<div class="assurance-info">
<h2>Souscription sur l'assurance</h2>
<div class="cote-cote">
<label>Date de départ:[date date-depart id:date-depart placeholder "Date de départ"]
</label>
<label>Date d'arrivé:[date date-fin id:date-fin placeholder "Date de départ"]
</label>
[hidden resultatDuree "date-depart,date-fin"]
</div>
<div class="cote-cote">
<label>Départ:[select* select-depart id:select-depart "Afrique du sud" "Madagascar" "France" "USA" "Ingland" "Russie" "Suisse" "Maroc"]
</label>
<label>Destination:[select* select-destination id:select-destination "Afrique du sud" "Madagascar" "France" "USA" "Ingland" "Russie" "Suisse" "Maroc"]
</label>
</div>
<fieldset data-loop="[number-pers]">
<label>Date de naissance du personne
[date date-naiss id:date-naiss placeholder "Date de naissance"]
</label>[hidden age "date-naiss"]
</fieldset>
</div>
<div style="overflow:auto; float:right">
<input type="button" id="prevBtn" style="margin-rigth: 15px;" class="button prevBtn button-secondary" value="Previous"/>[submit id:nextBtn class:button  class:nextBtn class:button-primary "Next"]</div>
