hidden devis-st]
<div class="col-12 mt-3">
<div class="pl-2 pr-2" style="background-color: darkorange">
    <p class="mustache text-white">Estimated cost of your Travel Insurance : <span class="devis-st">€ [devis-st]</span> VAT Inc.</p></div>

<h2>List of Insured</h2>


    <div class="btn-plus ml-1"><i class="fa fa-plus-circle" style="font-size: 35px;color: rgba(33,37,41,0.51);"> </i><i class="fa fa-trash-o" style="font-size: 25px;color: rgb(247,1,1);"> </i><small class="text-muted">  Add/Remove insured</small></div>
</div>
   

<div class="row mt-1 mr-5" id="assure">
    <div class="col-12">
        
        <div class="row mt-2" v-for="(person, index) in people" :data-loop-index="index">
[hidden personne--num_client]
            <div class="col-xl-12 pl-2">
             <h3 class="title">Insured n° {{index+1}} - <strong class="mustache devis-pp">- Price: € [[personne--devis-pp]] </strong></h3>
             </div>
            <div class="row">
                <div class="col-12 col-sm-4 pl-2 pr-2">
                    <fieldset><label>NAME</label>[text* personne--nom id:personne--nom]</fieldset>
                </div>
                <div class="col-12 col-sm-4 pl-2 pr-2">
                    <fieldset><label>LAST NAME</label>[text* personne--prenom id:personne--prenom]</fieldset>
                </div>
                <div class="col-12 col-sm-4 pl-2 pr-2">
       <fieldset><label class="text-uppercase">BIRTHDATE</label>[date personne--date-naiss id:personne--date-naiss class:w-100]</fieldset>[diffdate personne--age id:personne--age date1:personne--date-naiss date2:now get:y]
                </div>
                <div class="close-col" >
             <div class="delete" v-on:click="deletePerson(index)"><i class="fa fa-trash-o" style="font-size: 25px;color: rgb(247,1,1);"></i></div>
                </div>

            </div>
    </div>
<div class="col-12 mt-3">
            <div class="btn-plus" v-on:click="add()">
                <i class="fa fa-plus-circle" style="font-size: 35px;color: rgba(33,37,41,0.51);"></i>
            </div>
       </div>    
</div>

<div class="col col-12 d-flex justify-content-end">
<input type="button" id="prevBtn" style="margin-rigth: 15px;" class="wpcf7-form-control wpcf7-submit button prevBtn btn-radius button-secondary" value="Back"/>[submit id:nextBtn class:nextBtn class:btn-radius "Next"]
</div>


    <div class="col-12">
        <div class="row mt-4">
                <div class="col-12 mt-2">
                <label class="checkbox-group">[acceptance terms]<small>The information collected on this page is subject to a treatment designed to receive information about our services, and to follow up and training of your application. Your personal information is exclusively intended for the persons authorized to process these requests. By clicking on "Next", I acknowledge having read the <strong> <a href="http://193.70.73.91/wp-content/uploads/2020/01/PGPD-AGIS-2020.pdf" target="_blank"> AGIS data protection policy</a></strong> having appointed a Data Protection Officer to the CNIL, by proving your identity, you can exercise your rights of access, rectification or deletion of information about you. You can also, for legitimate reasons, oppose the processing of your data. Please send us an email to dpo@agis-group.com.</small>[/acceptance]</label>
            </div>
        </div>
    </div>

</div>
</div>
</div>
</div>