{"id":730,"date":"2023-10-05T09:05:13","date_gmt":"2023-10-05T09:05:13","guid":{"rendered":"https:\/\/alcredit.ch\/credit-application\/"},"modified":"2025-06-18T09:06:13","modified_gmt":"2025-06-18T09:06:13","slug":"credit-application","status":"publish","type":"page","link":"https:\/\/alcredit.ch\/en\/credit-application\/","title":{"rendered":"Credit application"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;About Section&#8221; module_id=&#8221;credit&#8221; _builder_version=&#8221;4.22.0&#8243; background_color=&#8221;#f7f7f7&#8243; min_height=&#8221;50vh&#8221; custom_padding=&#8221;3px||6px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row custom_padding_last_edited=&#8221;on|phone&#8221; admin_label=&#8221;Service Area&#8221; _builder_version=&#8221;4.22.0&#8243; width=&#8221;100%&#8221; max_width=&#8221;2560px&#8221; min_height=&#8221;100%&#8221; height=&#8221;100%&#8221; max_height=&#8221;100%&#8221; custom_margin=&#8221;auto||auto||false|false&#8221; custom_padding=&#8221;100px||198px||false|false&#8221; custom_padding_tablet=&#8221;100px||198px||false|false&#8221; custom_padding_phone=&#8221;25px||0px||false|false&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Title&#8221; _builder_version=&#8221;4.22.0&#8243; text_font=&#8221;||||||||&#8221; header_font=&#8221;||||||||&#8221; header_2_font=&#8221;Montserrat|600||on|||||&#8221; header_2_text_align=&#8221;center&#8221; header_2_font_size=&#8221;30px&#8221; custom_margin=&#8221;||5px|&#8221; animation_style=&#8221;slide&#8221; animation_direction=&#8221;top&#8221; animation_intensity_slide=&#8221;20%&#8221; animation_starting_opacity=&#8221;100%&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; custom_padding_last_edited=&#8221;on|phone&#8221; sticky_enabled=&#8221;0&#8243; custom_padding_phone=&#8221;||||false|false&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; header_font_size_phone=&#8221;15px&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_font_size_phone=&#8221;38px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; header_2_font_size_phone=&#8221;25px&#8221; header_2_font_size_tablet=&#8221;30px&#8221;]<\/p>\n<h2>Simulate your credit<\/h2>\n<p>[\/et_pb_text][et_pb_divider color=&#8221;#f47e29&#8243; divider_weight=&#8221;4px&#8221; _builder_version=&#8221;4.22.0&#8243; max_width=&#8221;100px&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;20px|26px|-2px||false|false&#8221; custom_padding=&#8221;|0px|20px|0px||&#8221; animation_style=&#8221;fade&#8221; hover_enabled=&#8221;0&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][\/et_pb_divider][et_pb_code _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; custom_margin=&#8221;||100px|||&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<!-- GET CONFIG -->\r\n\r\n<div id=\"cs-form\" class=\"pgcs pgcs_all\" data-t1=\"4.9\" data-t2=\"7.7\" data-t3=\"9.95\">\r\n\t\r\n\t<div>\r\n\t\t<div id=\"myPopup\" style=\"display:none;\" class=\"alert alert-success\"><\/div>\r\n\t<\/div>\r\n\t<div id=\"myPopup_error\" style=\"display:none;\" class=\"alert alert-danger\"><\/div>\r\n\t\r\n\r\n\t<form id=\"pg_form_height\" name=\"form_all\" method=\"post\" enctype=\"multipart\/form-data\" action=\"https:\/\/alcredit.ch\/wp-admin\/admin-post.php\" onsubmit=\"return pg_submit_all();\">\r\n\t\t<input type=\"hidden\" name=\"action\" value=\"pgcs_send_form\">\r\n\t\t<input type=\"hidden\" name=\"form_size_big\" value=\"1\">\r\n\t\t<input type=\"hidden\" name=\"app_fb\" value=\"\">\r\n\r\n\t\t<div class=\"pgcs__wrapper\">\r\n            <div id=\"form1\" style=\"max-height:400px;\" class=\"row justify-content-center form1 visited\">\r\n\t\t\t\t<div class=\"col-md-5 pg_csform_col pgcs_col_margin pg_1st_col\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-md-1 pgcs_col_space\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs_montant_duree\">\r\n\t\t\t\t\t\t\t\t\tAmount of credit\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t\t<div class=\" slider-box\">\r\n\t\t\t\t\t\t\t\t\t\t<label class=\"pgcs__big-input\">\r\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"pgcs__montant pgcs_input_value\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_simulator_ammount\" class=\"pgcs__montant-slider\" name=\"montant_real\" type=\"text\" data-slider-value=\"30000\" data-slider-step=\"1000\" data-slider-min=\"3000\" data-slider-max=\"350000\" >\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-md-1\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs_montant_duree\">\r\n\t\t\t\t\t\t\t\t\tDuration \r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t\t<div class=\" slider-box\">\r\n\t\t\t\t\t\t\t\t\t\t<label class=\"pgcs__big-input\">\r\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"pgcs__duree pgcs_input_value\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\t\t<span> Month <\/span>\r\n\t\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_simulator_time\" class=\"pgcs__duree-slider\" name=\"duree_real\" type=\"text\" data-slider-value=\"48\" data-slider-step=\"1\" data-slider-min=\"6\" data-slider-max=\"120\" >\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-md-5 pg_csform_col pgcs_col_margin pg_2nd_col\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\">\r\n\t\t\t\t\t\t\t\t\tYour monthly payment from \r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-1\"><\/span>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-head\">\r\n\t\t\t\t\t\t\t\t\t\tfor a rate of \r\n\t\t\t\t\t\t\t\t\t\tRate of \r\n\t\t\t\t\t\t\t\t\t\t4.9\t\t\t\t\t\t\t\t\t\t% *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-3\"><\/span>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-head\">\r\n\t\t\t\t\t\t\t\t\t\tfor a rate of \r\n\t\t\t\t\t\t\t\t\t\tRate of \r\n\t\t\t\t\t\t\t\t\t\t9.95\t\t\t\t\t\t\t\t\t\t% *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t \r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-conditions\">\r\n\t\t\t\t\t\t\t\t\tThe granting of credit is prohibited if it leads to overindebtedness (art. 3 LCD).\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"pgcs_btn_center pg_media_767\">\r\n\t\t\t\t\t\t<button type=\"button\" id=\"btn_next1\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\tConfirm\t\t\t\t\t\t\t<span class=\"pg_icon_next2\">\r\n\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-right pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-right pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"pgcs_text_taux col-md-12\" style=\"margin-top: 100px !important;\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box pgcs__mens-box-indications\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t\t\t* Rates are indicative only. The effective annual interest rate is between \t\t\t\t\t\t\t\t4.9% \r\n\t\t\t\t\t\t\t\t  and\t\t\t\t\t\t\t\t9.95% \r\n\t\t\t\t\t\t\t\t  and is calculated according to your financial situation. For an amount of   \t\t\t\t\t\t\t\t30000  and an interest rate of 10.95%, the total costs incurred \r\n are CHF 8,270.20 over an 84-month term. Each file is treated individually and \r\n according to the conditions of our partners. \t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div id=\"pg_agt_number_div\" class=\"col-sm-12\"style=\"font-size: 10px;\" ><\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Donn\u00e9es personnelles - Personne -->\r\n            <div id=\"form2\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form\">\r\n\t\t\t\t\t<!-- Step = Donnees personnelles -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tYour personal data\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = VOUS -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<!-- Section = Vous -->\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYou\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\tPlease enter your details as they appear on your official identity document.\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Titre + \u00c9tat civil -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTitle*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify verify input-field pg_check_default\" tabindex=\"1\" name=\"pg_dp_v_titre\" id=\"pg_dp_v_titre\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tTitle *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tMs.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMr.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCivil status*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"2\" name=\"pg_dp_v_ec\" id=\"pg_dp_v_ec\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tCivil status *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tSingle\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMarried\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tDivorced\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tWidower\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Nom + Pr\u00e9nom -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tName *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_v_nom\" class=\"verify input-field\" tabindex=\"3\" name=\"pg_dp_v_nom\" type=\"text\" placeholder=\"Name *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" >\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tSurname *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_v_prenom\" class=\"verify input-field\"  tabindex=\"4\" name=\"pg_dp_v_prenom\" type=\"text\" placeholder=\"Surname *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Date de Naissance -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n  \t\t\t\t\t\t\t\t<input tabindex=\"5\" type=\"date\" class=\"verify_date input-field\" id=\"pg_dp_v_n_date\" name=\"pg_dp_v_n_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_v_n_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tYou must be between 18 and 69 years of age.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Nationalit\u00e9 -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nationalit\u00e9 + Pays -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNationality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select name=\"pg_dp_n_pays\" tabindex=\"8\" class=\"verify input-field pg_check_default\" id=\"pg_dp_n_pays\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Nationality *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CHSuisse\" value=\"CH\" data-text=\"Suisse\">Switzerland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LILiechtenstein\" value=\"LI\" data-text=\"Liechtenstein\">Liechtenstein<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DEAllemagne\" value=\"DE\" data-text=\"Allemagne\">Germany<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ATAutriche\" value=\"AT\" data-text=\"Autriche\">Austria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FRFrance\" value=\"FR\" data-text=\"France\">France<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ITItalie\" value=\"IT\" data-text=\"Italie\">Italy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PTPortugal\" value=\"PT\" data-text=\"Portugal\">Portugal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZAAfrique du Sud\" value=\"ZA\" data-text=\"Afrique du Sud\">South Africa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ALAlbanie\" value=\"AL\" data-text=\"Albanie\">Albania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DZAlg\u00e9rie\" value=\"DZ\" data-text=\"Alg\u00e9rie\">Algeria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ADAndorre\" value=\"AD\" data-text=\"Andorre\">Andorra<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AOAngola\" value=\"AO\" data-text=\"Angola\">Angola<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AIAnguilla\" value=\"AI\" data-text=\"Anguilla\">Anguilla<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AQAntarctique\" value=\"AQ\" data-text=\"Antarctique\">Antarctica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AGAntigua-et-Barbuda\" value=\"AG\" data-text=\"Antigua-et-Barbuda\">Antigua and Barbuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SAArabie saoudite\" value=\"SA\" data-text=\"Arabie saoudite\">Saudi Arabia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ARArgentine\" value=\"AR\" data-text=\"Argentine\">Argentina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AMArm\u00e9nie\" value=\"AM\" data-text=\"Arm\u00e9nie\">Armenia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AWAruba\" value=\"AW\" data-text=\"Aruba\">Aruba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AUAustralie\" value=\"AU\" data-text=\"Australie\">Australia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AZAzerba\u00efdjan\" value=\"AZ\" data-text=\"Azerba\u00efdjan\">Azerbaijan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BSBahamas\" value=\"BS\" data-text=\"Bahamas\">Bahamas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BHBahre\u00efn\" value=\"BH\" data-text=\"Bahre\u00efn\">Bahrain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BDBangladesh\" value=\"BD\" data-text=\"Bangladesh\">Bangladesh<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BBBarbade\" value=\"BB\" data-text=\"Barbade\">Barbados<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BYB\u00e9larus\" value=\"BY\" data-text=\"B\u00e9larus\">Belarus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BEBelgique\" value=\"BE\" data-text=\"Belgique\">Belgium<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BZBelize\" value=\"BZ\" data-text=\"Belize\">Belize<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BJB\u00e9nin\" value=\"BJ\" data-text=\"B\u00e9nin\">Benin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BMBermudes\" value=\"BM\" data-text=\"Bermudes\">Bermuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BTBhoutan\" value=\"BT\" data-text=\"Bhoutan\">Bhutan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BOBolivie\" value=\"BO\" data-text=\"Bolivie\">Bolivia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BQBonaire, Saint Eustatius et Saba\" value=\"BQ\" data-text=\"Bonaire, Saint Eustatius et Saba\">Bonaire, Saint Eustatius and Saba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BABosnie et Herz\u00e9govine\" value=\"BA\" data-text=\"Bosnie et Herz\u00e9govine\">Bosnia and Herzegovina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BWBotswana\" value=\"BW\" data-text=\"Botswana\">Botswana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BRBr\u00e9sil\" value=\"BR\" data-text=\"Br\u00e9sil\">Brazil<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BNBrun\u00e9i Darussalam\" value=\"BN\" data-text=\"Brun\u00e9i Darussalam\">Brunei Darussalam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BGBulgarie\" value=\"BG\" data-text=\"Bulgarie\">Bulgaria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BFBurkina Faso\" value=\"BF\" data-text=\"Burkina Faso\">Burkina Faso<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BIBurundi\" value=\"BI\" data-text=\"Burundi\">Burundi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CVCabo Verde\" value=\"CV\" data-text=\"Cabo Verde\">Cabo Verde<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KHCambodge\" value=\"KH\" data-text=\"Cambodge\">Cambodia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CMCameroun\" value=\"CM\" data-text=\"Cameroun\">Cameroon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CACanada\" value=\"CA\" data-text=\"Canada\">Canada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CLChili\" value=\"CL\" data-text=\"Chili\">Chile<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CNChine\" value=\"CN\" data-text=\"Chine\">China<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CYChypre\" value=\"CY\" data-text=\"Chypre\">Cyprus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VACit\u00e9 du Vatican\" value=\"VA\" data-text=\"Cit\u00e9 du Vatican\">Vatican City<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-COColombie\" value=\"CO\" data-text=\"Colombie\">Colombia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KMComores\" value=\"KM\" data-text=\"Comores\">Comoros<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CGCongo (Brazzaville)\" value=\"CG\" data-text=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CDCongo (Kinshasa)\" value=\"CD\" data-text=\"Congo (Kinshasa)\">Congo (Kinshasa)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KPCor\u00e9e du Nord\" value=\"KP\" data-text=\"Cor\u00e9e du Nord\">North Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KRCor\u00e9e du Sud\" value=\"KR\" data-text=\"Cor\u00e9e du Sud\">South Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CRCosta Rica\" value=\"CR\" data-text=\"Costa Rica\">Costa Rica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CIC\u00f4te d\u2019Ivoire\" value=\"CI\" data-text=\"C\u00f4te d\u2019Ivoire\">Ivory Coast<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HRCroatie\" value=\"HR\" data-text=\"Croatie\">Croatia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CUCuba\" value=\"CU\" data-text=\"Cuba\">Cuba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CWCura\u00e7ao\" value=\"CW\" data-text=\"Cura\u00e7ao\">Cura\u00e7ao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DKDanemark\" value=\"DK\" data-text=\"Danemark\">Denmark<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DJDjibouti\" value=\"DJ\" data-text=\"Djibouti\">Djibouti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DMDominique\" value=\"DM\" data-text=\"Dominique\">Dominique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EG\u00c9gypte\" value=\"EG\" data-text=\"\u00c9gypte\">Egypt<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SVEl Salvador\" value=\"SV\" data-text=\"El Salvador\">El Salvador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AE\u00c9mirats arabes unis\" value=\"AE\" data-text=\"\u00c9mirats arabes unis\">United Arab Emirates<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EC\u00c9quateur\" value=\"EC\" data-text=\"\u00c9quateur\">Ecuador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ER\u00c9rythr\u00e9e\" value=\"ER\" data-text=\"\u00c9rythr\u00e9e\">Eritrea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ESEspagne\" value=\"ES\" data-text=\"Espagne\">Spain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EEEstonie\" value=\"EE\" data-text=\"Estonie\">Estonia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SZEswatini\" value=\"SZ\" data-text=\"Eswatini\">Eswatini<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-US\u00c9tats-Unis\" value=\"US\" data-text=\"\u00c9tats-Unis\">United States<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ET\u00c9thiopie\" value=\"ET\" data-text=\"\u00c9thiopie\">Ethiopia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FJFidji\" value=\"FJ\" data-text=\"Fidji\">Fiji<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FIFinlande\" value=\"FI\" data-text=\"Finlande\">Finland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GAGabon\" value=\"GA\" data-text=\"Gabon\">Gabon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GMGambie\" value=\"GM\" data-text=\"Gambie\">Gambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GEG\u00e9orgie\" value=\"GE\" data-text=\"G\u00e9orgie\">Georgia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GSG\u00e9orgie du Sud et les \u00celes Sandwich du Sud\" value=\"GS\" data-text=\"G\u00e9orgie du Sud et les \u00celes Sandwich du Sud\">South Georgia and the South Sandwich Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GHGhana\" value=\"GH\" data-text=\"Ghana\">Ghana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GIGibraltar\" value=\"GI\" data-text=\"Gibraltar\">Gibraltar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GRGr\u00e8ce\" value=\"GR\" data-text=\"Gr\u00e8ce\">Greece<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GDGrenade\" value=\"GD\" data-text=\"Grenade\">Granada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GLGroenland\" value=\"GL\" data-text=\"Groenland\">Greenland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GPGuadeloupe\" value=\"GP\" data-text=\"Guadeloupe\">Guadeloupe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GUGuam\" value=\"GU\" data-text=\"Guam\">Guam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GTGuatemala\" value=\"GT\" data-text=\"Guatemala\">Guatemala<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GGGuernesey\" value=\"GG\" data-text=\"Guernesey\">Guernsey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GNGuin\u00e9e\" value=\"GN\" data-text=\"Guin\u00e9e\">Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GQGuin\u00e9e \u00e9quatoriale\" value=\"GQ\" data-text=\"Guin\u00e9e \u00e9quatoriale\">Equatorial Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GWGuin\u00e9e-Bissau\" value=\"GW\" data-text=\"Guin\u00e9e-Bissau\">Guinea-Bissau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GYGuyana\" value=\"GY\" data-text=\"Guyana\">Guyana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GFGuyane fran\u00e7aise\" value=\"GF\" data-text=\"Guyane fran\u00e7aise\">French Guiana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HTHa\u00efti\" value=\"HT\" data-text=\"Ha\u00efti\">Haiti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HNHonduras\" value=\"HN\" data-text=\"Honduras\">Honduras<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HKHong Kong\" value=\"HK\" data-text=\"Hong Kong\">Hong Kong<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HUHongrie\" value=\"HU\" data-text=\"Hongrie\">Hungary<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BV\u00cele Bouvet\" value=\"BV\" data-text=\"\u00cele Bouvet\">Bouvet Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NF\u00cele Norfolk\" value=\"NF\" data-text=\"\u00cele Norfolk\">Norfolk Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KY\u00celes Ca\u00efmans\" value=\"KY\" data-text=\"\u00celes Ca\u00efmans\">Cayman Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CC\u00celes Cocos (Keeling)\" value=\"CC\" data-text=\"\u00celes Cocos (Keeling)\">Cocos Islands (Keeling)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CK\u00celes Cook\" value=\"CK\" data-text=\"\u00celes Cook\">Cook Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AX\u00celes d'Aland\" value=\"AX\" data-text=\"\u00celes d'Aland\">Aland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FO\u00celes F\u00e9ro\u00e9\" value=\"FO\" data-text=\"\u00celes F\u00e9ro\u00e9\">Faroe Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HM\u00celes Heard et MacDonald\" value=\"HM\" data-text=\"\u00celes Heard et MacDonald\">Heard and MacDonald Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FK\u00celes Malouines\" value=\"FK\" data-text=\"\u00celes Malouines\">Falkland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MP\u00celes Mariannes du Nord\" value=\"MP\" data-text=\"\u00celes Mariannes du Nord\">Northern Mariana Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MH\u00celes Marshall\" value=\"MH\" data-text=\"\u00celes Marshall\">Marshall Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PN\u00celes Pitcairn\" value=\"PN\" data-text=\"\u00celes Pitcairn\">Pitcairn Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SB\u00celes Salomon\" value=\"SB\" data-text=\"\u00celes Salomon\">Solomon Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TC\u00celes Turques-et-Ca\u00efques\" value=\"TC\" data-text=\"\u00celes Turques-et-Ca\u00efques\">Turks and Caicos Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VI\u00celes Vierges am\u00e9ricaines\" value=\"VI\" data-text=\"\u00celes Vierges am\u00e9ricaines\">U.S. Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VG\u00celes Vierges britanniques\" value=\"VG\" data-text=\"\u00celes Vierges britanniques\">British Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-INInde\" value=\"IN\" data-text=\"Inde\">India<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IDIndon\u00e9sie\" value=\"ID\" data-text=\"Indon\u00e9sie\">Indonesia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IQIrak\" value=\"IQ\" data-text=\"Irak\">Iraq<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IRIran\" value=\"IR\" data-text=\"Iran\">Iran<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IEIrlande\" value=\"IE\" data-text=\"Irlande\">Irlande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ISIslande\" value=\"IS\" data-text=\"Islande\">Islande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ILIsra\u00ebl\" value=\"IL\" data-text=\"Isra\u00ebl\">Isra\u00ebl<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JMJama\u00efque\" value=\"JM\" data-text=\"Jama\u00efque\">Jama\u00efque<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JPJapon\" value=\"JP\" data-text=\"Japon\">Japon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JOJordanie\" value=\"JO\" data-text=\"Jordanie\">Jordanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KZKazakhstan\" value=\"KZ\" data-text=\"Kazakhstan\">Kazakhstan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KEKenya\" value=\"KE\" data-text=\"Kenya\">Kenya<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KGKirghizistan\" value=\"KG\" data-text=\"Kirghizistan\">Kirghizistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KIKiribati\" value=\"KI\" data-text=\"Kiribati\">Kiribati<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-XKKosovo\" value=\"XK\" data-text=\"Kosovo\">Kosovo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KWKowe\u00eft\" value=\"KW\" data-text=\"Kowe\u00eft\">Kowe\u00eft<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RELa R\u00e9union\" value=\"RE\" data-text=\"La R\u00e9union\">La R\u00e9union<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LALaos\" value=\"LA\" data-text=\"Laos\">Laos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LSLesotho\" value=\"LS\" data-text=\"Lesotho\">Lesotho<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LVLettonie\" value=\"LV\" data-text=\"Lettonie\">Lettonie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LBLiban\" value=\"LB\" data-text=\"Liban\">Liban<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LRLib\u00e9ria\" value=\"LR\" data-text=\"Lib\u00e9ria\">Lib\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LYLibye\" value=\"LY\" data-text=\"Libye\">Libye<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LTLituanie\" value=\"LT\" data-text=\"Lituanie\">Lituanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LULuxembourg\" value=\"LU\" data-text=\"Luxembourg\">Luxembourg<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MOMacao\" value=\"MO\" data-text=\"Macao\">Macao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MKMac\u00e9doine du Nord\" value=\"MK\" data-text=\"Mac\u00e9doine du Nord\">Mac\u00e9doine du Nord<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MGMadagascar\" value=\"MG\" data-text=\"Madagascar\">Madagascar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MYMalaisie\" value=\"MY\" data-text=\"Malaisie\">Malaisie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MWMalawi\" value=\"MW\" data-text=\"Malawi\">Malawi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MVMaldives\" value=\"MV\" data-text=\"Maldives\">Maldives<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MLMali\" value=\"ML\" data-text=\"Mali\">Mali<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MTMalte\" value=\"MT\" data-text=\"Malte\">Malte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MAMaroc\" value=\"MA\" data-text=\"Maroc\">Maroc<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MQMartinique\" value=\"MQ\" data-text=\"Martinique\">Martinique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MUMaurice\" value=\"MU\" data-text=\"Maurice\">Maurice<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MRMauritanie\" value=\"MR\" data-text=\"Mauritanie\">Mauritanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YTMayotte\" value=\"YT\" data-text=\"Mayotte\">Mayotte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MXMexique\" value=\"MX\" data-text=\"Mexique\">Mexique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FMMicron\u00e9sie\" value=\"FM\" data-text=\"Micron\u00e9sie\">Micron\u00e9sie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MDMoldavie\" value=\"MD\" data-text=\"Moldavie\">Moldavie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MCMonaco\" value=\"MC\" data-text=\"Monaco\">Monaco<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MNMongolie\" value=\"MN\" data-text=\"Mongolie\">Mongolie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MEMont\u00e9n\u00e9gro\" value=\"ME\" data-text=\"Mont\u00e9n\u00e9gro\">Mont\u00e9n\u00e9gro<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MSMontserrat\" value=\"MS\" data-text=\"Montserrat\">Montserrat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MZMozambique\" value=\"MZ\" data-text=\"Mozambique\">Mozambique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MMMyanmar\" value=\"MM\" data-text=\"Myanmar\">Myanmar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NANamibie\" value=\"NA\" data-text=\"Namibie\">Namibie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NRNauru\" value=\"NR\" data-text=\"Nauru\">Nauru<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NPN\u00e9pal\" value=\"NP\" data-text=\"N\u00e9pal\">N\u00e9pal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NINicaragua\" value=\"NI\" data-text=\"Nicaragua\">Nicaragua<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NENiger\" value=\"NE\" data-text=\"Niger\">Niger<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NGNig\u00e9ria\" value=\"NG\" data-text=\"Nig\u00e9ria\">Nig\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NUNiue\" value=\"NU\" data-text=\"Niue\">Niue<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NONorv\u00e8ge\" value=\"NO\" data-text=\"Norv\u00e8ge\">Norv\u00e8ge<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NCNouvelle-Cal\u00e9donie\" value=\"NC\" data-text=\"Nouvelle-Cal\u00e9donie\">Nouvelle-Cal\u00e9donie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NZNouvelle-Z\u00e9lande\" value=\"NZ\" data-text=\"Nouvelle-Z\u00e9lande\">Nouvelle-Z\u00e9lande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-OMOman\" value=\"OM\" data-text=\"Oman\">Oman<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UGOuganda\" value=\"UG\" data-text=\"Ouganda\">Ouganda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UZOuzb\u00e9kistan\" value=\"UZ\" data-text=\"Ouzb\u00e9kistan\">Ouzb\u00e9kistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PKPakistan\" value=\"PK\" data-text=\"Pakistan\">Pakistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PWPalaos\" value=\"PW\" data-text=\"Palaos\">Palaos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PSPalestine\" value=\"PS\" data-text=\"Palestine\">Palestine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PAPanama\" value=\"PA\" data-text=\"Panama\">Panama<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PGPapouasie-Nouvelle-Guin\u00e9e\" value=\"PG\" data-text=\"Papouasie-Nouvelle-Guin\u00e9e\">Papouasie-Nouvelle-Guin\u00e9e<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PYParaguay\" value=\"PY\" data-text=\"Paraguay\">Paraguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NLPays-Bas\" value=\"NL\" data-text=\"Pays-Bas\">Pays-Bas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PEP\u00e9rou\" value=\"PE\" data-text=\"P\u00e9rou\">P\u00e9rou<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PHPhilippines\" value=\"PH\" data-text=\"Philippines\">Philippines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PLPologne\" value=\"PL\" data-text=\"Pologne\">Pologne<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PRPorto Rico\" value=\"PR\" data-text=\"Porto Rico\">Porto Rico<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-QAQatar\" value=\"QA\" data-text=\"Qatar\">Qatar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CFR\u00e9publique centrafricaine\" value=\"CF\" data-text=\"R\u00e9publique centrafricaine\">R\u00e9publique centrafricaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DOR\u00e9publique dominicaine\" value=\"DO\" data-text=\"R\u00e9publique dominicaine\">R\u00e9publique dominicaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RORoumanie\" value=\"RO\" data-text=\"Roumanie\">Roumanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GBRoyaume-Uni\" value=\"GB\" data-text=\"Royaume-Uni\">Royaume-Uni<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RURussie\" value=\"RU\" data-text=\"Russie\">Russie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RWRwanda\" value=\"RW\" data-text=\"Rwanda\">Rwanda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EHSahara occidental\" value=\"EH\" data-text=\"Sahara occidental\">Sahara occidental<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BLSaint-Barth\u00e9lemy\" value=\"BL\" data-text=\"Saint-Barth\u00e9lemy\">Saint-Barth\u00e9lemy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KNSaint-Kitts-et-Nevis\" value=\"KN\" data-text=\"Saint-Kitts-et-Nevis\">Saint-Kitts-et-Nevis<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SMSaint-Marin\" value=\"SM\" data-text=\"Saint-Marin\">Saint-Marin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MFSaint-Martin (France)\" value=\"MF\" data-text=\"Saint-Martin (France)\">Saint-Martin (France)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PMSaint-Pierre-et-Miquelon\" value=\"PM\" data-text=\"Saint-Pierre-et-Miquelon\">Saint-Pierre-et-Miquelon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VCSaint-Vincent-et-les Grenadines\" value=\"VC\" data-text=\"Saint-Vincent-et-les Grenadines\">Saint-Vincent-et-les Grenadines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SHSainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\" value=\"SH\" data-text=\"Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\">Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LCSainte-Lucie\" value=\"LC\" data-text=\"Sainte-Lucie\">Sainte-Lucie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WSSamoa\" value=\"WS\" data-text=\"Samoa\">Samoa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ASSamoa am\u00e9ricaines\" value=\"AS\" data-text=\"Samoa am\u00e9ricaines\">Samoa am\u00e9ricaines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-STSao Tom\u00e9-et-Principe\" value=\"ST\" data-text=\"Sao Tom\u00e9-et-Principe\">Sao Tom\u00e9-et-Principe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SNS\u00e9n\u00e9gal\" value=\"SN\" data-text=\"S\u00e9n\u00e9gal\">S\u00e9n\u00e9gal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RSSerbie\" value=\"RS\" data-text=\"Serbie\">Serbie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SCSeychelles\" value=\"SC\" data-text=\"Seychelles\">Seychelles<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SLSierra Leone\" value=\"SL\" data-text=\"Sierra Leone\">Sierra Leone<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SGSingapour\" value=\"SG\" data-text=\"Singapour\">Singapour<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SXSint Maarten (Pays-Bas)\" value=\"SX\" data-text=\"Sint Maarten (Pays-Bas)\">Sint Maarten (Pays-Bas)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SKSlovaquie\" value=\"SK\" data-text=\"Slovaquie\">Slovaquie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SISlov\u00e9nie\" value=\"SI\" data-text=\"Slov\u00e9nie\">Slov\u00e9nie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SOSomalie\" value=\"SO\" data-text=\"Somalie\">Somalie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SDSoudan\" value=\"SD\" data-text=\"Soudan\">Soudan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SSSoudan du Sud\" value=\"SS\" data-text=\"Soudan du Sud\">Soudan du Sud<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LKSri Lanka\" value=\"LK\" data-text=\"Sri Lanka\">Sri Lanka<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SESu\u00e8de\" value=\"SE\" data-text=\"Su\u00e8de\">Su\u00e8de<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SRSuriname\" value=\"SR\" data-text=\"Suriname\">Suriname<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SJSvalbard et Jan Mayen\" value=\"SJ\" data-text=\"Svalbard et Jan Mayen\">Svalbard and Jan Mayen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SYSyrie\" value=\"SY\" data-text=\"Syrie\">Syria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TJTadjikistan\" value=\"TJ\" data-text=\"Tadjikistan\">Tajikistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TWTa\u00efwan\" value=\"TW\" data-text=\"Ta\u00efwan\">Taiwan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TZTanzanie\" value=\"TZ\" data-text=\"Tanzanie\">Tanzania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TDTchad\" value=\"TD\" data-text=\"Tchad\">Chad<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CZTch\u00e9quie\" value=\"CZ\" data-text=\"Tch\u00e9quie\">Czech Republic<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TFTerres australes et antarctiques fran\u00e7aises\" value=\"TF\" data-text=\"Terres australes et antarctiques fran\u00e7aises\">French Southern and Antarctic Lands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IOTerritoire britannique de l\u2019oc\u00e9an Indien\" value=\"IO\" data-text=\"Territoire britannique de l\u2019oc\u00e9an Indien\">British Indian Ocean Territory<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-THTha\u00eflande\" value=\"TH\" data-text=\"Tha\u00eflande\">Thailand<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TIBTibet\" value=\"TIB\" data-text=\"Tibet\">Tibet<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TLTimor-Leste\" value=\"TL\" data-text=\"Timor-Leste\">Timor-Leste<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TGTogo\" value=\"TG\" data-text=\"Togo\">Togo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TKTokelau\" value=\"TK\" data-text=\"Tokelau\">Tokelau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TOTonga\" value=\"TO\" data-text=\"Tonga\">Tonga<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TTTristan da Cunha\" value=\"TT\" data-text=\"Tristan da Cunha\">Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TNTunisie\" value=\"TN\" data-text=\"Tunisie\">Tunisia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TMTurkm\u00e9nistan\" value=\"TM\" data-text=\"Turkm\u00e9nistan\">Turkmenistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TRTurquie\" value=\"TR\" data-text=\"Turquie\">Turkey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TVTuvalu\" value=\"TV\" data-text=\"Tuvalu\">Tuvalu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UAUkraine\" value=\"UA\" data-text=\"Ukraine\">Ukraine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UYUruguay\" value=\"UY\" data-text=\"Uruguay\">Uruguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VUVanuatu\" value=\"VU\" data-text=\"Vanuatu\">Vanuatu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VEVenezuela\" value=\"VE\" data-text=\"Venezuela\">Venezuela<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VNVietnam\" value=\"VN\" data-text=\"Vietnam\">Vietnam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WFWallis-et-Futuna\" value=\"WF\" data-text=\"Wallis-et-Futuna\">Wallis and Futuna<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YEY\u00e9men\" value=\"YE\" data-text=\"Y\u00e9men\">Yemen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZMZambie\" value=\"ZM\" data-text=\"Zambie\">Zambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZWZimbabwe\" value=\"ZW\" data-text=\"Zimbabwe\">Zimbabwe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-00Autre\" value=\"00\" data-text=\"Autre\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_permis\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"9\" name=\"pg_dp_n_permis\" id=\"pg_dp_n_permis\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tB\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tC\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de permis + Valable jusqu'\u00e0 quand-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_entre\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"10\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_n_p_date\" name=\"pg_dp_n_p_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_n_p_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date of entry into Switzerland.\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_valid\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"13\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_n_v_date\" name=\"pg_dp_n_v_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_n_v_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid validity date.\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Infos de contact -->\t\t\t\t\t\t\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tContact information\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- N\u00b0 de t\u00e9l\u00e9phone + Adresse e-mail -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMobile phone *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_ic_tel\" class=\"verify input-field\" tabindex=\"16\" name=\"pg_dp_ic_tel\" type=\"text\" placeholder=\"Mobile phone *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tEmail address *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_ic_mail\" class=\"verify input-field\" tabindex=\"17\" name=\"pg_dp_ic_mail\" type=\"text\" placeholder=\"Email address *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t\t<input class=\"verify form-check-input\" tabindex=\"18\" type=\"checkbox\" id=\"pg_dp_ic_rgpd\" name=\"pg_dp_ic_rgpd\" >\r\n\t\t\t\t\t\t\t\t\t<label class=\"form-check-label\">\r\n\t\t\t\t\t\t\t\t\t\tI have read and accept the provisions relating to the use of electronic means of communication and  \t\t\t\t\t\t\t\t\t\t<a target=\"_blank\" href=\"\/wp-content\/uploads\/2024\/03\/politiqueconfidentialite.pdf\">\r\n\t\t\t\t\t\t\t\t\t\t\tthe entire privacy policy.\t\t\t\t\t\t\t\t\t\t<\/a>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Domicile -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tHome\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_rue\" class=\"verify verify_adresse input-field\" tabindex=\"19\" name=\"pg_dp_d_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_num\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"20\" name=\"pg_dp_d_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\r\n\t\t\t\t\t\t\r\n\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_npa\" class=\"verify verify_adresse input-field\" tabindex=\"21\" name=\"pg_dp_d_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_ville\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"22\" name=\"pg_dp_d_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCanton*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"23\" name=\"pg_dp_d_canton\" id=\"pg_dp_d_canton\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Canton *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">AG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">AI<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">AR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">BE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">BL<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">BS<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">FR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">GE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">GL<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">GR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">JU<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">LU<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">NE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"14\">NW<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"15\">OW<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"16\">SG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"17\">SH<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"18\">SO<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"19\">SZ<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"20\">TG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"21\">TI<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"22\">UR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"23\">VD<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"24\">VS<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"25\">ZG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"26\">ZH<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"27\">FL<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div> \r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date d'habitation et situation de logement? -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAt this address since when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHousing situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Date d'habitation -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"23\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_d_dep_date\" name=\"pg_dp_d_dep_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation de logement-->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tYou live in*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"25\" name=\"pg_dp_d_sit_log\" id=\"pg_dp_d_sit_log\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>You live in *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">With my partner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Only<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Shared flat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Parents' home<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Single-parent families<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_d_dep_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- Section = Logement -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tHousing\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Section = logement + Hypoth\u00e9que-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAre you a homeowner?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Depuis quand ? et m\u00eame adresse --> \r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Logement -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHousing*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"26\" name=\"pg_dp_l_prop\" id=\"pg_dp_l_prop\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Housing situation *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Tenant<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Employer-provided housing<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Condominium apartment<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Single-family home<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Pro rata rent (unmarried or shared)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Living with parents\/relatives<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Hypoth\u00e9que -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_l_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMortgage in CHF *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_hyp\" class=\"verify input-field\" tabindex=\"27\" name=\"pg_dp_l_hyp\" type=\"text\" placeholder=\"Mortgage in CHF *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-0 order-md-0\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHow long have you owned this property?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-3 order-md-1\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDoes the address of the property correspond to the home address?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Date d'achat ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-1 order-md-2\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"28\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_l_date\" name=\"pg_dp_l_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Domicile = Propri\u00e9t\u00e9 ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-4 order-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHome ownership*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"30\" name=\"pg_dp_l_dom\" id=\"pg_dp_l_dom\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tHome ownership *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-2 order-md-4\" id=\"pg_dp_l_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tInvalid date.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- section = Domicile -->\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_dom_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAddress of your property\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_rue\" class=\"verify verify_adresse input-field\" tabindex=\"31\" name=\"pg_dp_l_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_num\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"32\" name=\"pg_dp_l_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_dom_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_npa\" class=\"verify verify_adresse input-field\" tabindex=\"33\" name=\"pg_dp_l_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_ville\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"34\" name=\"pg_dp_l_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Vous (Conjoint)-->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_dp_vc\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour spouse\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- section = Partenaire ?  -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tWould you like to provide information about your partner?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tPartner information*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"35\" name=\"pg_dp_vc_inf\" id=\"pg_dp_vc_inf\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tPartner information *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Infos Conjoint choix -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"form-check pb-3 pg_sec_dp_vc_accept\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<input class=\"verify form-check-input\" tabindex=\"36\" type=\"checkbox\" id=\"pg_dp_vc_accept\" name=\"pg_dp_vc_accept\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"form-check-label\">\r\n\t\t\t\t\t\t\t\t\t\tI confirm that a) my partner has been informed of this request, b) the bank can verify the information about my partner by contacting him directly, c) my partner authorizes the bank to obtain information about him from the Central Office for Credit Information (ZEK) and the Consumer Credit Information Center (IKO).   \t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t\r\n\t\t\t\t<!-- Buttons before \/ next -->\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before2\" tabindex=\"37\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"38\" id=\"btn_next2\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t<!-- Revenus et d\u00e9penses - Personne -->\r\n            <div id=\"form3\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tRevenue\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Situation professionnelle -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"39\" name=\"pg_rd_sp_sit\"  id=\"pg_rd_sp_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_ctr\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"40\" name=\"pg_rd_sp_ctr\" id=\"pg_rd_sp_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Infos employeur -->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_e\" style=\"display:none;\" >\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_name\" class=\"verify input-field\" tabindex=\"45\" name=\"pg_rd_e_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_rue\" class=\"verify input-field\" tabindex=\"46\" name=\"pg_rd_e_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_num\" class=\"verify input-field\" tabindex=\"47\" name=\"pg_rd_e_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_npa\" class=\"verify input-field\" tabindex=\"48\" name=\"pg_rd_e_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_ville\" class=\"verify input-field\" tabindex=\"49\" name=\"pg_rd_e_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\r\n\t\t\t\t\t\t<!-- Date de d\u00e9but et fin de contrat -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_dq\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"41\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_sp_ctr_date\" name=\"pg_rd_sp_ctr_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_ej\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"43\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_sp_ctr_f_date\" name=\"pg_rd_sp_ctr_f_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_sp_ctr_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_sp_ctr_f_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\r\n\t\t\t\t\t\t<!-- section = Infos transport travail -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_g_transp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = Moyen de transport vers votre lieu de travail -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMeans of transport to your place of work\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tMeans of transport\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"57\" name=\"pg_rd_g_transp\"  id=\"pg_rd_g_transp\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Means of transport *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Car<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Public transport<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Motorcycle<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Bike<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Electric bikes up to 25 km\/h<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Electric bike up to 45 km\/h<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">On foot<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<div style=\"display:none;\">\t\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_g_auto\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = R\u00e9el besoin de voiture -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDo you need your car because you have no other means of transport, or for health reasons?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<!-- Oui ou non -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"58\" name=\"pg_rd_g_auto\"  id=\"pg_rd_g_auto\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- KM avec voiture -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_g_km\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of kilometers to your workplace *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_g_km\" class=\"verify input-field\" tabindex=\"59\" name=\"pg_rd_g_km\" type=\"text\" placeholder=\"Number of kilometers to your workplace *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Revenu -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour main income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Salaire net -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (in CHF)*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rp_sal\" class=\"verify input-field\" tabindex=\"60\" name=\"pg_rd_rp_sal\" type=\"text\" placeholder=\"Net monthly income (in CHF)*\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Nombre de salaires -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"61\" name=\"pg_rd_rp_mens\"  id=\"pg_rd_rp_mens\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of annual revenues *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tHourly wage\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t12\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t13\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t14\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<!-- Bonus -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tBonus \/ gratuity (in CHF)\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rp_bns\" class=\"verify input-field\" tabindex=\"62\" name=\"pg_rd_rp_bns\" type=\"text\" placeholder=\"Bonus \/ gratuity (in CHF)\">\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Activit\u00e9 accessoire \/ autres -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Activit\u00e9 accesssoire ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAncillary activity*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"63\" name=\"pg_rd_aa_rs\" id=\"pg_rd_aa_rs\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation PROF -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"64\" name=\"pg_rd_aa_sit\"  id=\"pg_rd_aa_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Professional situation *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Employee<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Self-employed (sole proprietorship)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Self-employed (owner of a S\u00e0rl or SA)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">AHV pensioner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">DI pensioner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Homemaker<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Revenue -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_rev\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF) *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_rev\" class=\"verify input-field\" tabindex=\"65\" name=\"pg_rd_aa_rev\" type=\"text\" placeholder=\"Net monthly income (CHF) *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6  pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Type de contrat -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_ctr\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"66\" name=\"pg_rd_aa_ctr\" id=\"pg_rd_aa_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"67\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_aa_date\" name=\"pg_rd_aa_date\">\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_ctrfdate\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_f_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"68\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_aa_f_date\" name=\"pg_rd_aa_f_date\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Adresse entreprise-->\r\n\t\t\t\t\t\t\t<div class=\"row pg_sec_rd_aa_adress\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_name\" class=\"verify input-field\" tabindex=\"68\" name=\"pg_rd_aa_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_rue\" class=\"verify input-field\" tabindex=\"69\" name=\"pg_rd_aa_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_num\" class=\"verify input-field\" tabindex=\"70\" name=\"pg_rd_aa_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_npa\" class=\"verify input-field\" tabindex=\"71\" name=\"pg_rd_aa_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_ville\" class=\"verify input-field\" tabindex=\"72\" name=\"pg_rd_aa_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Revenue suppl\u00e9mentaire et source de revenus  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"73\" name=\"pg_rd_rs_sr\"  id=\"pg_rd_rs_sr\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Additional income *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">No additional income<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Alimony<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Rental income<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Widow's pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Orphan's pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">DI \/ AVS pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">Children's apprentice wages<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_rs\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet income in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rs_rn\" class=\"verify input-field\" tabindex=\"74\" name=\"pg_rd_rs_rn\" type=\"text\" placeholder=\"Net income in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = D\u00e9penses  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony payments per month *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_dp_pa\" class=\"verify input-field\" tabindex=\"75\" name=\"pg_rd_dp_pa\" type=\"text\" placeholder=\"Alimony in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tOther monthly expenses *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_dp_adm\" class=\"verify input-field\" tabindex=\"76\" name=\"pg_rd_dp_adm\" type=\"text\" placeholder=\"Other monthly expenses in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<!-- Buttons before \/ next -->\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before3\" tabindex=\"77\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"78\" id=\"btn_next3\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Donn\u00e9es personnelles - Conjoint -->\r\n            <div id=\"form4\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form\">\r\n\t\t\t\t\t<!-- Step = Donnees personnelles votre conjoint -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tYour spouse's personal data\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Votre conjoint -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<!-- Section = Vous -->\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour spouse\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\tPlease enter the information as it appears on the official identity document.\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Titre + \u00c9tat civil -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTitle*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"79\" name=\"pg_dpvc_v_titre\" id=\"pg_dpvc_v_titre\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tTitle *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tMs.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMr.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nom + Pr\u00e9nom -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tName *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_v_nom\" class=\"verify input-field\" tabindex=\"80\" name=\"pg_dpvc_v_nom\" type=\"text\" placeholder=\"Name *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" >\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tSurname *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_v_prenom\" class=\"verify input-field\"  tabindex=\"81\" name=\"pg_dpvc_v_prenom\" type=\"text\" placeholder=\"Surname *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de Naissance -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"82\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_v_n_date\" name=\"pg_dpvc_v_n_date\">\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dpvc_v_n_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tYou must be between 18 and 69 years of age.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Nationalit\u00e9 -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nationalit\u00e9 + Pays -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNationality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select name=\"pg_dpvc_n_pays\" tabindex=\"85\" class=\"verify input-field pg_check_default\" id=\"pg_dpvc_n_pays\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Nationality *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CHSuisse\" value=\"CH\" data-text=\"Suisse\">Switzerland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LILiechtenstein\" value=\"LI\" data-text=\"Liechtenstein\">Liechtenstein<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DEAllemagne\" value=\"DE\" data-text=\"Allemagne\">Germany<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ATAutriche\" value=\"AT\" data-text=\"Autriche\">Austria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FRFrance\" value=\"FR\" data-text=\"France\">France<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ITItalie\" value=\"IT\" data-text=\"Italie\">Italy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PTPortugal\" value=\"PT\" data-text=\"Portugal\">Portugal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZAAfrique du Sud\" value=\"ZA\" data-text=\"Afrique du Sud\">South Africa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ALAlbanie\" value=\"AL\" data-text=\"Albanie\">Albania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DZAlg\u00e9rie\" value=\"DZ\" data-text=\"Alg\u00e9rie\">Algeria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ADAndorre\" value=\"AD\" data-text=\"Andorre\">Andorra<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AOAngola\" value=\"AO\" data-text=\"Angola\">Angola<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AIAnguilla\" value=\"AI\" data-text=\"Anguilla\">Anguilla<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AQAntarctique\" value=\"AQ\" data-text=\"Antarctique\">Antarctica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AGAntigua-et-Barbuda\" value=\"AG\" data-text=\"Antigua-et-Barbuda\">Antigua and Barbuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SAArabie saoudite\" value=\"SA\" data-text=\"Arabie saoudite\">Saudi Arabia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ARArgentine\" value=\"AR\" data-text=\"Argentine\">Argentina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AMArm\u00e9nie\" value=\"AM\" data-text=\"Arm\u00e9nie\">Armenia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AWAruba\" value=\"AW\" data-text=\"Aruba\">Aruba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AUAustralie\" value=\"AU\" data-text=\"Australie\">Australia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AZAzerba\u00efdjan\" value=\"AZ\" data-text=\"Azerba\u00efdjan\">Azerbaijan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BSBahamas\" value=\"BS\" data-text=\"Bahamas\">Bahamas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BHBahre\u00efn\" value=\"BH\" data-text=\"Bahre\u00efn\">Bahrain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BDBangladesh\" value=\"BD\" data-text=\"Bangladesh\">Bangladesh<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BBBarbade\" value=\"BB\" data-text=\"Barbade\">Barbados<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BYB\u00e9larus\" value=\"BY\" data-text=\"B\u00e9larus\">Belarus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BEBelgique\" value=\"BE\" data-text=\"Belgique\">Belgium<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BZBelize\" value=\"BZ\" data-text=\"Belize\">Belize<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BJB\u00e9nin\" value=\"BJ\" data-text=\"B\u00e9nin\">Benin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BMBermudes\" value=\"BM\" data-text=\"Bermudes\">Bermuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BTBhoutan\" value=\"BT\" data-text=\"Bhoutan\">Bhutan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BOBolivie\" value=\"BO\" data-text=\"Bolivie\">Bolivia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BQBonaire, Saint Eustatius et Saba\" value=\"BQ\" data-text=\"Bonaire, Saint Eustatius et Saba\">Bonaire, Saint Eustatius and Saba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BABosnie et Herz\u00e9govine\" value=\"BA\" data-text=\"Bosnie et Herz\u00e9govine\">Bosnia and Herzegovina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BWBotswana\" value=\"BW\" data-text=\"Botswana\">Botswana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BRBr\u00e9sil\" value=\"BR\" data-text=\"Br\u00e9sil\">Brazil<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BNBrun\u00e9i Darussalam\" value=\"BN\" data-text=\"Brun\u00e9i Darussalam\">Brunei Darussalam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BGBulgarie\" value=\"BG\" data-text=\"Bulgarie\">Bulgaria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BFBurkina Faso\" value=\"BF\" data-text=\"Burkina Faso\">Burkina Faso<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BIBurundi\" value=\"BI\" data-text=\"Burundi\">Burundi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CVCabo Verde\" value=\"CV\" data-text=\"Cabo Verde\">Cabo Verde<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KHCambodge\" value=\"KH\" data-text=\"Cambodge\">Cambodia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CMCameroun\" value=\"CM\" data-text=\"Cameroun\">Cameroon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CACanada\" value=\"CA\" data-text=\"Canada\">Canada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CLChili\" value=\"CL\" data-text=\"Chili\">Chile<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CNChine\" value=\"CN\" data-text=\"Chine\">China<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CYChypre\" value=\"CY\" data-text=\"Chypre\">Cyprus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VACit\u00e9 du Vatican\" value=\"VA\" data-text=\"Cit\u00e9 du Vatican\">Vatican City<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-COColombie\" value=\"CO\" data-text=\"Colombie\">Colombia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KMComores\" value=\"KM\" data-text=\"Comores\">Comoros<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CGCongo (Brazzaville)\" value=\"CG\" data-text=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CDCongo (Kinshasa)\" value=\"CD\" data-text=\"Congo (Kinshasa)\">Congo (Kinshasa)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KPCor\u00e9e du Nord\" value=\"KP\" data-text=\"Cor\u00e9e du Nord\">North Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KRCor\u00e9e du Sud\" value=\"KR\" data-text=\"Cor\u00e9e du Sud\">South Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CRCosta Rica\" value=\"CR\" data-text=\"Costa Rica\">Costa Rica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CIC\u00f4te d\u2019Ivoire\" value=\"CI\" data-text=\"C\u00f4te d\u2019Ivoire\">Ivory Coast<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HRCroatie\" value=\"HR\" data-text=\"Croatie\">Croatia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CUCuba\" value=\"CU\" data-text=\"Cuba\">Cuba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CWCura\u00e7ao\" value=\"CW\" data-text=\"Cura\u00e7ao\">Cura\u00e7ao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DKDanemark\" value=\"DK\" data-text=\"Danemark\">Denmark<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DJDjibouti\" value=\"DJ\" data-text=\"Djibouti\">Djibouti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DMDominique\" value=\"DM\" data-text=\"Dominique\">Dominique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EG\u00c9gypte\" value=\"EG\" data-text=\"\u00c9gypte\">Egypt<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SVEl Salvador\" value=\"SV\" data-text=\"El Salvador\">El Salvador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AE\u00c9mirats arabes unis\" value=\"AE\" data-text=\"\u00c9mirats arabes unis\">United Arab Emirates<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EC\u00c9quateur\" value=\"EC\" data-text=\"\u00c9quateur\">Ecuador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ER\u00c9rythr\u00e9e\" value=\"ER\" data-text=\"\u00c9rythr\u00e9e\">Eritrea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ESEspagne\" value=\"ES\" data-text=\"Espagne\">Spain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EEEstonie\" value=\"EE\" data-text=\"Estonie\">Estonia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SZEswatini\" value=\"SZ\" data-text=\"Eswatini\">Eswatini<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-US\u00c9tats-Unis\" value=\"US\" data-text=\"\u00c9tats-Unis\">United States<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ET\u00c9thiopie\" value=\"ET\" data-text=\"\u00c9thiopie\">Ethiopia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FJFidji\" value=\"FJ\" data-text=\"Fidji\">Fiji<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FIFinlande\" value=\"FI\" data-text=\"Finlande\">Finland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GAGabon\" value=\"GA\" data-text=\"Gabon\">Gabon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GMGambie\" value=\"GM\" data-text=\"Gambie\">Gambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GEG\u00e9orgie\" value=\"GE\" data-text=\"G\u00e9orgie\">Georgia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GSG\u00e9orgie du Sud et les \u00celes Sandwich du Sud\" value=\"GS\" data-text=\"G\u00e9orgie du Sud et les \u00celes Sandwich du Sud\">South Georgia and the South Sandwich Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GHGhana\" value=\"GH\" data-text=\"Ghana\">Ghana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GIGibraltar\" value=\"GI\" data-text=\"Gibraltar\">Gibraltar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GRGr\u00e8ce\" value=\"GR\" data-text=\"Gr\u00e8ce\">Greece<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GDGrenade\" value=\"GD\" data-text=\"Grenade\">Granada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GLGroenland\" value=\"GL\" data-text=\"Groenland\">Greenland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GPGuadeloupe\" value=\"GP\" data-text=\"Guadeloupe\">Guadeloupe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GUGuam\" value=\"GU\" data-text=\"Guam\">Guam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GTGuatemala\" value=\"GT\" data-text=\"Guatemala\">Guatemala<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GGGuernesey\" value=\"GG\" data-text=\"Guernesey\">Guernsey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GNGuin\u00e9e\" value=\"GN\" data-text=\"Guin\u00e9e\">Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GQGuin\u00e9e \u00e9quatoriale\" value=\"GQ\" data-text=\"Guin\u00e9e \u00e9quatoriale\">Equatorial Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GWGuin\u00e9e-Bissau\" value=\"GW\" data-text=\"Guin\u00e9e-Bissau\">Guinea-Bissau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GYGuyana\" value=\"GY\" data-text=\"Guyana\">Guyana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GFGuyane fran\u00e7aise\" value=\"GF\" data-text=\"Guyane fran\u00e7aise\">French Guiana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HTHa\u00efti\" value=\"HT\" data-text=\"Ha\u00efti\">Haiti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HNHonduras\" value=\"HN\" data-text=\"Honduras\">Honduras<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HKHong Kong\" value=\"HK\" data-text=\"Hong Kong\">Hong Kong<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HUHongrie\" value=\"HU\" data-text=\"Hongrie\">Hungary<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BV\u00cele Bouvet\" value=\"BV\" data-text=\"\u00cele Bouvet\">Bouvet Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NF\u00cele Norfolk\" value=\"NF\" data-text=\"\u00cele Norfolk\">Norfolk Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KY\u00celes Ca\u00efmans\" value=\"KY\" data-text=\"\u00celes Ca\u00efmans\">Cayman Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CC\u00celes Cocos (Keeling)\" value=\"CC\" data-text=\"\u00celes Cocos (Keeling)\">Cocos Islands (Keeling)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CK\u00celes Cook\" value=\"CK\" data-text=\"\u00celes Cook\">Cook Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AX\u00celes d'Aland\" value=\"AX\" data-text=\"\u00celes d'Aland\">Aland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FO\u00celes F\u00e9ro\u00e9\" value=\"FO\" data-text=\"\u00celes F\u00e9ro\u00e9\">Faroe Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HM\u00celes Heard et MacDonald\" value=\"HM\" data-text=\"\u00celes Heard et MacDonald\">Heard and MacDonald Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FK\u00celes Malouines\" value=\"FK\" data-text=\"\u00celes Malouines\">Falkland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MP\u00celes Mariannes du Nord\" value=\"MP\" data-text=\"\u00celes Mariannes du Nord\">Northern Mariana Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MH\u00celes Marshall\" value=\"MH\" data-text=\"\u00celes Marshall\">Marshall Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PN\u00celes Pitcairn\" value=\"PN\" data-text=\"\u00celes Pitcairn\">Pitcairn Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SB\u00celes Salomon\" value=\"SB\" data-text=\"\u00celes Salomon\">Solomon Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TC\u00celes Turques-et-Ca\u00efques\" value=\"TC\" data-text=\"\u00celes Turques-et-Ca\u00efques\">Turks and Caicos Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VI\u00celes Vierges am\u00e9ricaines\" value=\"VI\" data-text=\"\u00celes Vierges am\u00e9ricaines\">U.S. Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VG\u00celes Vierges britanniques\" value=\"VG\" data-text=\"\u00celes Vierges britanniques\">British Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-INInde\" value=\"IN\" data-text=\"Inde\">India<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IDIndon\u00e9sie\" value=\"ID\" data-text=\"Indon\u00e9sie\">Indonesia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IQIrak\" value=\"IQ\" data-text=\"Irak\">Iraq<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IRIran\" value=\"IR\" data-text=\"Iran\">Iran<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IEIrlande\" value=\"IE\" data-text=\"Irlande\">Irlande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ISIslande\" value=\"IS\" data-text=\"Islande\">Islande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ILIsra\u00ebl\" value=\"IL\" data-text=\"Isra\u00ebl\">Isra\u00ebl<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JMJama\u00efque\" value=\"JM\" data-text=\"Jama\u00efque\">Jama\u00efque<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JPJapon\" value=\"JP\" data-text=\"Japon\">Japon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JOJordanie\" value=\"JO\" data-text=\"Jordanie\">Jordanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KZKazakhstan\" value=\"KZ\" data-text=\"Kazakhstan\">Kazakhstan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KEKenya\" value=\"KE\" data-text=\"Kenya\">Kenya<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KGKirghizistan\" value=\"KG\" data-text=\"Kirghizistan\">Kirghizistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KIKiribati\" value=\"KI\" data-text=\"Kiribati\">Kiribati<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-XKKosovo\" value=\"XK\" data-text=\"Kosovo\">Kosovo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KWKowe\u00eft\" value=\"KW\" data-text=\"Kowe\u00eft\">Kowe\u00eft<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RELa R\u00e9union\" value=\"RE\" data-text=\"La R\u00e9union\">La R\u00e9union<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LALaos\" value=\"LA\" data-text=\"Laos\">Laos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LSLesotho\" value=\"LS\" data-text=\"Lesotho\">Lesotho<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LVLettonie\" value=\"LV\" data-text=\"Lettonie\">Lettonie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LBLiban\" value=\"LB\" data-text=\"Liban\">Liban<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LRLib\u00e9ria\" value=\"LR\" data-text=\"Lib\u00e9ria\">Lib\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LYLibye\" value=\"LY\" data-text=\"Libye\">Libye<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LTLituanie\" value=\"LT\" data-text=\"Lituanie\">Lituanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LULuxembourg\" value=\"LU\" data-text=\"Luxembourg\">Luxembourg<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MOMacao\" value=\"MO\" data-text=\"Macao\">Macao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MKMac\u00e9doine du Nord\" value=\"MK\" data-text=\"Mac\u00e9doine du Nord\">Mac\u00e9doine du Nord<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MGMadagascar\" value=\"MG\" data-text=\"Madagascar\">Madagascar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MYMalaisie\" value=\"MY\" data-text=\"Malaisie\">Malaisie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MWMalawi\" value=\"MW\" data-text=\"Malawi\">Malawi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MVMaldives\" value=\"MV\" data-text=\"Maldives\">Maldives<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MLMali\" value=\"ML\" data-text=\"Mali\">Mali<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MTMalte\" value=\"MT\" data-text=\"Malte\">Malte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MAMaroc\" value=\"MA\" data-text=\"Maroc\">Maroc<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MQMartinique\" value=\"MQ\" data-text=\"Martinique\">Martinique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MUMaurice\" value=\"MU\" data-text=\"Maurice\">Maurice<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MRMauritanie\" value=\"MR\" data-text=\"Mauritanie\">Mauritanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YTMayotte\" value=\"YT\" data-text=\"Mayotte\">Mayotte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MXMexique\" value=\"MX\" data-text=\"Mexique\">Mexique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FMMicron\u00e9sie\" value=\"FM\" data-text=\"Micron\u00e9sie\">Micron\u00e9sie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MDMoldavie\" value=\"MD\" data-text=\"Moldavie\">Moldavie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MCMonaco\" value=\"MC\" data-text=\"Monaco\">Monaco<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MNMongolie\" value=\"MN\" data-text=\"Mongolie\">Mongolie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MEMont\u00e9n\u00e9gro\" value=\"ME\" data-text=\"Mont\u00e9n\u00e9gro\">Mont\u00e9n\u00e9gro<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MSMontserrat\" value=\"MS\" data-text=\"Montserrat\">Montserrat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MZMozambique\" value=\"MZ\" data-text=\"Mozambique\">Mozambique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MMMyanmar\" value=\"MM\" data-text=\"Myanmar\">Myanmar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NANamibie\" value=\"NA\" data-text=\"Namibie\">Namibie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NRNauru\" value=\"NR\" data-text=\"Nauru\">Nauru<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NPN\u00e9pal\" value=\"NP\" data-text=\"N\u00e9pal\">N\u00e9pal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NINicaragua\" value=\"NI\" data-text=\"Nicaragua\">Nicaragua<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NENiger\" value=\"NE\" data-text=\"Niger\">Niger<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NGNig\u00e9ria\" value=\"NG\" data-text=\"Nig\u00e9ria\">Nig\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NUNiue\" value=\"NU\" data-text=\"Niue\">Niue<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NONorv\u00e8ge\" value=\"NO\" data-text=\"Norv\u00e8ge\">Norv\u00e8ge<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NCNouvelle-Cal\u00e9donie\" value=\"NC\" data-text=\"Nouvelle-Cal\u00e9donie\">Nouvelle-Cal\u00e9donie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NZNouvelle-Z\u00e9lande\" value=\"NZ\" data-text=\"Nouvelle-Z\u00e9lande\">Nouvelle-Z\u00e9lande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-OMOman\" value=\"OM\" data-text=\"Oman\">Oman<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UGOuganda\" value=\"UG\" data-text=\"Ouganda\">Ouganda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UZOuzb\u00e9kistan\" value=\"UZ\" data-text=\"Ouzb\u00e9kistan\">Ouzb\u00e9kistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PKPakistan\" value=\"PK\" data-text=\"Pakistan\">Pakistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PWPalaos\" value=\"PW\" data-text=\"Palaos\">Palaos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PSPalestine\" value=\"PS\" data-text=\"Palestine\">Palestine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PAPanama\" value=\"PA\" data-text=\"Panama\">Panama<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PGPapouasie-Nouvelle-Guin\u00e9e\" value=\"PG\" data-text=\"Papouasie-Nouvelle-Guin\u00e9e\">Papouasie-Nouvelle-Guin\u00e9e<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PYParaguay\" value=\"PY\" data-text=\"Paraguay\">Paraguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NLPays-Bas\" value=\"NL\" data-text=\"Pays-Bas\">Pays-Bas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PEP\u00e9rou\" value=\"PE\" data-text=\"P\u00e9rou\">P\u00e9rou<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PHPhilippines\" value=\"PH\" data-text=\"Philippines\">Philippines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PLPologne\" value=\"PL\" data-text=\"Pologne\">Pologne<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PRPorto Rico\" value=\"PR\" data-text=\"Porto Rico\">Porto Rico<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-QAQatar\" value=\"QA\" data-text=\"Qatar\">Qatar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CFR\u00e9publique centrafricaine\" value=\"CF\" data-text=\"R\u00e9publique centrafricaine\">R\u00e9publique centrafricaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DOR\u00e9publique dominicaine\" value=\"DO\" data-text=\"R\u00e9publique dominicaine\">R\u00e9publique dominicaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RORoumanie\" value=\"RO\" data-text=\"Roumanie\">Roumanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GBRoyaume-Uni\" value=\"GB\" data-text=\"Royaume-Uni\">Royaume-Uni<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RURussie\" value=\"RU\" data-text=\"Russie\">Russie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RWRwanda\" value=\"RW\" data-text=\"Rwanda\">Rwanda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EHSahara occidental\" value=\"EH\" data-text=\"Sahara occidental\">Sahara occidental<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BLSaint-Barth\u00e9lemy\" value=\"BL\" data-text=\"Saint-Barth\u00e9lemy\">Saint-Barth\u00e9lemy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KNSaint-Kitts-et-Nevis\" value=\"KN\" data-text=\"Saint-Kitts-et-Nevis\">Saint-Kitts-et-Nevis<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SMSaint-Marin\" value=\"SM\" data-text=\"Saint-Marin\">Saint-Marin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MFSaint-Martin (France)\" value=\"MF\" data-text=\"Saint-Martin (France)\">Saint-Martin (France)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PMSaint-Pierre-et-Miquelon\" value=\"PM\" data-text=\"Saint-Pierre-et-Miquelon\">Saint-Pierre-et-Miquelon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VCSaint-Vincent-et-les Grenadines\" value=\"VC\" data-text=\"Saint-Vincent-et-les Grenadines\">Saint-Vincent-et-les Grenadines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SHSainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\" value=\"SH\" data-text=\"Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\">Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LCSainte-Lucie\" value=\"LC\" data-text=\"Sainte-Lucie\">Sainte-Lucie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WSSamoa\" value=\"WS\" data-text=\"Samoa\">Samoa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ASSamoa am\u00e9ricaines\" value=\"AS\" data-text=\"Samoa am\u00e9ricaines\">Samoa am\u00e9ricaines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-STSao Tom\u00e9-et-Principe\" value=\"ST\" data-text=\"Sao Tom\u00e9-et-Principe\">Sao Tom\u00e9-et-Principe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SNS\u00e9n\u00e9gal\" value=\"SN\" data-text=\"S\u00e9n\u00e9gal\">S\u00e9n\u00e9gal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RSSerbie\" value=\"RS\" data-text=\"Serbie\">Serbie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SCSeychelles\" value=\"SC\" data-text=\"Seychelles\">Seychelles<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SLSierra Leone\" value=\"SL\" data-text=\"Sierra Leone\">Sierra Leone<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SGSingapour\" value=\"SG\" data-text=\"Singapour\">Singapour<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SXSint Maarten (Pays-Bas)\" value=\"SX\" data-text=\"Sint Maarten (Pays-Bas)\">Sint Maarten (Pays-Bas)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SKSlovaquie\" value=\"SK\" data-text=\"Slovaquie\">Slovaquie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SISlov\u00e9nie\" value=\"SI\" data-text=\"Slov\u00e9nie\">Slov\u00e9nie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SOSomalie\" value=\"SO\" data-text=\"Somalie\">Somalie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SDSoudan\" value=\"SD\" data-text=\"Soudan\">Soudan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SSSoudan du Sud\" value=\"SS\" data-text=\"Soudan du Sud\">Soudan du Sud<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LKSri Lanka\" value=\"LK\" data-text=\"Sri Lanka\">Sri Lanka<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SESu\u00e8de\" value=\"SE\" data-text=\"Su\u00e8de\">Su\u00e8de<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SRSuriname\" value=\"SR\" data-text=\"Suriname\">Suriname<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SJSvalbard et Jan Mayen\" value=\"SJ\" data-text=\"Svalbard et Jan Mayen\">Svalbard and Jan Mayen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SYSyrie\" value=\"SY\" data-text=\"Syrie\">Syria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TJTadjikistan\" value=\"TJ\" data-text=\"Tadjikistan\">Tajikistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TWTa\u00efwan\" value=\"TW\" data-text=\"Ta\u00efwan\">Taiwan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TZTanzanie\" value=\"TZ\" data-text=\"Tanzanie\">Tanzania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TDTchad\" value=\"TD\" data-text=\"Tchad\">Chad<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CZTch\u00e9quie\" value=\"CZ\" data-text=\"Tch\u00e9quie\">Czech Republic<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TFTerres australes et antarctiques fran\u00e7aises\" value=\"TF\" data-text=\"Terres australes et antarctiques fran\u00e7aises\">French Southern and Antarctic Lands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IOTerritoire britannique de l\u2019oc\u00e9an Indien\" value=\"IO\" data-text=\"Territoire britannique de l\u2019oc\u00e9an Indien\">British Indian Ocean Territory<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-THTha\u00eflande\" value=\"TH\" data-text=\"Tha\u00eflande\">Thailand<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TIBTibet\" value=\"TIB\" data-text=\"Tibet\">Tibet<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TLTimor-Leste\" value=\"TL\" data-text=\"Timor-Leste\">Timor-Leste<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TGTogo\" value=\"TG\" data-text=\"Togo\">Togo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TKTokelau\" value=\"TK\" data-text=\"Tokelau\">Tokelau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TOTonga\" value=\"TO\" data-text=\"Tonga\">Tonga<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TTTristan da Cunha\" value=\"TT\" data-text=\"Tristan da Cunha\">Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TNTunisie\" value=\"TN\" data-text=\"Tunisie\">Tunisia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TMTurkm\u00e9nistan\" value=\"TM\" data-text=\"Turkm\u00e9nistan\">Turkmenistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TRTurquie\" value=\"TR\" data-text=\"Turquie\">Turkey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TVTuvalu\" value=\"TV\" data-text=\"Tuvalu\">Tuvalu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UAUkraine\" value=\"UA\" data-text=\"Ukraine\">Ukraine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UYUruguay\" value=\"UY\" data-text=\"Uruguay\">Uruguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VUVanuatu\" value=\"VU\" data-text=\"Vanuatu\">Vanuatu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VEVenezuela\" value=\"VE\" data-text=\"Venezuela\">Venezuela<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VNVietnam\" value=\"VN\" data-text=\"Vietnam\">Vietnam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WFWallis-et-Futuna\" value=\"WF\" data-text=\"Wallis-et-Futuna\">Wallis and Futuna<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YEY\u00e9men\" value=\"YE\" data-text=\"Y\u00e9men\">Yemen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZMZambie\" value=\"ZM\" data-text=\"Zambie\">Zambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZWZimbabwe\" value=\"ZW\" data-text=\"Zimbabwe\">Zimbabwe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-00Autre\" value=\"00\" data-text=\"Autre\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_permis\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"86\" name=\"pg_dpvc_n_permis\" id=\"pg_dpvc_n_permis\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tB\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tC\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de permis + Valable jusqu'\u00e0 quand-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_entre\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"87\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_n_p_date\" name=\"pg_dpvc_n_p_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_valid\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"90\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_n_v_date\" name=\"pg_dpvc_n_v_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Infos de contact -->\t\t\t\t\t\t\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tContact information\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- N\u00b0 de t\u00e9l\u00e9phone + Adresse e-mail -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMobile phone *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_ic_tel\" class=\"verify input-field\" tabindex=\"93\" name=\"pg_dpvc_ic_tel\" type=\"text\" placeholder=\"Mobile phone *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tEmail address *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_ic_mail\" class=\"verify input-field\" tabindex=\"94\" name=\"pg_dpvc_ic_mail\" type=\"text\" placeholder=\"Email address *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before4\" tabindex=\"95\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"96\" id=\"btn_next4\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Revenus  - Partenaire -->\r\n            <div id=\"form5\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<!-- Revenus Partenaire -->\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tIncome - Spouse\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Situation professionnelle -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"97\" name=\"pg_rdvc_sp_sit\"  id=\"pg_rdvc_sp_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_ctr\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"98\" name=\"pg_rdvc_sp_ctr\" id=\"pg_rdvc_sp_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Infos employeur -->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_e\" style=\"display:none;\" >\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_name\" class=\"verify input-field\" tabindex=\"103\" name=\"pg_rdvc_e_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_rue\" class=\"verify input-field\" tabindex=\"104\" name=\"pg_rdvc_e_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_num\" class=\"verify input-field\" tabindex=\"105\" name=\"pg_rdvc_e_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_npa\" class=\"verify input-field\" tabindex=\"106\" name=\"pg_rdvc_e_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_ville\" class=\"verify input-field\" tabindex=\"107\" name=\"pg_rdvc_e_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de d\u00e9but et fin de contrat -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_dq\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"99\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_sp_ctr_date\" name=\"pg_rdvc_sp_ctr_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_ej\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"101\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_sp_ctr_f_date\" name=\"pg_rdvc_sp_ctr_f_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_sp_ctr_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_sp_ctr_f_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t<!-- section = Infos transport travail -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_g_transp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = Moyen de transport vers votre lieu de travail -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMeans of transport to your place of work\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tMeans of transport\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"115\" name=\"pg_rdvc_g_transp\"  id=\"pg_rdvc_g_transp\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tMeans of transport *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tCar\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tPublic transport\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tMotorcycle\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tBike\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tElectric bikes up to 25 km\/h\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tElectric bike up to 45 km\/h\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOn foot\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_g_auto\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = R\u00e9el besoin de voiture -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDo you need your car because you have no other means of transport, or for health reasons?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<!-- Oui ou non -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"116\" name=\"pg_rdvc_g_auto\"  id=\"pg_rdvc_g_auto\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- KM avec voiture -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_g_km\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of kilometers to your workplace per trip *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_g_km\" class=\"verify input-field\" tabindex=\"117\" name=\"pg_rdvc_g_km\" type=\"text\" placeholder=\"Number of kilometers to your workplace per trip *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- section = Revenu -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour main income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Salaire net -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (in CHF)*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rp_sal\" class=\"verify input-field\" tabindex=\"118\" name=\"pg_rdvc_rp_sal\" type=\"text\" placeholder=\"Net monthly income (in CHF)*\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Nombre de salaires -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"119\" name=\"pg_rdvc_rp_mens\"  id=\"pg_rdvc_rp_mens\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of annual revenues *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tHourly wage\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t12\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t13\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t14\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Bonus -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tBonus \/ gratuity (in CHF)\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rp_bns\" class=\"verify input-field\" tabindex=\"120\" name=\"pg_rdvc_rp_bns\" type=\"text\" placeholder=\"Bonus \/ gratuity (in CHF)\">\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Activit\u00e9 accessoire \/ autres -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Activit\u00e9 accesssoire ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAncillary activity*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"121\" name=\"pg_rdvc_aa_rs\" id=\"pg_rdvc_aa_rs\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation PROF -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"122\" name=\"pg_rdvc_aa_sit\"  id=\"pg_rdvc_aa_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Revenue -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_rev\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF) *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_rev\" class=\"verify input-field\" tabindex=\"123\" name=\"pg_rdvc_aa_rev\" type=\"text\" placeholder=\"Net monthly income (CHF) *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6  pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Type de contrat -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_ctr\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"124\" name=\"pg_rdvc_aa_ctr\" id=\"pg_rdvc_aa_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"125\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_aa_date\" name=\"pg_rdvc_aa_date\">\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_ctrfdate\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_f_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"126\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_aa_f_date\" name=\"pg_rdvc_aa_f_date\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Adresse entreprise-->\r\n\t\t\t\t\t\t\t<div class=\"row pg_sec_rdvc_aa_adress\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_name\" class=\"verify input-field\" tabindex=\"127\" name=\"pg_rdvc_aa_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_rue\" class=\"verify input-field\" tabindex=\"128\" name=\"pg_rdvc_aa_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_num\" class=\"verify input-field\" tabindex=\"129\" name=\"pg_rdvc_aa_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_npa\" class=\"verify input-field\" tabindex=\"130\" name=\"pg_rdvc_aa_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_ville\" class=\"verify input-field\" tabindex=\"131\" name=\"pg_rdvc_aa_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Revenue suppl\u00e9mentaire et source de revenus  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"131\" name=\"pg_rdvc_rs_sr\"  id=\"pg_rdvc_rs_sr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo additional income\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tAlimony\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tRental income\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tWidow's pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tOrphan's pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI \/ AVS pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\tChildren's apprentice wages\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_rs\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet income in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rs_rn\" class=\"verify input-field\" tabindex=\"132\" name=\"pg_rdvc_rs_rn\" type=\"text\" placeholder=\"Net income in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = D\u00e9penses  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTotal alimony payments per month *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_dp_pa\" class=\"verify input-field\" tabindex=\"133\" name=\"pg_rdvc_dp_pa\" type=\"text\" placeholder=\"Alimony in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tOther monthly expenses *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_dp_adm\" class=\"verify input-field\" tabindex=\"134\" name=\"pg_rdvc_dp_adm\" type=\"text\" placeholder=\"Other monthly expenses in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before5\" tabindex=\"135\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"136\" id=\"btn_next5\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- D\u00e9penses Communes  -->\r\n            <div id=\"form6\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tCommon expenses\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- section = Enfants dans le foyer -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tChildren in the household\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Enfants -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tChildren under 25 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"137\" name=\"pg_dc_ef\" id=\"pg_dc_ef\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tChildren *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 01-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_1\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"138\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_1_date\" name=\"pg_dc_ef_1_date\">\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\"><\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_1_add\" tabindex=\"139\" class=\"pg_icon_state pg_add_children\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_1_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 02-->\r\n\t\t\t\t\t\t<div  id=\"pg_sec_dc_ef_2\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"140\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_2_date\" name=\"pg_dc_ef_2_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_2_del\" tabindex=\"141\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_2_add\" tabindex=\"142\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_2_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 03-->\r\n\t\t\t\t\t\t<div  id=\"pg_sec_dc_ef_3\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"143\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_3_date\" name=\"pg_dc_ef_3_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_3_del\" tabindex=\"144\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_3_add\" tabindex=\"145\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_3_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 04-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_4\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"146\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_4_date\" name=\"pg_dc_ef_4_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_4_del\" tabindex=\"147\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_4_add\" tabindex=\"148\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_4_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 05-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_5\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"149\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_5_date\" name=\"pg_dc_ef_5_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_5_del\" tabindex=\"150\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_5_add\" tabindex=\"151\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_5_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 06-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_6\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"152\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_6_date\" name=\"pg_dc_ef_6_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_6_del\" tabindex=\"153\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_6_add\" tabindex=\"154\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_6_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 07-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_7\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"155\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_7_date\" name=\"pg_dc_ef_7_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_7_del\" tabindex=\"156\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_7_add\" tabindex=\"157\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_8_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 08-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_8\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"158\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_8_date\" name=\"pg_dc_ef_8_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_8_del\" tabindex=\"159\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\"><\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_8_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Autres d\u00e9penses -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tOther monthly expenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tChildcare expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCustody fees in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fg\" class=\"verify input-field\" tabindex=\"160\" name=\"pg_dc_adm_fg\" type=\"text\" placeholder=\"Custody fees in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAccommodation expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAccommodation costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fl\" class=\"verify input-field\" tabindex=\"161\" name=\"pg_dc_adm_fl\" type=\"text\" placeholder=\"Accommodation costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBusiness travel expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTravel costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_ft\" class=\"verify input-field\" tabindex=\"162\" name=\"pg_dc_adm_ft\" type=\"text\" placeholder=\"Travel costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tCatering costs\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCatering costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fr\" class=\"verify input-field\" tabindex=\"163\" name=\"pg_dc_adm_fr\" type=\"text\" placeholder=\"Catering costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHealth insurance - Total household amount\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTotal household amount (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_cm\" class=\"verify input-field\" tabindex=\"163\" name=\"pg_dc_adm_cm\" type=\"text\" placeholder=\"Total household amount (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Dettes et cr\u00e9dits -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tDebts and credits\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tLoans or leases from other institutions?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCurrent loans or leases?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"164\" name=\"pg_dc_dc_cred\"  id=\"pg_dc_dc_cred\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tCurrent loans or leases? *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dc\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMonthly payments to other institutions in (CHF)\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMonthly instalments in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_dc_cred_mont\" class=\"verify input-field\" tabindex=\"165\" name=\"pg_dc_dc_cred_mont\" type=\"text\" placeholder=\"Monthly instalments in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dc\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tWould you like an offer on your current credit?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCurrent bank name\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"166\" name=\"pg_dc_dc_off\"  id=\"pg_dc_dc_off\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tBank name *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Cembra Money Bank\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Migros Bank\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Cashgate\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Bob Money\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Other\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"167\" name=\"pg_dc_dc_nbp\"  id=\"pg_dc_dc_nbp\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of prosecutions *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t0\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t1 Pursuit\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t2 Lawsuits\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t3 Lawsuits\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tMore\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAre there any deeds of default or foreclosures in progress?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tDefault deeds\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"168\" name=\"pg_dc_dc_act\"  id=\"pg_dc_dc_act\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tDefault deeds *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tTotal amount sued\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAmount in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_dc_mont\" class=\"verify input-field\" tabindex=\"169\" name=\"pg_dc_dc_mont\" type=\"text\" placeholder=\"Amount in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Remarques \/ questions -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHow would you like to use the credit?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHow would you like to use the credit?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"170\" name=\"pg_rq_cadre\"  id=\"pg_rq_cadre\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tPlease select *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"Aucune indication\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo indication\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tCurrent expenses\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tPassenger car\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tMotorcycle, moped, scooter\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tConversion of residential property\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tConversion of owner-occupied housing\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\tContinuing education\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">\r\n\t\t\t\t\t\t\t\t\t\t\tConsumer electronics, computers\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">\r\n\t\t\t\t\t\t\t\t\t\t\tHousehold appliances\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">\r\n\t\t\t\t\t\t\t\t\t\t\tHealth expenses\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">\r\n\t\t\t\t\t\t\t\t\t\t\tClothing, jewelry\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">\r\n\t\t\t\t\t\t\t\t\t\t\tSports and fitness equipment\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">\r\n\t\t\t\t\t\t\t\t\t\t\tCombining several loans\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tComments\/questions on the funding application\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<textarea class=\"verify input-field pg_check_default\" tabindex=\"171\"  id=\"pg_rq_remarque\" name=\"pg_rq_remarque\" rows=\"4\" col=\"50\" maxlength=\"1000\"><\/textarea>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- Documents \/ pi\u00e8ces jointes -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tDocuments \/ attachments\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div>For a quicker analysis of your credit application, please send us the necessary documents<\/div>\r\n\t\t\t\t\t\t\t\t<a href=\"\/documents-necessaires\/\" target=\"_blank\">List of documents required for your credit application<\/a>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__attachments\" style=\"min-height: 100px!important;\">\r\n\t\t\t\t\t\t\t\t\t<b>\r\n\t\t\t\t\t\t\t\t\t\tAttachments \r\n\t\t\t\t\t\t\t\t\t\t(max. 3 MB) <\/b>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<input class=\"pgcs__attachment\" tabindex=\"172\" name=\"attachment\" type=\"file\" accept=\".jpg,.jpeg,.png,.pdf\">\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before6\" tabindex=\"173\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"174\" id=\"btn_next6\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- R\u00e9capitulatif -->\r\n            <div id=\"form7\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tShipment confirmation\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Confirmation des informations mentionn\u00e9es -->\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t<input class=\"form-check-input\" tabindex=\"174\" type=\"checkbox\" id=\"accept_infos\" name=\"accept_infos\" >\r\n\t\t\t\t\t\t\t\t<label id=\"pgcs__legal3\" class=\"form-check-label\" for=\"accept_infos\">\r\n\t\t\t\t\t\t\t\t\tI confirm that the amounts and information below are complete, accurate and reflect my true economic situation.\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t<input class=\"form-check-input\" tabindex=\"175\" type=\"checkbox\" id=\"accept\" name=\"accept\" >\r\n\t\t\t\t\t\t\t\t<label id=\"pgcs__legal2\" class=\"form-check-label\" for=\"accept\">\r\n\t\t\t\t\t\t\t\t\tI hereby confirm that I have read the <a target=\"_blank\" href=\"\/wp-content\/uploads\/2024\/03\/Informations_juridiques.pdf\">legal information<\/a> in their entirety and declare that I accept them in all respects\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<div class=\"row\" style=\"margin-bottom : 50px;\">\r\n\t\t\t\t\t\t<div class=\"col-12 pg_media_767\" style=\"margin-bottom: 50px;\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before7\" tabindex=\"176\" class=\"pgcs_btn_validation_return pgcs_btn_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<span class=\"et-pb-icon\" style=\"font-size:12px !important;\">&#x6a;<\/span>\r\n\t\t\t\t\t\t\t\t\tModify your information \r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div id=\"pg_captcha_border\">\r\n\t\t\t\t\t\t\t\t<div class=\"h-captcha\" data-sitekey=\"24a52aeb-d749-4d60-a17a-a268e37f6469\"><\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div id=\"pg_error_captcha\" style=\"display:none; color:red !important;\">Solve the captcha to confirm that you are not a robot. <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"177\" id=\"btn_next7\" class=\"pgcs_btn_validation_all pgcs_btn_send pg_icon_state \">\r\n\t\t\t\t\t\t\t\t\tApply for credit \r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\tOverview of your information\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"form2 pg_recap_form\" style=\"padding-top: 20px;  box-shadow: 1px 2px 5px darkgrey; border-radius: 10px;\">\r\n\t\t\t\t\t<div class=\"row\" style=\"border-bottom: 1px solid #f47b24!important; padding-left:0px; padding-right:0px; padding-bottom: 0px; box-shadow: 0px 2px 2px -2px black;\">\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_1\" class=\"pg_btn_confirm activ\">\r\n\t\t\t\t\t\t\t\tCredit and monthly payments\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_2\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tPersonal data\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_3\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tProfessions and income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_4\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tHousing and expenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Cr\u00e9dit et mensualit\u00e9s -->\r\n\t\t\t\t\t<div id=\"confirm_1\" style=\"display:block; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Cr\u00e9dit souhait\u00e9 -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tCredit Required\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDesired credit in CHF\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_simulator_ammount\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDuration in months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\"  id=\"display_pg_simulator_time\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Donn\u00e9es personnelles -->\r\n\t\t\t\t\t<div id=\"confirm_2\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Donn\u00e9es personnelles -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tPersonal data\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_titre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_titre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_nom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_nom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_prenom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tFirst name\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_prenom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_ec\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCivil status\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_ec\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_nj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_nj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_pays\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_pays\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_permis\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_permis\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_pj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_pj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_vj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_vj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Coordonn\u00e9es -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tContact details and address\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_ic_tel\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPhone number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_ic_tel\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_ic_mail\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tE-mail address\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_ic_mail\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_canton\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCanton\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_canton\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_dep_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResident at this address since\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_dep_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_sit_log\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHousing situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_sit_log\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Logement en propri\u00e9t\u00e9-->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">Housing\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_prop\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHousing type  \t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_prop\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_hyp\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMortgage in CHF\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_hyp\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOwner since  \t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_dom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHome ownership\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_dom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and house number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tZip code and location\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section = Donn\u00e9es personnelles - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tPersonal data - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_titre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_titre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_nom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_nom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_prenom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tFirst name\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_prenom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_nj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_nj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_pays\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_pays\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_permis\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_permis\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_pj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_pj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_vj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_vj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Coordonn\u00e9es - Conjoint-->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tContact details - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_ic_tel\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPhone number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_ic_tel\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_ic_mail\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tE-mail address\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_ic_mail\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Professions et revenus -->\r\n\t\t\t\t\t<div id=\"confirm_3\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Revenus -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tEmployed until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section SOIT = Employeur -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_sp_employeur\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Si emplyeur ou ind\u00e9pendant = Moyen de transport -->\r\n\t\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_sp_transports\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_transp\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tHow to get to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_transp\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_auto\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tDo you have any reasons for\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_auto\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_km\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of km to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_km\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus nets -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tNet income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_sal\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMain income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_sal\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_bns\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_bns\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus Accessoires -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_aa_activity\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rs\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rs\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tUntil when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rev\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rev\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus suppl\u00e9mentaire -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_rs_revenusup\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rs_sr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rs_sr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rs_rn\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rs_rn\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t\t<!-- section = Revenus - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployment status - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tEmployed until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section SOIT = Employeur - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_sp_employeur\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployer - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section Autres = RIEN -->\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Si emplyeur ou ind\u00e9pendant = Moyen de transport - Conjoint -->\r\n\t\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_sp_transports\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_transp\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tHow to get to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_transp\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_auto\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tDo you have any reasons for\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_auto\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_km\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of km to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_km\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- section = Revenus nets - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" >\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tNet income - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_sal\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMain income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_sal\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_bns\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_bns\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus Accessoires - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_aa_activity\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tSecondary activity \/ other employers - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rs\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rs\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tUntil when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rev\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rev\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus suppl\u00e9mentaire - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_rs_revenusup\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rs_sr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rs_sr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rs_rn\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rs_rn\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Logements et d\u00e9penses -->\r\n\t\t\t\t\t<div id=\"confirm_4\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = D\u00e9penses -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_dp_pa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_dp_pa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_dp_adm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOther expenses (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_dp_adm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = D\u00e9penses - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tExpenses - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_dp_pa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_dp_pa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_dp_adm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOther expenses (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_dp_adm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\t\t\t\t\r\n\r\n\r\n\t\t\t\t\t\t<!-- section = Enfants dans le foyer  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tChildren in the household\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tChildren under 25\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_1\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t1) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_1\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_2\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t2) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_2\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_3\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t3) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_3\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_4\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t4) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_4\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_5\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t5) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_5\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_6\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t6) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_6\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_7\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t7) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_7\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_8\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t8) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_8\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section = Autres d\u00e9penses  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tOther monthly expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fg\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tChildcare expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fg\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fl\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAccommodation expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fl\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_ft\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBusiness travel expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_ft\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCatering costs\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_cm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHealth insurance\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_cm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Dettes et cr\u00e9dits  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tDebts and credits\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_cred\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tLoans or leases from other institutions?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_cred\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_cred_mont\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMonthly payments in (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_cred_mont\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_off\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOffer for your current credit?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_off\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_nbp\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_nbp\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_act\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDefault deeds\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_act\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_mont\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTotal amount pursued (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_mont\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Remarques questions  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rq_cadre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCredit utilization framework\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rq_cadre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rq_remarque\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rq_remarque\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- input = send recap by post  -->\r\n\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t<input id=\"pg_send_form\" style=\"visibility:hidden;\" name=\"pg_send_form\" type=\"text\">\r\n\t\t\t\t\t\t\t\t<input id=\"pg_agt_number\" name=\"pg_agt_number\" style=\"visibility:hidden;\" type=\"text\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\r\n\t\t<button type=\"submit\" id=\"pg_send_button\" style=\"visibility:hidden !important;\"><\/button>\r\n\t<\/form>\r\n<\/div>\r\n\r\n<script src='https:\/\/www.hCaptcha.com\/1\/api.js' async defer><\/script>\r\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;footer&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#edecec&#8221; min_height=&#8221;274px&#8221; custom_margin=&#8221;||-6px|||&#8221; custom_padding=&#8221;5px||5px|||&#8221; global_module=&#8221;208&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_4,1_4,1_4,1_4&#8243; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;|auto||auto|false|false&#8221; border_color_right=&#8221;#FFFFFF&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Leitao Agency&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_icon font_icon=&#8221;&#xf015;||fa||900&#8243; icon_color=&#8221;#f47b24&#8243; icon_width=&#8221;48px&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_icon][et_pb_blurb title=&#8221;AL Finance SA&#8221; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.22.0&#8243; header_font=&#8221;Montserrat|600|||||||&#8221; header_text_align=&#8221;center&#8221; header_font_size=&#8221;20px&#8221; body_font=&#8221;||||||||&#8221; body_font_size=&#8221;16px&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;||0px||false|false&#8221; animation_style=&#8221;fold&#8221; animation_direction=&#8221;bottom&#8221; animation_intensity_fold=&#8221;20%&#8221; animation_starting_opacity=&#8221;100%&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][et_pb_text _builder_version=&#8221;4.22.0&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#666666&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.8em&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: center;\">Route des Arseaux 7<br \/>1700 Fribourg<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Opening hours&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_icon font_icon=&#8221;&#xf017;||fa||900&#8243; icon_color=&#8221;#f47b24&#8243; icon_width=&#8221;48px&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_icon][et_pb_blurb title=&#8221;Opening hours&#8221; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.22.0&#8243; header_font=&#8221;Montserrat|600|||||||&#8221; header_text_align=&#8221;center&#8221; header_font_size=&#8221;20px&#8221; body_font=&#8221;||||||||&#8221; body_font_size=&#8221;16px&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;||1px|||&#8221; animation_style=&#8221;fold&#8221; animation_direction=&#8221;bottom&#8221; animation_intensity_fold=&#8221;20%&#8221; animation_starting_opacity=&#8221;100%&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][et_pb_text _builder_version=&#8221;4.22.0&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#666666&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.8em&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: center;\">Monday &#8211; Friday<br \/>08:30-12:00 &#8211; 13h30-18h00<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Call&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_icon font_icon=&#8221;&#xe090;||divi||400&#8243; icon_color=&#8221;#f47b24&#8243; icon_width=&#8221;48px&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_icon][et_pb_blurb title=&#8221;Call&#8221; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.22.0&#8243; header_font=&#8221;Montserrat|600|||||||&#8221; header_text_align=&#8221;center&#8221; header_font_size=&#8221;20px&#8221; body_font=&#8221;||||||||&#8221; body_font_size=&#8221;16px&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;||1px|||&#8221; animation_style=&#8221;fold&#8221; animation_direction=&#8221;bottom&#8221; animation_intensity_fold=&#8221;20%&#8221; animation_starting_opacity=&#8221;100%&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][et_pb_text _builder_version=&#8221;4.22.0&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#666666&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.8em&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: center;\">026 424 48 88<br \/>079 230 70 06<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Contact&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; border_width_right=&#8221;0px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_icon font_icon=&#8221;&#xe076;||divi||400&#8243; icon_color=&#8221;#f47b24&#8243; icon_width=&#8221;48px&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_icon][et_pb_blurb title=&#8221;Contact&#8221; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.22.0&#8243; header_font=&#8221;Montserrat|600|||||||&#8221; header_text_align=&#8221;center&#8221; header_font_size=&#8221;20px&#8221; body_font=&#8221;||||||||&#8221; body_font_size=&#8221;16px&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;||1px|||&#8221; animation_style=&#8221;fold&#8221; animation_direction=&#8221;bottom&#8221; animation_intensity_fold=&#8221;20%&#8221; animation_starting_opacity=&#8221;100%&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][et_pb_text _builder_version=&#8221;4.22.0&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#666666&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.8em&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: center;\">Become a partner<br \/><a href=\"mailto:agence@leitao.ch\">info@alfinance.ch<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; min_height=&#8221;76px&#8221; custom_margin=&#8221;|auto|-3px|auto||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_social_media_follow use_icon_font_size=&#8221;on&#8221; icon_font_size=&#8221;30px&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; text_orientation=&#8221;center&#8221; custom_margin=&#8221;||-21px|0px|false|false&#8221; custom_padding=&#8221;|||0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_social_media_follow_network social_network=&#8221;facebook&#8221; url=&#8221;https:\/\/www.facebook.com\/ALFinanceSA&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#3b5998&#8243; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]facebook[\/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=&#8221;linkedin&#8221; url=&#8221;https:\/\/www.linkedin.com\/company\/al-finance-sa\/&#8221; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#007bb6&#8243; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]linkedin[\/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=&#8221;whatsapp&#8221; url=&#8221;https:\/\/wa.me\/41792307006&#8243; _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#25D366&#8243; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]whatsapp[\/et_pb_social_media_follow_network][\/et_pb_social_media_follow][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Simulate your credit<!-- GET CONFIG -->\r\n\r\n<div id=\"cs-form\" class=\"pgcs pgcs_all\" data-t1=\"4.9\" data-t2=\"7.7\" data-t3=\"9.95\">\r\n\t\r\n\t<div>\r\n\t\t<div id=\"myPopup\" style=\"display:none;\" class=\"alert alert-success\"><\/div>\r\n\t<\/div>\r\n\t<div id=\"myPopup_error\" style=\"display:none;\" class=\"alert alert-danger\"><\/div>\r\n\t\r\n\r\n\t<form id=\"pg_form_height\" name=\"form_all\" method=\"post\" enctype=\"multipart\/form-data\" action=\"https:\/\/alcredit.ch\/wp-admin\/admin-post.php\" onsubmit=\"return pg_submit_all();\">\r\n\t\t<input type=\"hidden\" name=\"action\" value=\"pgcs_send_form\">\r\n\t\t<input type=\"hidden\" name=\"form_size_big\" value=\"1\">\r\n\t\t<input type=\"hidden\" name=\"app_fb\" value=\"\">\r\n\r\n\t\t<div class=\"pgcs__wrapper\">\r\n            <div id=\"form1\" style=\"max-height:400px;\" class=\"row justify-content-center form1 visited\">\r\n\t\t\t\t<div class=\"col-md-5 pg_csform_col pgcs_col_margin pg_1st_col\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-md-1 pgcs_col_space\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs_montant_duree\">\r\n\t\t\t\t\t\t\t\t\tAmount of credit\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t\t<div class=\" slider-box\">\r\n\t\t\t\t\t\t\t\t\t\t<label class=\"pgcs__big-input\">\r\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"pgcs__montant pgcs_input_value\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_simulator_ammount\" class=\"pgcs__montant-slider\" name=\"montant_real\" type=\"text\" data-slider-value=\"30000\" data-slider-step=\"1000\" data-slider-min=\"3000\" data-slider-max=\"350000\" >\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-md-1\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs_montant_duree\">\r\n\t\t\t\t\t\t\t\t\tDuration \r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t\t<div class=\" slider-box\">\r\n\t\t\t\t\t\t\t\t\t\t<label class=\"pgcs__big-input\">\r\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"pgcs__duree pgcs_input_value\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\t\t<span> Month <\/span>\r\n\t\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_simulator_time\" class=\"pgcs__duree-slider\" name=\"duree_real\" type=\"text\" data-slider-value=\"48\" data-slider-step=\"1\" data-slider-min=\"6\" data-slider-max=\"120\" >\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-md-5 pg_csform_col pgcs_col_margin pg_2nd_col\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\">\r\n\t\t\t\t\t\t\t\t\tYour monthly payment from \r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-1\"><\/span>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-head\">\r\n\t\t\t\t\t\t\t\t\t\tfor a rate of \r\n\t\t\t\t\t\t\t\t\t\tRate of \r\n\t\t\t\t\t\t\t\t\t\t4.9\t\t\t\t\t\t\t\t\t\t% *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-montant_fs pgcs__mens-montant_fs_al\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-3\"><\/span>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<span class=\"pgcs__mens-head\">\r\n\t\t\t\t\t\t\t\t\t\tfor a rate of \r\n\t\t\t\t\t\t\t\t\t\tRate of \r\n\t\t\t\t\t\t\t\t\t\t9.95\t\t\t\t\t\t\t\t\t\t% *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t \r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__mens-conditions\">\r\n\t\t\t\t\t\t\t\t\tThe granting of credit is prohibited if it leads to overindebtedness (art. 3 LCD).\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"pgcs_btn_center pg_media_767\">\r\n\t\t\t\t\t\t<button type=\"button\" id=\"btn_next1\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\tConfirm\t\t\t\t\t\t\t<span class=\"pg_icon_next2\">\r\n\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-right pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-right pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"pgcs_text_taux col-md-12\" style=\"margin-top: 100px !important;\">\r\n\t\t\t\t\t<div class=\"pgcs__mens-box pgcs__mens-box-indications\">\r\n\t\t\t\t\t\t<div class=\"row pgcs__mens\">\r\n\t\t\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t\t\t* Rates are indicative only. The effective annual interest rate is between \t\t\t\t\t\t\t\t4.9% \r\n\t\t\t\t\t\t\t\t  and\t\t\t\t\t\t\t\t9.95% \r\n\t\t\t\t\t\t\t\t  and is calculated according to your financial situation. For an amount of   \t\t\t\t\t\t\t\t30000  and an interest rate of 10.95%, the total costs incurred \r\n are CHF 8,270.20 over an 84-month term. Each file is treated individually and \r\n according to the conditions of our partners. \t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div id=\"pg_agt_number_div\" class=\"col-sm-12\"style=\"font-size: 10px;\" ><\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Donn\u00e9es personnelles - Personne -->\r\n            <div id=\"form2\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form\">\r\n\t\t\t\t\t<!-- Step = Donnees personnelles -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tYour personal data\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = VOUS -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<!-- Section = Vous -->\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYou\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\tPlease enter your details as they appear on your official identity document.\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Titre + \u00c9tat civil -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTitle*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify verify input-field pg_check_default\" tabindex=\"1\" name=\"pg_dp_v_titre\" id=\"pg_dp_v_titre\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tTitle *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tMs.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMr.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCivil status*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"2\" name=\"pg_dp_v_ec\" id=\"pg_dp_v_ec\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tCivil status *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tSingle\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMarried\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tDivorced\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tWidower\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Nom + Pr\u00e9nom -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tName *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_v_nom\" class=\"verify input-field\" tabindex=\"3\" name=\"pg_dp_v_nom\" type=\"text\" placeholder=\"Name *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" >\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tSurname *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_v_prenom\" class=\"verify input-field\"  tabindex=\"4\" name=\"pg_dp_v_prenom\" type=\"text\" placeholder=\"Surname *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Date de Naissance -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n  \t\t\t\t\t\t\t\t<input tabindex=\"5\" type=\"date\" class=\"verify_date input-field\" id=\"pg_dp_v_n_date\" name=\"pg_dp_v_n_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_v_n_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tYou must be between 18 and 69 years of age.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Nationalit\u00e9 -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nationalit\u00e9 + Pays -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNationality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select name=\"pg_dp_n_pays\" tabindex=\"8\" class=\"verify input-field pg_check_default\" id=\"pg_dp_n_pays\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Nationality *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CHSuisse\" value=\"CH\" data-text=\"Suisse\">Switzerland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LILiechtenstein\" value=\"LI\" data-text=\"Liechtenstein\">Liechtenstein<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DEAllemagne\" value=\"DE\" data-text=\"Allemagne\">Germany<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ATAutriche\" value=\"AT\" data-text=\"Autriche\">Austria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FRFrance\" value=\"FR\" data-text=\"France\">France<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ITItalie\" value=\"IT\" data-text=\"Italie\">Italy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PTPortugal\" value=\"PT\" data-text=\"Portugal\">Portugal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZAAfrique du Sud\" value=\"ZA\" data-text=\"Afrique du Sud\">South Africa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ALAlbanie\" value=\"AL\" data-text=\"Albanie\">Albania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DZAlg\u00e9rie\" value=\"DZ\" data-text=\"Alg\u00e9rie\">Algeria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ADAndorre\" value=\"AD\" data-text=\"Andorre\">Andorra<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AOAngola\" value=\"AO\" data-text=\"Angola\">Angola<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AIAnguilla\" value=\"AI\" data-text=\"Anguilla\">Anguilla<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AQAntarctique\" value=\"AQ\" data-text=\"Antarctique\">Antarctica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AGAntigua-et-Barbuda\" value=\"AG\" data-text=\"Antigua-et-Barbuda\">Antigua and Barbuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SAArabie saoudite\" value=\"SA\" data-text=\"Arabie saoudite\">Saudi Arabia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ARArgentine\" value=\"AR\" data-text=\"Argentine\">Argentina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AMArm\u00e9nie\" value=\"AM\" data-text=\"Arm\u00e9nie\">Armenia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AWAruba\" value=\"AW\" data-text=\"Aruba\">Aruba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AUAustralie\" value=\"AU\" data-text=\"Australie\">Australia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AZAzerba\u00efdjan\" value=\"AZ\" data-text=\"Azerba\u00efdjan\">Azerbaijan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BSBahamas\" value=\"BS\" data-text=\"Bahamas\">Bahamas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BHBahre\u00efn\" value=\"BH\" data-text=\"Bahre\u00efn\">Bahrain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BDBangladesh\" value=\"BD\" data-text=\"Bangladesh\">Bangladesh<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BBBarbade\" value=\"BB\" data-text=\"Barbade\">Barbados<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BYB\u00e9larus\" value=\"BY\" data-text=\"B\u00e9larus\">Belarus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BEBelgique\" value=\"BE\" data-text=\"Belgique\">Belgium<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BZBelize\" value=\"BZ\" data-text=\"Belize\">Belize<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BJB\u00e9nin\" value=\"BJ\" data-text=\"B\u00e9nin\">Benin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BMBermudes\" value=\"BM\" data-text=\"Bermudes\">Bermuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BTBhoutan\" value=\"BT\" data-text=\"Bhoutan\">Bhutan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BOBolivie\" value=\"BO\" data-text=\"Bolivie\">Bolivia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BQBonaire, Saint Eustatius et Saba\" value=\"BQ\" data-text=\"Bonaire, Saint Eustatius et Saba\">Bonaire, Saint Eustatius and Saba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BABosnie et Herz\u00e9govine\" value=\"BA\" data-text=\"Bosnie et Herz\u00e9govine\">Bosnia and Herzegovina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BWBotswana\" value=\"BW\" data-text=\"Botswana\">Botswana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BRBr\u00e9sil\" value=\"BR\" data-text=\"Br\u00e9sil\">Brazil<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BNBrun\u00e9i Darussalam\" value=\"BN\" data-text=\"Brun\u00e9i Darussalam\">Brunei Darussalam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BGBulgarie\" value=\"BG\" data-text=\"Bulgarie\">Bulgaria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BFBurkina Faso\" value=\"BF\" data-text=\"Burkina Faso\">Burkina Faso<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BIBurundi\" value=\"BI\" data-text=\"Burundi\">Burundi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CVCabo Verde\" value=\"CV\" data-text=\"Cabo Verde\">Cabo Verde<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KHCambodge\" value=\"KH\" data-text=\"Cambodge\">Cambodia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CMCameroun\" value=\"CM\" data-text=\"Cameroun\">Cameroon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CACanada\" value=\"CA\" data-text=\"Canada\">Canada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CLChili\" value=\"CL\" data-text=\"Chili\">Chile<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CNChine\" value=\"CN\" data-text=\"Chine\">China<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CYChypre\" value=\"CY\" data-text=\"Chypre\">Cyprus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VACit\u00e9 du Vatican\" value=\"VA\" data-text=\"Cit\u00e9 du Vatican\">Vatican City<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-COColombie\" value=\"CO\" data-text=\"Colombie\">Colombia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KMComores\" value=\"KM\" data-text=\"Comores\">Comoros<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CGCongo (Brazzaville)\" value=\"CG\" data-text=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CDCongo (Kinshasa)\" value=\"CD\" data-text=\"Congo (Kinshasa)\">Congo (Kinshasa)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KPCor\u00e9e du Nord\" value=\"KP\" data-text=\"Cor\u00e9e du Nord\">North Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KRCor\u00e9e du Sud\" value=\"KR\" data-text=\"Cor\u00e9e du Sud\">South Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CRCosta Rica\" value=\"CR\" data-text=\"Costa Rica\">Costa Rica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CIC\u00f4te d\u2019Ivoire\" value=\"CI\" data-text=\"C\u00f4te d\u2019Ivoire\">Ivory Coast<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HRCroatie\" value=\"HR\" data-text=\"Croatie\">Croatia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CUCuba\" value=\"CU\" data-text=\"Cuba\">Cuba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CWCura\u00e7ao\" value=\"CW\" data-text=\"Cura\u00e7ao\">Cura\u00e7ao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DKDanemark\" value=\"DK\" data-text=\"Danemark\">Denmark<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DJDjibouti\" value=\"DJ\" data-text=\"Djibouti\">Djibouti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DMDominique\" value=\"DM\" data-text=\"Dominique\">Dominique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EG\u00c9gypte\" value=\"EG\" data-text=\"\u00c9gypte\">Egypt<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SVEl Salvador\" value=\"SV\" data-text=\"El Salvador\">El Salvador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AE\u00c9mirats arabes unis\" value=\"AE\" data-text=\"\u00c9mirats arabes unis\">United Arab Emirates<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EC\u00c9quateur\" value=\"EC\" data-text=\"\u00c9quateur\">Ecuador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ER\u00c9rythr\u00e9e\" value=\"ER\" data-text=\"\u00c9rythr\u00e9e\">Eritrea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ESEspagne\" value=\"ES\" data-text=\"Espagne\">Spain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EEEstonie\" value=\"EE\" data-text=\"Estonie\">Estonia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SZEswatini\" value=\"SZ\" data-text=\"Eswatini\">Eswatini<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-US\u00c9tats-Unis\" value=\"US\" data-text=\"\u00c9tats-Unis\">United States<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ET\u00c9thiopie\" value=\"ET\" data-text=\"\u00c9thiopie\">Ethiopia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FJFidji\" value=\"FJ\" data-text=\"Fidji\">Fiji<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FIFinlande\" value=\"FI\" data-text=\"Finlande\">Finland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GAGabon\" value=\"GA\" data-text=\"Gabon\">Gabon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GMGambie\" value=\"GM\" data-text=\"Gambie\">Gambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GEG\u00e9orgie\" value=\"GE\" data-text=\"G\u00e9orgie\">Georgia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GSG\u00e9orgie du Sud et les \u00celes Sandwich du Sud\" value=\"GS\" data-text=\"G\u00e9orgie du Sud et les \u00celes Sandwich du Sud\">South Georgia and the South Sandwich Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GHGhana\" value=\"GH\" data-text=\"Ghana\">Ghana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GIGibraltar\" value=\"GI\" data-text=\"Gibraltar\">Gibraltar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GRGr\u00e8ce\" value=\"GR\" data-text=\"Gr\u00e8ce\">Greece<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GDGrenade\" value=\"GD\" data-text=\"Grenade\">Granada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GLGroenland\" value=\"GL\" data-text=\"Groenland\">Greenland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GPGuadeloupe\" value=\"GP\" data-text=\"Guadeloupe\">Guadeloupe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GUGuam\" value=\"GU\" data-text=\"Guam\">Guam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GTGuatemala\" value=\"GT\" data-text=\"Guatemala\">Guatemala<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GGGuernesey\" value=\"GG\" data-text=\"Guernesey\">Guernsey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GNGuin\u00e9e\" value=\"GN\" data-text=\"Guin\u00e9e\">Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GQGuin\u00e9e \u00e9quatoriale\" value=\"GQ\" data-text=\"Guin\u00e9e \u00e9quatoriale\">Equatorial Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GWGuin\u00e9e-Bissau\" value=\"GW\" data-text=\"Guin\u00e9e-Bissau\">Guinea-Bissau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GYGuyana\" value=\"GY\" data-text=\"Guyana\">Guyana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GFGuyane fran\u00e7aise\" value=\"GF\" data-text=\"Guyane fran\u00e7aise\">French Guiana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HTHa\u00efti\" value=\"HT\" data-text=\"Ha\u00efti\">Haiti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HNHonduras\" value=\"HN\" data-text=\"Honduras\">Honduras<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HKHong Kong\" value=\"HK\" data-text=\"Hong Kong\">Hong Kong<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HUHongrie\" value=\"HU\" data-text=\"Hongrie\">Hungary<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BV\u00cele Bouvet\" value=\"BV\" data-text=\"\u00cele Bouvet\">Bouvet Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NF\u00cele Norfolk\" value=\"NF\" data-text=\"\u00cele Norfolk\">Norfolk Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KY\u00celes Ca\u00efmans\" value=\"KY\" data-text=\"\u00celes Ca\u00efmans\">Cayman Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CC\u00celes Cocos (Keeling)\" value=\"CC\" data-text=\"\u00celes Cocos (Keeling)\">Cocos Islands (Keeling)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CK\u00celes Cook\" value=\"CK\" data-text=\"\u00celes Cook\">Cook Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AX\u00celes d'Aland\" value=\"AX\" data-text=\"\u00celes d'Aland\">Aland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FO\u00celes F\u00e9ro\u00e9\" value=\"FO\" data-text=\"\u00celes F\u00e9ro\u00e9\">Faroe Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HM\u00celes Heard et MacDonald\" value=\"HM\" data-text=\"\u00celes Heard et MacDonald\">Heard and MacDonald Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FK\u00celes Malouines\" value=\"FK\" data-text=\"\u00celes Malouines\">Falkland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MP\u00celes Mariannes du Nord\" value=\"MP\" data-text=\"\u00celes Mariannes du Nord\">Northern Mariana Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MH\u00celes Marshall\" value=\"MH\" data-text=\"\u00celes Marshall\">Marshall Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PN\u00celes Pitcairn\" value=\"PN\" data-text=\"\u00celes Pitcairn\">Pitcairn Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SB\u00celes Salomon\" value=\"SB\" data-text=\"\u00celes Salomon\">Solomon Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TC\u00celes Turques-et-Ca\u00efques\" value=\"TC\" data-text=\"\u00celes Turques-et-Ca\u00efques\">Turks and Caicos Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VI\u00celes Vierges am\u00e9ricaines\" value=\"VI\" data-text=\"\u00celes Vierges am\u00e9ricaines\">U.S. Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VG\u00celes Vierges britanniques\" value=\"VG\" data-text=\"\u00celes Vierges britanniques\">British Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-INInde\" value=\"IN\" data-text=\"Inde\">India<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IDIndon\u00e9sie\" value=\"ID\" data-text=\"Indon\u00e9sie\">Indonesia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IQIrak\" value=\"IQ\" data-text=\"Irak\">Iraq<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IRIran\" value=\"IR\" data-text=\"Iran\">Iran<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IEIrlande\" value=\"IE\" data-text=\"Irlande\">Irlande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ISIslande\" value=\"IS\" data-text=\"Islande\">Islande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ILIsra\u00ebl\" value=\"IL\" data-text=\"Isra\u00ebl\">Isra\u00ebl<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JMJama\u00efque\" value=\"JM\" data-text=\"Jama\u00efque\">Jama\u00efque<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JPJapon\" value=\"JP\" data-text=\"Japon\">Japon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JOJordanie\" value=\"JO\" data-text=\"Jordanie\">Jordanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KZKazakhstan\" value=\"KZ\" data-text=\"Kazakhstan\">Kazakhstan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KEKenya\" value=\"KE\" data-text=\"Kenya\">Kenya<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KGKirghizistan\" value=\"KG\" data-text=\"Kirghizistan\">Kirghizistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KIKiribati\" value=\"KI\" data-text=\"Kiribati\">Kiribati<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-XKKosovo\" value=\"XK\" data-text=\"Kosovo\">Kosovo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KWKowe\u00eft\" value=\"KW\" data-text=\"Kowe\u00eft\">Kowe\u00eft<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RELa R\u00e9union\" value=\"RE\" data-text=\"La R\u00e9union\">La R\u00e9union<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LALaos\" value=\"LA\" data-text=\"Laos\">Laos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LSLesotho\" value=\"LS\" data-text=\"Lesotho\">Lesotho<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LVLettonie\" value=\"LV\" data-text=\"Lettonie\">Lettonie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LBLiban\" value=\"LB\" data-text=\"Liban\">Liban<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LRLib\u00e9ria\" value=\"LR\" data-text=\"Lib\u00e9ria\">Lib\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LYLibye\" value=\"LY\" data-text=\"Libye\">Libye<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LTLituanie\" value=\"LT\" data-text=\"Lituanie\">Lituanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LULuxembourg\" value=\"LU\" data-text=\"Luxembourg\">Luxembourg<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MOMacao\" value=\"MO\" data-text=\"Macao\">Macao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MKMac\u00e9doine du Nord\" value=\"MK\" data-text=\"Mac\u00e9doine du Nord\">Mac\u00e9doine du Nord<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MGMadagascar\" value=\"MG\" data-text=\"Madagascar\">Madagascar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MYMalaisie\" value=\"MY\" data-text=\"Malaisie\">Malaisie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MWMalawi\" value=\"MW\" data-text=\"Malawi\">Malawi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MVMaldives\" value=\"MV\" data-text=\"Maldives\">Maldives<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MLMali\" value=\"ML\" data-text=\"Mali\">Mali<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MTMalte\" value=\"MT\" data-text=\"Malte\">Malte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MAMaroc\" value=\"MA\" data-text=\"Maroc\">Maroc<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MQMartinique\" value=\"MQ\" data-text=\"Martinique\">Martinique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MUMaurice\" value=\"MU\" data-text=\"Maurice\">Maurice<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MRMauritanie\" value=\"MR\" data-text=\"Mauritanie\">Mauritanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YTMayotte\" value=\"YT\" data-text=\"Mayotte\">Mayotte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MXMexique\" value=\"MX\" data-text=\"Mexique\">Mexique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FMMicron\u00e9sie\" value=\"FM\" data-text=\"Micron\u00e9sie\">Micron\u00e9sie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MDMoldavie\" value=\"MD\" data-text=\"Moldavie\">Moldavie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MCMonaco\" value=\"MC\" data-text=\"Monaco\">Monaco<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MNMongolie\" value=\"MN\" data-text=\"Mongolie\">Mongolie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MEMont\u00e9n\u00e9gro\" value=\"ME\" data-text=\"Mont\u00e9n\u00e9gro\">Mont\u00e9n\u00e9gro<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MSMontserrat\" value=\"MS\" data-text=\"Montserrat\">Montserrat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MZMozambique\" value=\"MZ\" data-text=\"Mozambique\">Mozambique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MMMyanmar\" value=\"MM\" data-text=\"Myanmar\">Myanmar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NANamibie\" value=\"NA\" data-text=\"Namibie\">Namibie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NRNauru\" value=\"NR\" data-text=\"Nauru\">Nauru<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NPN\u00e9pal\" value=\"NP\" data-text=\"N\u00e9pal\">N\u00e9pal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NINicaragua\" value=\"NI\" data-text=\"Nicaragua\">Nicaragua<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NENiger\" value=\"NE\" data-text=\"Niger\">Niger<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NGNig\u00e9ria\" value=\"NG\" data-text=\"Nig\u00e9ria\">Nig\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NUNiue\" value=\"NU\" data-text=\"Niue\">Niue<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NONorv\u00e8ge\" value=\"NO\" data-text=\"Norv\u00e8ge\">Norv\u00e8ge<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NCNouvelle-Cal\u00e9donie\" value=\"NC\" data-text=\"Nouvelle-Cal\u00e9donie\">Nouvelle-Cal\u00e9donie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NZNouvelle-Z\u00e9lande\" value=\"NZ\" data-text=\"Nouvelle-Z\u00e9lande\">Nouvelle-Z\u00e9lande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-OMOman\" value=\"OM\" data-text=\"Oman\">Oman<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UGOuganda\" value=\"UG\" data-text=\"Ouganda\">Ouganda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UZOuzb\u00e9kistan\" value=\"UZ\" data-text=\"Ouzb\u00e9kistan\">Ouzb\u00e9kistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PKPakistan\" value=\"PK\" data-text=\"Pakistan\">Pakistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PWPalaos\" value=\"PW\" data-text=\"Palaos\">Palaos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PSPalestine\" value=\"PS\" data-text=\"Palestine\">Palestine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PAPanama\" value=\"PA\" data-text=\"Panama\">Panama<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PGPapouasie-Nouvelle-Guin\u00e9e\" value=\"PG\" data-text=\"Papouasie-Nouvelle-Guin\u00e9e\">Papouasie-Nouvelle-Guin\u00e9e<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PYParaguay\" value=\"PY\" data-text=\"Paraguay\">Paraguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NLPays-Bas\" value=\"NL\" data-text=\"Pays-Bas\">Pays-Bas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PEP\u00e9rou\" value=\"PE\" data-text=\"P\u00e9rou\">P\u00e9rou<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PHPhilippines\" value=\"PH\" data-text=\"Philippines\">Philippines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PLPologne\" value=\"PL\" data-text=\"Pologne\">Pologne<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PRPorto Rico\" value=\"PR\" data-text=\"Porto Rico\">Porto Rico<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-QAQatar\" value=\"QA\" data-text=\"Qatar\">Qatar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CFR\u00e9publique centrafricaine\" value=\"CF\" data-text=\"R\u00e9publique centrafricaine\">R\u00e9publique centrafricaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DOR\u00e9publique dominicaine\" value=\"DO\" data-text=\"R\u00e9publique dominicaine\">R\u00e9publique dominicaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RORoumanie\" value=\"RO\" data-text=\"Roumanie\">Roumanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GBRoyaume-Uni\" value=\"GB\" data-text=\"Royaume-Uni\">Royaume-Uni<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RURussie\" value=\"RU\" data-text=\"Russie\">Russie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RWRwanda\" value=\"RW\" data-text=\"Rwanda\">Rwanda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EHSahara occidental\" value=\"EH\" data-text=\"Sahara occidental\">Sahara occidental<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BLSaint-Barth\u00e9lemy\" value=\"BL\" data-text=\"Saint-Barth\u00e9lemy\">Saint-Barth\u00e9lemy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KNSaint-Kitts-et-Nevis\" value=\"KN\" data-text=\"Saint-Kitts-et-Nevis\">Saint-Kitts-et-Nevis<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SMSaint-Marin\" value=\"SM\" data-text=\"Saint-Marin\">Saint-Marin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MFSaint-Martin (France)\" value=\"MF\" data-text=\"Saint-Martin (France)\">Saint-Martin (France)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PMSaint-Pierre-et-Miquelon\" value=\"PM\" data-text=\"Saint-Pierre-et-Miquelon\">Saint-Pierre-et-Miquelon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VCSaint-Vincent-et-les Grenadines\" value=\"VC\" data-text=\"Saint-Vincent-et-les Grenadines\">Saint-Vincent-et-les Grenadines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SHSainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\" value=\"SH\" data-text=\"Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\">Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LCSainte-Lucie\" value=\"LC\" data-text=\"Sainte-Lucie\">Sainte-Lucie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WSSamoa\" value=\"WS\" data-text=\"Samoa\">Samoa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ASSamoa am\u00e9ricaines\" value=\"AS\" data-text=\"Samoa am\u00e9ricaines\">Samoa am\u00e9ricaines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-STSao Tom\u00e9-et-Principe\" value=\"ST\" data-text=\"Sao Tom\u00e9-et-Principe\">Sao Tom\u00e9-et-Principe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SNS\u00e9n\u00e9gal\" value=\"SN\" data-text=\"S\u00e9n\u00e9gal\">S\u00e9n\u00e9gal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RSSerbie\" value=\"RS\" data-text=\"Serbie\">Serbie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SCSeychelles\" value=\"SC\" data-text=\"Seychelles\">Seychelles<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SLSierra Leone\" value=\"SL\" data-text=\"Sierra Leone\">Sierra Leone<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SGSingapour\" value=\"SG\" data-text=\"Singapour\">Singapour<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SXSint Maarten (Pays-Bas)\" value=\"SX\" data-text=\"Sint Maarten (Pays-Bas)\">Sint Maarten (Pays-Bas)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SKSlovaquie\" value=\"SK\" data-text=\"Slovaquie\">Slovaquie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SISlov\u00e9nie\" value=\"SI\" data-text=\"Slov\u00e9nie\">Slov\u00e9nie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SOSomalie\" value=\"SO\" data-text=\"Somalie\">Somalie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SDSoudan\" value=\"SD\" data-text=\"Soudan\">Soudan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SSSoudan du Sud\" value=\"SS\" data-text=\"Soudan du Sud\">Soudan du Sud<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LKSri Lanka\" value=\"LK\" data-text=\"Sri Lanka\">Sri Lanka<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SESu\u00e8de\" value=\"SE\" data-text=\"Su\u00e8de\">Su\u00e8de<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SRSuriname\" value=\"SR\" data-text=\"Suriname\">Suriname<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SJSvalbard et Jan Mayen\" value=\"SJ\" data-text=\"Svalbard et Jan Mayen\">Svalbard and Jan Mayen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SYSyrie\" value=\"SY\" data-text=\"Syrie\">Syria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TJTadjikistan\" value=\"TJ\" data-text=\"Tadjikistan\">Tajikistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TWTa\u00efwan\" value=\"TW\" data-text=\"Ta\u00efwan\">Taiwan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TZTanzanie\" value=\"TZ\" data-text=\"Tanzanie\">Tanzania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TDTchad\" value=\"TD\" data-text=\"Tchad\">Chad<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CZTch\u00e9quie\" value=\"CZ\" data-text=\"Tch\u00e9quie\">Czech Republic<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TFTerres australes et antarctiques fran\u00e7aises\" value=\"TF\" data-text=\"Terres australes et antarctiques fran\u00e7aises\">French Southern and Antarctic Lands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IOTerritoire britannique de l\u2019oc\u00e9an Indien\" value=\"IO\" data-text=\"Territoire britannique de l\u2019oc\u00e9an Indien\">British Indian Ocean Territory<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-THTha\u00eflande\" value=\"TH\" data-text=\"Tha\u00eflande\">Thailand<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TIBTibet\" value=\"TIB\" data-text=\"Tibet\">Tibet<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TLTimor-Leste\" value=\"TL\" data-text=\"Timor-Leste\">Timor-Leste<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TGTogo\" value=\"TG\" data-text=\"Togo\">Togo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TKTokelau\" value=\"TK\" data-text=\"Tokelau\">Tokelau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TOTonga\" value=\"TO\" data-text=\"Tonga\">Tonga<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TTTristan da Cunha\" value=\"TT\" data-text=\"Tristan da Cunha\">Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TNTunisie\" value=\"TN\" data-text=\"Tunisie\">Tunisia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TMTurkm\u00e9nistan\" value=\"TM\" data-text=\"Turkm\u00e9nistan\">Turkmenistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TRTurquie\" value=\"TR\" data-text=\"Turquie\">Turkey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TVTuvalu\" value=\"TV\" data-text=\"Tuvalu\">Tuvalu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UAUkraine\" value=\"UA\" data-text=\"Ukraine\">Ukraine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UYUruguay\" value=\"UY\" data-text=\"Uruguay\">Uruguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VUVanuatu\" value=\"VU\" data-text=\"Vanuatu\">Vanuatu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VEVenezuela\" value=\"VE\" data-text=\"Venezuela\">Venezuela<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VNVietnam\" value=\"VN\" data-text=\"Vietnam\">Vietnam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WFWallis-et-Futuna\" value=\"WF\" data-text=\"Wallis-et-Futuna\">Wallis and Futuna<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YEY\u00e9men\" value=\"YE\" data-text=\"Y\u00e9men\">Yemen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZMZambie\" value=\"ZM\" data-text=\"Zambie\">Zambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZWZimbabwe\" value=\"ZW\" data-text=\"Zimbabwe\">Zimbabwe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-00Autre\" value=\"00\" data-text=\"Autre\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_permis\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"9\" name=\"pg_dp_n_permis\" id=\"pg_dp_n_permis\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tB\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tC\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de permis + Valable jusqu'\u00e0 quand-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_entre\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"10\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_n_p_date\" name=\"pg_dp_n_p_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_n_p_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date of entry into Switzerland.\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_n_valid\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"13\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_n_v_date\" name=\"pg_dp_n_v_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_n_v_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid validity date.\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Infos de contact -->\t\t\t\t\t\t\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tContact information\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- N\u00b0 de t\u00e9l\u00e9phone + Adresse e-mail -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMobile phone *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_ic_tel\" class=\"verify input-field\" tabindex=\"16\" name=\"pg_dp_ic_tel\" type=\"text\" placeholder=\"Mobile phone *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tEmail address *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_ic_mail\" class=\"verify input-field\" tabindex=\"17\" name=\"pg_dp_ic_mail\" type=\"text\" placeholder=\"Email address *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t\t<input class=\"verify form-check-input\" tabindex=\"18\" type=\"checkbox\" id=\"pg_dp_ic_rgpd\" name=\"pg_dp_ic_rgpd\" >\r\n\t\t\t\t\t\t\t\t\t<label class=\"form-check-label\">\r\n\t\t\t\t\t\t\t\t\t\tI have read and accept the provisions relating to the use of electronic means of communication and  \t\t\t\t\t\t\t\t\t\t<a target=\"_blank\" href=\"\/wp-content\/uploads\/2024\/03\/politiqueconfidentialite.pdf\">\r\n\t\t\t\t\t\t\t\t\t\t\tthe entire privacy policy.\t\t\t\t\t\t\t\t\t\t<\/a>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Domicile -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tHome\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_rue\" class=\"verify verify_adresse input-field\" tabindex=\"19\" name=\"pg_dp_d_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_num\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"20\" name=\"pg_dp_d_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\r\n\t\t\t\t\t\t\r\n\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_npa\" class=\"verify verify_adresse input-field\" tabindex=\"21\" name=\"pg_dp_d_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_d_ville\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"22\" name=\"pg_dp_d_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCanton*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"23\" name=\"pg_dp_d_canton\" id=\"pg_dp_d_canton\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Canton *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">AG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">AI<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">AR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">BE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">BL<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">BS<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">FR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">GE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">GL<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">GR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">JU<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">LU<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">NE<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"14\">NW<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"15\">OW<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"16\">SG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"17\">SH<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"18\">SO<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"19\">SZ<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"20\">TG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"21\">TI<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"22\">UR<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"23\">VD<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"24\">VS<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"25\">ZG<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"26\">ZH<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"27\">FL<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div> \r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date d'habitation et situation de logement? -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAt this address since when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHousing situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Date d'habitation -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"23\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_d_dep_date\" name=\"pg_dp_d_dep_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation de logement-->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tYou live in*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"25\" name=\"pg_dp_d_sit_log\" id=\"pg_dp_d_sit_log\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>You live in *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">With my partner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Only<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Shared flat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Parents' home<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Single-parent families<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dp_d_dep_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- Section = Logement -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tHousing\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Section = logement + Hypoth\u00e9que-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAre you a homeowner?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Depuis quand ? et m\u00eame adresse --> \r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Logement -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHousing*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"26\" name=\"pg_dp_l_prop\" id=\"pg_dp_l_prop\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Housing situation *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Tenant<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Employer-provided housing<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Condominium apartment<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Single-family home<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Pro rata rent (unmarried or shared)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Living with parents\/relatives<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Hypoth\u00e9que -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dp_l_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMortgage in CHF *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_hyp\" class=\"verify input-field\" tabindex=\"27\" name=\"pg_dp_l_hyp\" type=\"text\" placeholder=\"Mortgage in CHF *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-0 order-md-0\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHow long have you owned this property?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-3 order-md-1\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDoes the address of the property correspond to the home address?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Date d'achat ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-1 order-md-2\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"28\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dp_l_date\" name=\"pg_dp_l_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Domicile = Propri\u00e9t\u00e9 ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 order-4 order-md-3\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHome ownership*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"30\" name=\"pg_dp_l_dom\" id=\"pg_dp_l_dom\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tHome ownership *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12 order-2 order-md-4\" id=\"pg_dp_l_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tInvalid date.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- section = Domicile -->\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_dom_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAddress of your property\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_rue\" class=\"verify verify_adresse input-field\" tabindex=\"31\" name=\"pg_dp_l_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_num\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"32\" name=\"pg_dp_l_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row pg_sec_dp_l_dom_prop\" style=\"display:none\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_npa\" class=\"verify verify_adresse input-field\" tabindex=\"33\" name=\"pg_dp_l_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dp_l_ville\" class=\"verify verify_adresse verify_adresse_L input-field\" tabindex=\"34\" name=\"pg_dp_l_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Vous (Conjoint)-->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_dp_vc\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour spouse\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- section = Partenaire ?  -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tWould you like to provide information about your partner?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tPartner information*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"35\" name=\"pg_dp_vc_inf\" id=\"pg_dp_vc_inf\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tPartner information *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Infos Conjoint choix -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"form-check pb-3 pg_sec_dp_vc_accept\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<input class=\"verify form-check-input\" tabindex=\"36\" type=\"checkbox\" id=\"pg_dp_vc_accept\" name=\"pg_dp_vc_accept\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"form-check-label\">\r\n\t\t\t\t\t\t\t\t\t\tI confirm that a) my partner has been informed of this request, b) the bank can verify the information about my partner by contacting him directly, c) my partner authorizes the bank to obtain information about him from the Central Office for Credit Information (ZEK) and the Consumer Credit Information Center (IKO).   \t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t\r\n\t\t\t\t<!-- Buttons before \/ next -->\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before2\" tabindex=\"37\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"38\" id=\"btn_next2\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t<!-- Revenus et d\u00e9penses - Personne -->\r\n            <div id=\"form3\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tRevenue\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Situation professionnelle -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"39\" name=\"pg_rd_sp_sit\"  id=\"pg_rd_sp_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_ctr\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"40\" name=\"pg_rd_sp_ctr\" id=\"pg_rd_sp_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Infos employeur -->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_e\" style=\"display:none;\" >\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_name\" class=\"verify input-field\" tabindex=\"45\" name=\"pg_rd_e_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_rue\" class=\"verify input-field\" tabindex=\"46\" name=\"pg_rd_e_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_num\" class=\"verify input-field\" tabindex=\"47\" name=\"pg_rd_e_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_npa\" class=\"verify input-field\" tabindex=\"48\" name=\"pg_rd_e_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_e_ville\" class=\"verify input-field\" tabindex=\"49\" name=\"pg_rd_e_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\r\n\t\t\t\t\t\t<!-- Date de d\u00e9but et fin de contrat -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_dq\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"41\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_sp_ctr_date\" name=\"pg_rd_sp_ctr_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_sp_ej\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"43\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_sp_ctr_f_date\" name=\"pg_rd_sp_ctr_f_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_sp_ctr_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_sp_ctr_f_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\r\n\t\t\t\t\t\t<!-- section = Infos transport travail -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_g_transp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = Moyen de transport vers votre lieu de travail -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMeans of transport to your place of work\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tMeans of transport\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"57\" name=\"pg_rd_g_transp\"  id=\"pg_rd_g_transp\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Means of transport *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Car<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Public transport<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Motorcycle<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Bike<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Electric bikes up to 25 km\/h<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Electric bike up to 45 km\/h<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">On foot<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<div style=\"display:none;\">\t\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rd_g_auto\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = R\u00e9el besoin de voiture -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDo you need your car because you have no other means of transport, or for health reasons?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<!-- Oui ou non -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"58\" name=\"pg_rd_g_auto\"  id=\"pg_rd_g_auto\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- KM avec voiture -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_g_km\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of kilometers to your workplace *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_g_km\" class=\"verify input-field\" tabindex=\"59\" name=\"pg_rd_g_km\" type=\"text\" placeholder=\"Number of kilometers to your workplace *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Revenu -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour main income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Salaire net -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (in CHF)*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rp_sal\" class=\"verify input-field\" tabindex=\"60\" name=\"pg_rd_rp_sal\" type=\"text\" placeholder=\"Net monthly income (in CHF)*\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Nombre de salaires -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"61\" name=\"pg_rd_rp_mens\"  id=\"pg_rd_rp_mens\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of annual revenues *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tHourly wage\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t12\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t13\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t14\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<!-- Bonus -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tBonus \/ gratuity (in CHF)\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rp_bns\" class=\"verify input-field\" tabindex=\"62\" name=\"pg_rd_rp_bns\" type=\"text\" placeholder=\"Bonus \/ gratuity (in CHF)\">\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Activit\u00e9 accessoire \/ autres -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Activit\u00e9 accesssoire ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAncillary activity*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"63\" name=\"pg_rd_aa_rs\" id=\"pg_rd_aa_rs\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation PROF -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"64\" name=\"pg_rd_aa_sit\"  id=\"pg_rd_aa_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Professional situation *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Employee<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Self-employed (sole proprietorship)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Self-employed (owner of a S\u00e0rl or SA)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">AHV pensioner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">DI pensioner<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Homemaker<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Revenue -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_rev\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF) *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_rev\" class=\"verify input-field\" tabindex=\"65\" name=\"pg_rd_aa_rev\" type=\"text\" placeholder=\"Net monthly income (CHF) *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6  pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Type de contrat -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_ctr\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"66\" name=\"pg_rd_aa_ctr\" id=\"pg_rd_aa_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"67\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_aa_date\" name=\"pg_rd_aa_date\">\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_ctrfdate\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_f_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"68\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rd_aa_f_date\" name=\"pg_rd_aa_f_date\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rd_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"pg_sec_rd_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Adresse entreprise-->\r\n\t\t\t\t\t\t\t<div class=\"row pg_sec_rd_aa_adress\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_name\" class=\"verify input-field\" tabindex=\"68\" name=\"pg_rd_aa_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_rue\" class=\"verify input-field\" tabindex=\"69\" name=\"pg_rd_aa_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_num\" class=\"verify input-field\" tabindex=\"70\" name=\"pg_rd_aa_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_npa\" class=\"verify input-field\" tabindex=\"71\" name=\"pg_rd_aa_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_aa_ville\" class=\"verify input-field\" tabindex=\"72\" name=\"pg_rd_aa_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Revenue suppl\u00e9mentaire et source de revenus  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"73\" name=\"pg_rd_rs_sr\"  id=\"pg_rd_rs_sr\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Additional income *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">No additional income<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Alimony<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Rental income<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">Widow's pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Orphan's pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">DI \/ AVS pension<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">Children's apprentice wages<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rd_rs\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet income in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_rs_rn\" class=\"verify input-field\" tabindex=\"74\" name=\"pg_rd_rs_rn\" type=\"text\" placeholder=\"Net income in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = D\u00e9penses  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony payments per month *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_dp_pa\" class=\"verify input-field\" tabindex=\"75\" name=\"pg_rd_dp_pa\" type=\"text\" placeholder=\"Alimony in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tOther monthly expenses *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rd_dp_adm\" class=\"verify input-field\" tabindex=\"76\" name=\"pg_rd_dp_adm\" type=\"text\" placeholder=\"Other monthly expenses in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<!-- Buttons before \/ next -->\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before3\" tabindex=\"77\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"78\" id=\"btn_next3\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Donn\u00e9es personnelles - Conjoint -->\r\n            <div id=\"form4\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form\">\r\n\t\t\t\t\t<!-- Step = Donnees personnelles votre conjoint -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tYour spouse's personal data\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Votre conjoint -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<!-- Section = Vous -->\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour spouse\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\tPlease enter the information as it appears on the official identity document.\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Titre + \u00c9tat civil -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTitle*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"79\" name=\"pg_dpvc_v_titre\" id=\"pg_dpvc_v_titre\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tTitle *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tMs.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tMr.\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nom + Pr\u00e9nom -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tName *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_v_nom\" class=\"verify input-field\" tabindex=\"80\" name=\"pg_dpvc_v_nom\" type=\"text\" placeholder=\"Name *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" >\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tSurname *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_v_prenom\" class=\"verify input-field\"  tabindex=\"81\" name=\"pg_dpvc_v_prenom\" type=\"text\" placeholder=\"Surname *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de Naissance -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"82\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_v_n_date\" name=\"pg_dpvc_v_n_date\">\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dpvc_v_n_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tYou must be between 18 and 69 years of age.\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Nationalit\u00e9 -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Nationalit\u00e9 + Pays -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNationality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select name=\"pg_dpvc_n_pays\" tabindex=\"85\" class=\"verify input-field pg_check_default\" id=\"pg_dpvc_n_pays\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>Nationality *<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CHSuisse\" value=\"CH\" data-text=\"Suisse\">Switzerland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LILiechtenstein\" value=\"LI\" data-text=\"Liechtenstein\">Liechtenstein<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DEAllemagne\" value=\"DE\" data-text=\"Allemagne\">Germany<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ATAutriche\" value=\"AT\" data-text=\"Autriche\">Austria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FRFrance\" value=\"FR\" data-text=\"France\">France<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ITItalie\" value=\"IT\" data-text=\"Italie\">Italy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PTPortugal\" value=\"PT\" data-text=\"Portugal\">Portugal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZAAfrique du Sud\" value=\"ZA\" data-text=\"Afrique du Sud\">South Africa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ALAlbanie\" value=\"AL\" data-text=\"Albanie\">Albania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DZAlg\u00e9rie\" value=\"DZ\" data-text=\"Alg\u00e9rie\">Algeria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ADAndorre\" value=\"AD\" data-text=\"Andorre\">Andorra<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AOAngola\" value=\"AO\" data-text=\"Angola\">Angola<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AIAnguilla\" value=\"AI\" data-text=\"Anguilla\">Anguilla<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AQAntarctique\" value=\"AQ\" data-text=\"Antarctique\">Antarctica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AGAntigua-et-Barbuda\" value=\"AG\" data-text=\"Antigua-et-Barbuda\">Antigua and Barbuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SAArabie saoudite\" value=\"SA\" data-text=\"Arabie saoudite\">Saudi Arabia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ARArgentine\" value=\"AR\" data-text=\"Argentine\">Argentina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AMArm\u00e9nie\" value=\"AM\" data-text=\"Arm\u00e9nie\">Armenia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AWAruba\" value=\"AW\" data-text=\"Aruba\">Aruba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AUAustralie\" value=\"AU\" data-text=\"Australie\">Australia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AZAzerba\u00efdjan\" value=\"AZ\" data-text=\"Azerba\u00efdjan\">Azerbaijan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BSBahamas\" value=\"BS\" data-text=\"Bahamas\">Bahamas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BHBahre\u00efn\" value=\"BH\" data-text=\"Bahre\u00efn\">Bahrain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BDBangladesh\" value=\"BD\" data-text=\"Bangladesh\">Bangladesh<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BBBarbade\" value=\"BB\" data-text=\"Barbade\">Barbados<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BYB\u00e9larus\" value=\"BY\" data-text=\"B\u00e9larus\">Belarus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BEBelgique\" value=\"BE\" data-text=\"Belgique\">Belgium<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BZBelize\" value=\"BZ\" data-text=\"Belize\">Belize<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BJB\u00e9nin\" value=\"BJ\" data-text=\"B\u00e9nin\">Benin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BMBermudes\" value=\"BM\" data-text=\"Bermudes\">Bermuda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BTBhoutan\" value=\"BT\" data-text=\"Bhoutan\">Bhutan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BOBolivie\" value=\"BO\" data-text=\"Bolivie\">Bolivia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BQBonaire, Saint Eustatius et Saba\" value=\"BQ\" data-text=\"Bonaire, Saint Eustatius et Saba\">Bonaire, Saint Eustatius and Saba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BABosnie et Herz\u00e9govine\" value=\"BA\" data-text=\"Bosnie et Herz\u00e9govine\">Bosnia and Herzegovina<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BWBotswana\" value=\"BW\" data-text=\"Botswana\">Botswana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BRBr\u00e9sil\" value=\"BR\" data-text=\"Br\u00e9sil\">Brazil<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BNBrun\u00e9i Darussalam\" value=\"BN\" data-text=\"Brun\u00e9i Darussalam\">Brunei Darussalam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BGBulgarie\" value=\"BG\" data-text=\"Bulgarie\">Bulgaria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BFBurkina Faso\" value=\"BF\" data-text=\"Burkina Faso\">Burkina Faso<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BIBurundi\" value=\"BI\" data-text=\"Burundi\">Burundi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CVCabo Verde\" value=\"CV\" data-text=\"Cabo Verde\">Cabo Verde<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KHCambodge\" value=\"KH\" data-text=\"Cambodge\">Cambodia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CMCameroun\" value=\"CM\" data-text=\"Cameroun\">Cameroon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CACanada\" value=\"CA\" data-text=\"Canada\">Canada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CLChili\" value=\"CL\" data-text=\"Chili\">Chile<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CNChine\" value=\"CN\" data-text=\"Chine\">China<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CYChypre\" value=\"CY\" data-text=\"Chypre\">Cyprus<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VACit\u00e9 du Vatican\" value=\"VA\" data-text=\"Cit\u00e9 du Vatican\">Vatican City<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-COColombie\" value=\"CO\" data-text=\"Colombie\">Colombia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KMComores\" value=\"KM\" data-text=\"Comores\">Comoros<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CGCongo (Brazzaville)\" value=\"CG\" data-text=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CDCongo (Kinshasa)\" value=\"CD\" data-text=\"Congo (Kinshasa)\">Congo (Kinshasa)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KPCor\u00e9e du Nord\" value=\"KP\" data-text=\"Cor\u00e9e du Nord\">North Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KRCor\u00e9e du Sud\" value=\"KR\" data-text=\"Cor\u00e9e du Sud\">South Korea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CRCosta Rica\" value=\"CR\" data-text=\"Costa Rica\">Costa Rica<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CIC\u00f4te d\u2019Ivoire\" value=\"CI\" data-text=\"C\u00f4te d\u2019Ivoire\">Ivory Coast<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HRCroatie\" value=\"HR\" data-text=\"Croatie\">Croatia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CUCuba\" value=\"CU\" data-text=\"Cuba\">Cuba<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CWCura\u00e7ao\" value=\"CW\" data-text=\"Cura\u00e7ao\">Cura\u00e7ao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DKDanemark\" value=\"DK\" data-text=\"Danemark\">Denmark<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DJDjibouti\" value=\"DJ\" data-text=\"Djibouti\">Djibouti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DMDominique\" value=\"DM\" data-text=\"Dominique\">Dominique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EG\u00c9gypte\" value=\"EG\" data-text=\"\u00c9gypte\">Egypt<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SVEl Salvador\" value=\"SV\" data-text=\"El Salvador\">El Salvador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AE\u00c9mirats arabes unis\" value=\"AE\" data-text=\"\u00c9mirats arabes unis\">United Arab Emirates<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EC\u00c9quateur\" value=\"EC\" data-text=\"\u00c9quateur\">Ecuador<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ER\u00c9rythr\u00e9e\" value=\"ER\" data-text=\"\u00c9rythr\u00e9e\">Eritrea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ESEspagne\" value=\"ES\" data-text=\"Espagne\">Spain<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EEEstonie\" value=\"EE\" data-text=\"Estonie\">Estonia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SZEswatini\" value=\"SZ\" data-text=\"Eswatini\">Eswatini<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-US\u00c9tats-Unis\" value=\"US\" data-text=\"\u00c9tats-Unis\">United States<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ET\u00c9thiopie\" value=\"ET\" data-text=\"\u00c9thiopie\">Ethiopia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FJFidji\" value=\"FJ\" data-text=\"Fidji\">Fiji<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FIFinlande\" value=\"FI\" data-text=\"Finlande\">Finland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GAGabon\" value=\"GA\" data-text=\"Gabon\">Gabon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GMGambie\" value=\"GM\" data-text=\"Gambie\">Gambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GEG\u00e9orgie\" value=\"GE\" data-text=\"G\u00e9orgie\">Georgia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GSG\u00e9orgie du Sud et les \u00celes Sandwich du Sud\" value=\"GS\" data-text=\"G\u00e9orgie du Sud et les \u00celes Sandwich du Sud\">South Georgia and the South Sandwich Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GHGhana\" value=\"GH\" data-text=\"Ghana\">Ghana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GIGibraltar\" value=\"GI\" data-text=\"Gibraltar\">Gibraltar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GRGr\u00e8ce\" value=\"GR\" data-text=\"Gr\u00e8ce\">Greece<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GDGrenade\" value=\"GD\" data-text=\"Grenade\">Granada<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GLGroenland\" value=\"GL\" data-text=\"Groenland\">Greenland<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GPGuadeloupe\" value=\"GP\" data-text=\"Guadeloupe\">Guadeloupe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GUGuam\" value=\"GU\" data-text=\"Guam\">Guam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GTGuatemala\" value=\"GT\" data-text=\"Guatemala\">Guatemala<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GGGuernesey\" value=\"GG\" data-text=\"Guernesey\">Guernsey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GNGuin\u00e9e\" value=\"GN\" data-text=\"Guin\u00e9e\">Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GQGuin\u00e9e \u00e9quatoriale\" value=\"GQ\" data-text=\"Guin\u00e9e \u00e9quatoriale\">Equatorial Guinea<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GWGuin\u00e9e-Bissau\" value=\"GW\" data-text=\"Guin\u00e9e-Bissau\">Guinea-Bissau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GYGuyana\" value=\"GY\" data-text=\"Guyana\">Guyana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GFGuyane fran\u00e7aise\" value=\"GF\" data-text=\"Guyane fran\u00e7aise\">French Guiana<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HTHa\u00efti\" value=\"HT\" data-text=\"Ha\u00efti\">Haiti<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HNHonduras\" value=\"HN\" data-text=\"Honduras\">Honduras<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HKHong Kong\" value=\"HK\" data-text=\"Hong Kong\">Hong Kong<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HUHongrie\" value=\"HU\" data-text=\"Hongrie\">Hungary<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BV\u00cele Bouvet\" value=\"BV\" data-text=\"\u00cele Bouvet\">Bouvet Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NF\u00cele Norfolk\" value=\"NF\" data-text=\"\u00cele Norfolk\">Norfolk Island<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KY\u00celes Ca\u00efmans\" value=\"KY\" data-text=\"\u00celes Ca\u00efmans\">Cayman Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CC\u00celes Cocos (Keeling)\" value=\"CC\" data-text=\"\u00celes Cocos (Keeling)\">Cocos Islands (Keeling)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CK\u00celes Cook\" value=\"CK\" data-text=\"\u00celes Cook\">Cook Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-AX\u00celes d'Aland\" value=\"AX\" data-text=\"\u00celes d'Aland\">Aland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FO\u00celes F\u00e9ro\u00e9\" value=\"FO\" data-text=\"\u00celes F\u00e9ro\u00e9\">Faroe Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-HM\u00celes Heard et MacDonald\" value=\"HM\" data-text=\"\u00celes Heard et MacDonald\">Heard and MacDonald Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FK\u00celes Malouines\" value=\"FK\" data-text=\"\u00celes Malouines\">Falkland Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MP\u00celes Mariannes du Nord\" value=\"MP\" data-text=\"\u00celes Mariannes du Nord\">Northern Mariana Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MH\u00celes Marshall\" value=\"MH\" data-text=\"\u00celes Marshall\">Marshall Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PN\u00celes Pitcairn\" value=\"PN\" data-text=\"\u00celes Pitcairn\">Pitcairn Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SB\u00celes Salomon\" value=\"SB\" data-text=\"\u00celes Salomon\">Solomon Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TC\u00celes Turques-et-Ca\u00efques\" value=\"TC\" data-text=\"\u00celes Turques-et-Ca\u00efques\">Turks and Caicos Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VI\u00celes Vierges am\u00e9ricaines\" value=\"VI\" data-text=\"\u00celes Vierges am\u00e9ricaines\">U.S. Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VG\u00celes Vierges britanniques\" value=\"VG\" data-text=\"\u00celes Vierges britanniques\">British Virgin Islands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-INInde\" value=\"IN\" data-text=\"Inde\">India<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IDIndon\u00e9sie\" value=\"ID\" data-text=\"Indon\u00e9sie\">Indonesia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IQIrak\" value=\"IQ\" data-text=\"Irak\">Iraq<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IRIran\" value=\"IR\" data-text=\"Iran\">Iran<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IEIrlande\" value=\"IE\" data-text=\"Irlande\">Irlande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ISIslande\" value=\"IS\" data-text=\"Islande\">Islande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ILIsra\u00ebl\" value=\"IL\" data-text=\"Isra\u00ebl\">Isra\u00ebl<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JMJama\u00efque\" value=\"JM\" data-text=\"Jama\u00efque\">Jama\u00efque<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JPJapon\" value=\"JP\" data-text=\"Japon\">Japon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-JOJordanie\" value=\"JO\" data-text=\"Jordanie\">Jordanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KZKazakhstan\" value=\"KZ\" data-text=\"Kazakhstan\">Kazakhstan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KEKenya\" value=\"KE\" data-text=\"Kenya\">Kenya<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KGKirghizistan\" value=\"KG\" data-text=\"Kirghizistan\">Kirghizistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KIKiribati\" value=\"KI\" data-text=\"Kiribati\">Kiribati<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-XKKosovo\" value=\"XK\" data-text=\"Kosovo\">Kosovo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KWKowe\u00eft\" value=\"KW\" data-text=\"Kowe\u00eft\">Kowe\u00eft<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RELa R\u00e9union\" value=\"RE\" data-text=\"La R\u00e9union\">La R\u00e9union<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LALaos\" value=\"LA\" data-text=\"Laos\">Laos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LSLesotho\" value=\"LS\" data-text=\"Lesotho\">Lesotho<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LVLettonie\" value=\"LV\" data-text=\"Lettonie\">Lettonie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LBLiban\" value=\"LB\" data-text=\"Liban\">Liban<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LRLib\u00e9ria\" value=\"LR\" data-text=\"Lib\u00e9ria\">Lib\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LYLibye\" value=\"LY\" data-text=\"Libye\">Libye<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LTLituanie\" value=\"LT\" data-text=\"Lituanie\">Lituanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LULuxembourg\" value=\"LU\" data-text=\"Luxembourg\">Luxembourg<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MOMacao\" value=\"MO\" data-text=\"Macao\">Macao<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MKMac\u00e9doine du Nord\" value=\"MK\" data-text=\"Mac\u00e9doine du Nord\">Mac\u00e9doine du Nord<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MGMadagascar\" value=\"MG\" data-text=\"Madagascar\">Madagascar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MYMalaisie\" value=\"MY\" data-text=\"Malaisie\">Malaisie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MWMalawi\" value=\"MW\" data-text=\"Malawi\">Malawi<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MVMaldives\" value=\"MV\" data-text=\"Maldives\">Maldives<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MLMali\" value=\"ML\" data-text=\"Mali\">Mali<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MTMalte\" value=\"MT\" data-text=\"Malte\">Malte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MAMaroc\" value=\"MA\" data-text=\"Maroc\">Maroc<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MQMartinique\" value=\"MQ\" data-text=\"Martinique\">Martinique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MUMaurice\" value=\"MU\" data-text=\"Maurice\">Maurice<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MRMauritanie\" value=\"MR\" data-text=\"Mauritanie\">Mauritanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YTMayotte\" value=\"YT\" data-text=\"Mayotte\">Mayotte<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MXMexique\" value=\"MX\" data-text=\"Mexique\">Mexique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-FMMicron\u00e9sie\" value=\"FM\" data-text=\"Micron\u00e9sie\">Micron\u00e9sie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MDMoldavie\" value=\"MD\" data-text=\"Moldavie\">Moldavie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MCMonaco\" value=\"MC\" data-text=\"Monaco\">Monaco<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MNMongolie\" value=\"MN\" data-text=\"Mongolie\">Mongolie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MEMont\u00e9n\u00e9gro\" value=\"ME\" data-text=\"Mont\u00e9n\u00e9gro\">Mont\u00e9n\u00e9gro<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MSMontserrat\" value=\"MS\" data-text=\"Montserrat\">Montserrat<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MZMozambique\" value=\"MZ\" data-text=\"Mozambique\">Mozambique<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MMMyanmar\" value=\"MM\" data-text=\"Myanmar\">Myanmar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NANamibie\" value=\"NA\" data-text=\"Namibie\">Namibie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NRNauru\" value=\"NR\" data-text=\"Nauru\">Nauru<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NPN\u00e9pal\" value=\"NP\" data-text=\"N\u00e9pal\">N\u00e9pal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NINicaragua\" value=\"NI\" data-text=\"Nicaragua\">Nicaragua<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NENiger\" value=\"NE\" data-text=\"Niger\">Niger<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NGNig\u00e9ria\" value=\"NG\" data-text=\"Nig\u00e9ria\">Nig\u00e9ria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NUNiue\" value=\"NU\" data-text=\"Niue\">Niue<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NONorv\u00e8ge\" value=\"NO\" data-text=\"Norv\u00e8ge\">Norv\u00e8ge<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NCNouvelle-Cal\u00e9donie\" value=\"NC\" data-text=\"Nouvelle-Cal\u00e9donie\">Nouvelle-Cal\u00e9donie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NZNouvelle-Z\u00e9lande\" value=\"NZ\" data-text=\"Nouvelle-Z\u00e9lande\">Nouvelle-Z\u00e9lande<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-OMOman\" value=\"OM\" data-text=\"Oman\">Oman<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UGOuganda\" value=\"UG\" data-text=\"Ouganda\">Ouganda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UZOuzb\u00e9kistan\" value=\"UZ\" data-text=\"Ouzb\u00e9kistan\">Ouzb\u00e9kistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PKPakistan\" value=\"PK\" data-text=\"Pakistan\">Pakistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PWPalaos\" value=\"PW\" data-text=\"Palaos\">Palaos<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PSPalestine\" value=\"PS\" data-text=\"Palestine\">Palestine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PAPanama\" value=\"PA\" data-text=\"Panama\">Panama<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PGPapouasie-Nouvelle-Guin\u00e9e\" value=\"PG\" data-text=\"Papouasie-Nouvelle-Guin\u00e9e\">Papouasie-Nouvelle-Guin\u00e9e<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PYParaguay\" value=\"PY\" data-text=\"Paraguay\">Paraguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-NLPays-Bas\" value=\"NL\" data-text=\"Pays-Bas\">Pays-Bas<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PEP\u00e9rou\" value=\"PE\" data-text=\"P\u00e9rou\">P\u00e9rou<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PHPhilippines\" value=\"PH\" data-text=\"Philippines\">Philippines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PLPologne\" value=\"PL\" data-text=\"Pologne\">Pologne<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PRPorto Rico\" value=\"PR\" data-text=\"Porto Rico\">Porto Rico<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-QAQatar\" value=\"QA\" data-text=\"Qatar\">Qatar<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CFR\u00e9publique centrafricaine\" value=\"CF\" data-text=\"R\u00e9publique centrafricaine\">R\u00e9publique centrafricaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-DOR\u00e9publique dominicaine\" value=\"DO\" data-text=\"R\u00e9publique dominicaine\">R\u00e9publique dominicaine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RORoumanie\" value=\"RO\" data-text=\"Roumanie\">Roumanie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-GBRoyaume-Uni\" value=\"GB\" data-text=\"Royaume-Uni\">Royaume-Uni<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RURussie\" value=\"RU\" data-text=\"Russie\">Russie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RWRwanda\" value=\"RW\" data-text=\"Rwanda\">Rwanda<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-EHSahara occidental\" value=\"EH\" data-text=\"Sahara occidental\">Sahara occidental<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-BLSaint-Barth\u00e9lemy\" value=\"BL\" data-text=\"Saint-Barth\u00e9lemy\">Saint-Barth\u00e9lemy<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-KNSaint-Kitts-et-Nevis\" value=\"KN\" data-text=\"Saint-Kitts-et-Nevis\">Saint-Kitts-et-Nevis<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SMSaint-Marin\" value=\"SM\" data-text=\"Saint-Marin\">Saint-Marin<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-MFSaint-Martin (France)\" value=\"MF\" data-text=\"Saint-Martin (France)\">Saint-Martin (France)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-PMSaint-Pierre-et-Miquelon\" value=\"PM\" data-text=\"Saint-Pierre-et-Miquelon\">Saint-Pierre-et-Miquelon<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VCSaint-Vincent-et-les Grenadines\" value=\"VC\" data-text=\"Saint-Vincent-et-les Grenadines\">Saint-Vincent-et-les Grenadines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SHSainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\" value=\"SH\" data-text=\"Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha\">Sainte-H\u00e9l\u00e8ne, Ascension, Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LCSainte-Lucie\" value=\"LC\" data-text=\"Sainte-Lucie\">Sainte-Lucie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WSSamoa\" value=\"WS\" data-text=\"Samoa\">Samoa<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ASSamoa am\u00e9ricaines\" value=\"AS\" data-text=\"Samoa am\u00e9ricaines\">Samoa am\u00e9ricaines<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-STSao Tom\u00e9-et-Principe\" value=\"ST\" data-text=\"Sao Tom\u00e9-et-Principe\">Sao Tom\u00e9-et-Principe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SNS\u00e9n\u00e9gal\" value=\"SN\" data-text=\"S\u00e9n\u00e9gal\">S\u00e9n\u00e9gal<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-RSSerbie\" value=\"RS\" data-text=\"Serbie\">Serbie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SCSeychelles\" value=\"SC\" data-text=\"Seychelles\">Seychelles<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SLSierra Leone\" value=\"SL\" data-text=\"Sierra Leone\">Sierra Leone<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SGSingapour\" value=\"SG\" data-text=\"Singapour\">Singapour<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SXSint Maarten (Pays-Bas)\" value=\"SX\" data-text=\"Sint Maarten (Pays-Bas)\">Sint Maarten (Pays-Bas)<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SKSlovaquie\" value=\"SK\" data-text=\"Slovaquie\">Slovaquie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SISlov\u00e9nie\" value=\"SI\" data-text=\"Slov\u00e9nie\">Slov\u00e9nie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SOSomalie\" value=\"SO\" data-text=\"Somalie\">Somalie<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SDSoudan\" value=\"SD\" data-text=\"Soudan\">Soudan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SSSoudan du Sud\" value=\"SS\" data-text=\"Soudan du Sud\">Soudan du Sud<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-LKSri Lanka\" value=\"LK\" data-text=\"Sri Lanka\">Sri Lanka<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SESu\u00e8de\" value=\"SE\" data-text=\"Su\u00e8de\">Su\u00e8de<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SRSuriname\" value=\"SR\" data-text=\"Suriname\">Suriname<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SJSvalbard et Jan Mayen\" value=\"SJ\" data-text=\"Svalbard et Jan Mayen\">Svalbard and Jan Mayen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-SYSyrie\" value=\"SY\" data-text=\"Syrie\">Syria<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TJTadjikistan\" value=\"TJ\" data-text=\"Tadjikistan\">Tajikistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TWTa\u00efwan\" value=\"TW\" data-text=\"Ta\u00efwan\">Taiwan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TZTanzanie\" value=\"TZ\" data-text=\"Tanzanie\">Tanzania<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TDTchad\" value=\"TD\" data-text=\"Tchad\">Chad<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-CZTch\u00e9quie\" value=\"CZ\" data-text=\"Tch\u00e9quie\">Czech Republic<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TFTerres australes et antarctiques fran\u00e7aises\" value=\"TF\" data-text=\"Terres australes et antarctiques fran\u00e7aises\">French Southern and Antarctic Lands<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-IOTerritoire britannique de l\u2019oc\u00e9an Indien\" value=\"IO\" data-text=\"Territoire britannique de l\u2019oc\u00e9an Indien\">British Indian Ocean Territory<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-THTha\u00eflande\" value=\"TH\" data-text=\"Tha\u00eflande\">Thailand<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TIBTibet\" value=\"TIB\" data-text=\"Tibet\">Tibet<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TLTimor-Leste\" value=\"TL\" data-text=\"Timor-Leste\">Timor-Leste<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TGTogo\" value=\"TG\" data-text=\"Togo\">Togo<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TKTokelau\" value=\"TK\" data-text=\"Tokelau\">Tokelau<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TOTonga\" value=\"TO\" data-text=\"Tonga\">Tonga<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TTTristan da Cunha\" value=\"TT\" data-text=\"Tristan da Cunha\">Tristan da Cunha<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TNTunisie\" value=\"TN\" data-text=\"Tunisie\">Tunisia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TMTurkm\u00e9nistan\" value=\"TM\" data-text=\"Turkm\u00e9nistan\">Turkmenistan<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TRTurquie\" value=\"TR\" data-text=\"Turquie\">Turkey<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-TVTuvalu\" value=\"TV\" data-text=\"Tuvalu\">Tuvalu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UAUkraine\" value=\"UA\" data-text=\"Ukraine\">Ukraine<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-UYUruguay\" value=\"UY\" data-text=\"Uruguay\">Uruguay<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VUVanuatu\" value=\"VU\" data-text=\"Vanuatu\">Vanuatu<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VEVenezuela\" value=\"VE\" data-text=\"Venezuela\">Venezuela<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-VNVietnam\" value=\"VN\" data-text=\"Vietnam\">Vietnam<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-WFWallis-et-Futuna\" value=\"WF\" data-text=\"Wallis-et-Futuna\">Wallis and Futuna<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-YEY\u00e9men\" value=\"YE\" data-text=\"Y\u00e9men\">Yemen<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZMZambie\" value=\"ZM\" data-text=\"Zambie\">Zambia<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-ZWZimbabwe\" value=\"ZW\" data-text=\"Zimbabwe\">Zimbabwe<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option---------------\" disabled=\"\" value=\"\" data-text=\"--------------\">--------------<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option id=\"pg_nationalite-option-00Autre\" value=\"00\" data-text=\"Autre\">Other<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_permis\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"86\" name=\"pg_dpvc_n_permis\" id=\"pg_dpvc_n_permis\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tResidence permits *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tB\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tC\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de permis + Valable jusqu'\u00e0 quand-->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_entre\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"87\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_n_p_date\" name=\"pg_dpvc_n_p_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dpvc_n_valid\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"margin-left:0px; margin-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"90\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dpvc_n_v_date\" name=\"pg_dpvc_n_v_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Infos de contact -->\t\t\t\t\t\t\r\n\t\t\t\t\t<section class=\"pg_section_form\">\t\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tContact information\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- N\u00b0 de t\u00e9l\u00e9phone + Adresse e-mail -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMobile phone *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_ic_tel\" class=\"verify input-field\" tabindex=\"93\" name=\"pg_dpvc_ic_tel\" type=\"text\" placeholder=\"Mobile phone *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tEmail address *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dpvc_ic_mail\" class=\"verify input-field\" tabindex=\"94\" name=\"pg_dpvc_ic_mail\" type=\"text\" placeholder=\"Email address *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before4\" tabindex=\"95\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"96\" id=\"btn_next4\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- Revenus  - Partenaire -->\r\n            <div id=\"form5\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<!-- Revenus Partenaire -->\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tIncome - Spouse\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t<!-- section = Situation professionnelle -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"97\" name=\"pg_rdvc_sp_sit\"  id=\"pg_rdvc_sp_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_ctr\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"98\" name=\"pg_rdvc_sp_ctr\" id=\"pg_rdvc_sp_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Infos employeur -->\r\n\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_e\" style=\"display:none;\" >\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_name\" class=\"verify input-field\" tabindex=\"103\" name=\"pg_rdvc_e_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_rue\" class=\"verify input-field\" tabindex=\"104\" name=\"pg_rdvc_e_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_num\" class=\"verify input-field\" tabindex=\"105\" name=\"pg_rdvc_e_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_npa\" class=\"verify input-field\" tabindex=\"106\" name=\"pg_rdvc_e_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_e_ville\" class=\"verify input-field\" tabindex=\"107\" name=\"pg_rdvc_e_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Date de d\u00e9but et fin de contrat -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_dq\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"99\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_sp_ctr_date\" name=\"pg_rdvc_sp_ctr_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_sp_ej\" style=\"display:none\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t<input tabindex=\"101\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_sp_ctr_f_date\" name=\"pg_rdvc_sp_ctr_f_date\">\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_sp_ctr_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_sp_ctr_f_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t<!-- section = Infos transport travail -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_g_transp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = Moyen de transport vers votre lieu de travail -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMeans of transport to your place of work\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- salari\u00e9 ou autre et type de salari\u00e9 -->\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tMeans of transport\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"115\" name=\"pg_rdvc_g_transp\"  id=\"pg_rdvc_g_transp\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tMeans of transport *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tCar\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tPublic transport\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tMotorcycle\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tBike\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tElectric bikes up to 25 km\/h\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tElectric bike up to 45 km\/h\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOn foot\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_sec_rdvc_g_auto\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- section = R\u00e9el besoin de voiture -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tDo you need your car because you have no other means of transport, or for health reasons?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<!-- Oui ou non -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"116\" name=\"pg_rdvc_g_auto\"  id=\"pg_rdvc_g_auto\" >\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tLack of other means or health reasons *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- KM avec voiture -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_g_km\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of kilometers to your workplace per trip *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_g_km\" class=\"verify input-field\" tabindex=\"117\" name=\"pg_rdvc_g_km\" type=\"text\" placeholder=\"Number of kilometers to your workplace per trip *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- section = Revenu -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tYour main income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Salaire net -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (in CHF)*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rp_sal\" class=\"verify input-field\" tabindex=\"118\" name=\"pg_rdvc_rp_sal\" type=\"text\" placeholder=\"Net monthly income (in CHF)*\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Nombre de salaires -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"119\" name=\"pg_rdvc_rp_mens\"  id=\"pg_rdvc_rp_mens\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of annual revenues *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tHourly wage\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t12\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t13\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t14\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Bonus -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tBonus \/ gratuity (in CHF)\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rp_bns\" class=\"verify input-field\" tabindex=\"120\" name=\"pg_rdvc_rp_bns\" type=\"text\" placeholder=\"Bonus \/ gratuity (in CHF)\">\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Activit\u00e9 accessoire \/ autres -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<!-- Activit\u00e9 accesssoire ? -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAncillary activity*\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"121\" name=\"pg_rdvc_aa_rs\" id=\"pg_rdvc_aa_rs\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- Situation PROF -->\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"122\" name=\"pg_rdvc_aa_sit\"  id=\"pg_rdvc_aa_sit\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tProfessional situation *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployee\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (sole proprietorship)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tSelf-employed (owner of a S\u00e0rl or SA)\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tAHV pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI pensioner\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tHomemaker\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Revenue -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_rev\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF) *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_rev\" class=\"verify input-field\" tabindex=\"123\" name=\"pg_rdvc_aa_rev\" type=\"text\" placeholder=\"Net monthly income (CHF) *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6  pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Type de contrat -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_ctr\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"124\" name=\"pg_rdvc_aa_ctr\" id=\"pg_rdvc_aa_ctr\">\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\t\tContract type *\r\n\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tOpen-ended employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tTemporary work\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tFixed-term employment contract\t\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<!-- Date de d\u00e9but ? -->\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"125\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_aa_date\" name=\"pg_rdvc_aa_date\">\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_ctrfdate\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t<!-- Date de fin ? -->\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_f_date\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\t\tEmployed until?\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" style=\"padding-left: 0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<input tabindex=\"126\" type=\"date\" class=\"input-field verify_date\" id=\"pg_rdvc_aa_f_date\" name=\"pg_rdvc_aa_f_date\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_rdvc_aa_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\tInvalid date\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"pg_sec_rdvc_aa_yes\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Adresse entreprise-->\r\n\t\t\t\t\t\t\t<div class=\"row pg_sec_rdvc_aa_adress\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tCompany *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_name\" class=\"verify input-field\" tabindex=\"127\" name=\"pg_rdvc_aa_name\" type=\"text\" placeholder=\"Company *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t\t<!-- Rue + Num\u00e9ro -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-10\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tStreet *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_rue\" class=\"verify input-field\" tabindex=\"128\" name=\"pg_rdvc_aa_rue\" type=\"text\" placeholder=\"Street *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tN\u00b0 *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_num\" class=\"verify input-field\" tabindex=\"129\" name=\"pg_rdvc_aa_num\" type=\"text\" placeholder=\"N\u00b0 *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<!-- NPA + Localit\u00e9 -->\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tNPA *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_npa\" class=\"verify input-field\" tabindex=\"130\" name=\"pg_rdvc_aa_npa\" type=\"text\" placeholder=\"NPA *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\t\tLocality *\r\n\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_aa_ville\" class=\"verify input-field\" tabindex=\"131\" name=\"pg_rdvc_aa_ville\" type=\"text\" placeholder=\"Locality *\" >\r\n\t\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<!-- section = Revenue suppl\u00e9mentaire et source de revenus  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"131\" name=\"pg_rdvc_rs_sr\"  id=\"pg_rdvc_rs_sr\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tAdditional income *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo additional income\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tAlimony\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tRental income\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tWidow's pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tOrphan's pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tDI \/ AVS pension\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\tChildren's apprentice wages\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_rdvc_rs\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tNet income in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_rs_rn\" class=\"verify input-field\" tabindex=\"132\" name=\"pg_rdvc_rs_rn\" type=\"text\" placeholder=\"Net income in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = D\u00e9penses  -->\r\n\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTotal alimony payments per month *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_dp_pa\" class=\"verify input-field\" tabindex=\"133\" name=\"pg_rdvc_dp_pa\" type=\"text\" placeholder=\"Alimony in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tOther monthly expenses *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_rdvc_dp_adm\" class=\"verify input-field\" tabindex=\"134\" name=\"pg_rdvc_dp_adm\" type=\"text\" placeholder=\"Other monthly expenses in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before5\" tabindex=\"135\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"136\" id=\"btn_next5\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- D\u00e9penses Communes  -->\r\n            <div id=\"form6\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tCommon expenses\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- section = Enfants dans le foyer -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tChildren in the household\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Enfants -->\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tChildren under 25 *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"137\" name=\"pg_dc_ef\" id=\"pg_dc_ef\">\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tChildren *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 01-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_1\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"138\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_1_date\" name=\"pg_dc_ef_1_date\">\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\"><\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_1_add\" tabindex=\"139\" class=\"pg_icon_state pg_add_children\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_1_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 02-->\r\n\t\t\t\t\t\t<div  id=\"pg_sec_dc_ef_2\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"140\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_2_date\" name=\"pg_dc_ef_2_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_2_del\" tabindex=\"141\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_2_add\" tabindex=\"142\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_2_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 03-->\r\n\t\t\t\t\t\t<div  id=\"pg_sec_dc_ef_3\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"143\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_3_date\" name=\"pg_dc_ef_3_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_3_del\" tabindex=\"144\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_3_add\" tabindex=\"145\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_3_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 04-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_4\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"146\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_4_date\" name=\"pg_dc_ef_4_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_4_del\" tabindex=\"147\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_4_add\" tabindex=\"148\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_4_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 05-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_5\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"149\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_5_date\" name=\"pg_dc_ef_5_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_5_del\" tabindex=\"150\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_5_add\" tabindex=\"151\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_5_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 06-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_6\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"152\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_6_date\" name=\"pg_dc_ef_6_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_6_del\" tabindex=\"153\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_6_add\" tabindex=\"154\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_6_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 07-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_7\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"155\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_7_date\" name=\"pg_dc_ef_7_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_7_del\" tabindex=\"156\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_7_add\" tabindex=\"157\" class=\"pg_add_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tAdd a child\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_8_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- Ann\u00e9e enfants 08-->\r\n\t\t\t\t\t\t<div id=\"pg_sec_dc_ef_8\" class=\"row\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<input tabindex=\"158\" type=\"date\" class=\"input-field verify_date\" id=\"pg_dc_ef_8_date\" name=\"pg_dc_ef_8_date\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-2\" style=\"margin: auto; height: 40px; text-align: left; padding-left: 0px;\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"pg_dc_ef_8_del\" tabindex=\"159\" class=\"pg_del_children pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\tx\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-4\" style=\"text-align:right;\"><\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\" id=\"pg_dc_ef_8_error\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title pg_form_error_date\" style=\"color:red !important;\">\r\n\t\t\t\t\t\t\t\t\tChildren up to age 25\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\r\n\t\t\t\t\t\r\n\t\t\t\t\t<!-- section = Autres d\u00e9penses -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tOther monthly expenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tChildcare expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCustody fees in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fg\" class=\"verify input-field\" tabindex=\"160\" name=\"pg_dc_adm_fg\" type=\"text\" placeholder=\"Custody fees in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAccommodation expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAccommodation costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fl\" class=\"verify input-field\" tabindex=\"161\" name=\"pg_dc_adm_fl\" type=\"text\" placeholder=\"Accommodation costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tBusiness travel expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTravel costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_ft\" class=\"verify input-field\" tabindex=\"162\" name=\"pg_dc_adm_ft\" type=\"text\" placeholder=\"Travel costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto; display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tCatering costs\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCatering costs in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_fr\" class=\"verify input-field\" tabindex=\"163\" name=\"pg_dc_adm_fr\" type=\"text\" placeholder=\"Catering costs in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\" style=\"margin-top: auto;    margin-bottom: auto;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHealth insurance - Total household amount\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tTotal household amount (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_adm_cm\" class=\"verify input-field\" tabindex=\"163\" name=\"pg_dc_adm_cm\" type=\"text\" placeholder=\"Total household amount (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Dettes et cr\u00e9dits -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tDebts and credits\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tLoans or leases from other institutions?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCurrent loans or leases?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"164\" name=\"pg_dc_dc_cred\"  id=\"pg_dc_dc_cred\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tCurrent loans or leases? *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dc\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tMonthly payments to other institutions in (CHF)\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tMonthly instalments in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_dc_cred_mont\" class=\"verify input-field\" tabindex=\"165\" name=\"pg_dc_dc_cred_mont\" type=\"text\" placeholder=\"Monthly instalments in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dc\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tWould you like an offer on your current credit?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tCurrent bank name\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"166\" name=\"pg_dc_dc_off\"  id=\"pg_dc_dc_off\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tBank name *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Cembra Money Bank\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Migros Bank\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Cashgate\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Bob Money\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes, Other\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"167\" name=\"pg_dc_dc_nbp\"  id=\"pg_dc_dc_nbp\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of prosecutions *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\t0\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\t1 Pursuit\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\t2 Lawsuits\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\t3 Lawsuits\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tMore\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tAre there any deeds of default or foreclosures in progress?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tDefault deeds\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"168\" name=\"pg_dc_dc_act\"  id=\"pg_dc_dc_act\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tDefault deeds *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tYes\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t\t<div class=\"col-md-6 pg_sec_dc_dp\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tTotal amount sued\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\" input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tAmount in (CHF) *\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<input id=\"pg_dc_dc_mont\" class=\"verify input-field\" tabindex=\"169\" name=\"pg_dc_dc_mont\" type=\"text\" placeholder=\"Amount in (CHF) *\" >\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- section = Remarques \/ questions -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tHow would you like to use the credit?\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tHow would you like to use the credit?\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<select class=\"verify input-field pg_check_default\" tabindex=\"170\" name=\"pg_rq_cadre\"  id=\"pg_rq_cadre\" >\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"0\" selected disabled hidden>\r\n\t\t\t\t\t\t\t\t\t\t\tPlease select *\r\n\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"Aucune indication\">\r\n\t\t\t\t\t\t\t\t\t\t\tNo indication\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">\r\n\t\t\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">\r\n\t\t\t\t\t\t\t\t\t\t\tCurrent expenses\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">\r\n\t\t\t\t\t\t\t\t\t\t\tPassenger car\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">\r\n\t\t\t\t\t\t\t\t\t\t\tMotorcycle, moped, scooter\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">\r\n\t\t\t\t\t\t\t\t\t\t\tConversion of residential property\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">\r\n\t\t\t\t\t\t\t\t\t\t\tConversion of owner-occupied housing\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">\r\n\t\t\t\t\t\t\t\t\t\t\tContinuing education\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">\r\n\t\t\t\t\t\t\t\t\t\t\tConsumer electronics, computers\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">\r\n\t\t\t\t\t\t\t\t\t\t\tHousehold appliances\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">\r\n\t\t\t\t\t\t\t\t\t\t\tHealth expenses\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">\r\n\t\t\t\t\t\t\t\t\t\t\tClothing, jewelry\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">\r\n\t\t\t\t\t\t\t\t\t\t\tSports and fitness equipment\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">\r\n\t\t\t\t\t\t\t\t\t\t\tCombining several loans\t\t\t\t\t\t\t\t\t\t<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\t\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_title\">\r\n\t\t\t\t\t\t\t\t\tComments\/questions on the funding application\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<label class=\"input\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"input-label\">\r\n\t\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<textarea class=\"verify input-field pg_check_default\" tabindex=\"171\"  id=\"pg_rq_remarque\" name=\"pg_rq_remarque\" rows=\"4\" col=\"50\" maxlength=\"1000\"><\/textarea>\r\n\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<!-- Documents \/ pi\u00e8ces jointes -->\r\n\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"pg_form_section_title\">\r\n\t\t\t\t\t\t\t\tDocuments \/ attachments\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div>For a quicker analysis of your credit application, please send us the necessary documents<\/div>\r\n\t\t\t\t\t\t\t\t<a href=\"\/documents-necessaires\/\" target=\"_blank\">List of documents required for your credit application<\/a>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t\t<div class=\"pgcs__attachments\" style=\"min-height: 100px!important;\">\r\n\t\t\t\t\t\t\t\t\t<b>\r\n\t\t\t\t\t\t\t\t\t\tAttachments \r\n\t\t\t\t\t\t\t\t\t\t(max. 3 MB) <\/b>\r\n\t\t\t\t\t\t\t\t\t<br>\r\n\t\t\t\t\t\t\t\t\t<input class=\"pgcs__attachment\" tabindex=\"172\" name=\"attachment\" type=\"file\" accept=\".jpg,.jpeg,.png,.pdf\">\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before6\" tabindex=\"173\" class=\"pgcs_btn_validation_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\tBack \r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"174\" id=\"btn_next6\" class=\"pgcs_btn_validation_all pg_icon_state \">\r\n\t\t\t\t\t\t\t\t\tNext \r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<!-- R\u00e9capitulatif -->\r\n            <div id=\"form7\" style=\"display:none;\" class=\"pg_csform2_col\">\r\n\t\t\t\t<div class=\"form2\">\r\n\t\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\t\tShipment confirmation\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Confirmation des informations mentionn\u00e9es -->\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t<input class=\"form-check-input\" tabindex=\"174\" type=\"checkbox\" id=\"accept_infos\" name=\"accept_infos\" >\r\n\t\t\t\t\t\t\t\t<label id=\"pgcs__legal3\" class=\"form-check-label\" for=\"accept_infos\">\r\n\t\t\t\t\t\t\t\t\tI confirm that the amounts and information below are complete, accurate and reflect my true economic situation.\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t<input class=\"form-check-input\" tabindex=\"175\" type=\"checkbox\" id=\"accept\" name=\"accept\" >\r\n\t\t\t\t\t\t\t\t<label id=\"pgcs__legal2\" class=\"form-check-label\" for=\"accept\">\r\n\t\t\t\t\t\t\t\t\tI hereby confirm that I have read the <a target=\"_blank\" href=\"\/wp-content\/uploads\/2024\/03\/Informations_juridiques.pdf\">legal information<\/a> in their entirety and declare that I accept them in all respects\t\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\r\n\t\t\t\t\t<div class=\"row\" style=\"margin-bottom : 50px;\">\r\n\t\t\t\t\t\t<div class=\"col-12 pg_media_767\" style=\"margin-bottom: 50px;\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_left\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" id=\"btn_before7\" tabindex=\"176\" class=\"pgcs_btn_validation_return pgcs_btn_return pg_icon_state\">\r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_before2\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angle-left pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-angles-left pg_icon-lock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t\t<span class=\"et-pb-icon\" style=\"font-size:12px !important;\">&#x6a;<\/span>\r\n\t\t\t\t\t\t\t\t\tModify your information \r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div id=\"pg_captcha_border\">\r\n\t\t\t\t\t\t\t\t<div class=\"h-captcha\" data-sitekey=\"24a52aeb-d749-4d60-a17a-a268e37f6469\"><\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div id=\"pg_error_captcha\" style=\"display:none; color:red !important;\">Solve the captcha to confirm that you are not a robot. <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-6 pg_media_767\">\r\n\t\t\t\t\t\t\t<div class=\"pgcs_btn_f4_right\">\r\n\t\t\t\t\t\t\t\t<button type=\"button\" tabindex=\"177\" id=\"btn_next7\" class=\"pgcs_btn_validation_all pgcs_btn_send pg_icon_state \">\r\n\t\t\t\t\t\t\t\t\tApply for credit \r\n\t\t\t\t\t\t\t\t\t<span class=\"pg_icon_next3\">\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check pg_icon-unlock\"><\/i>\r\n\t\t\t\t\t\t\t\t\t\t<i class=\"fa-solid fa-check-double pg_icon-lock pg_icon_biggest\"><\/i>\r\n\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t\t<\/button>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<!-- Step = Biens, revenus et d\u00e9penses -->\r\n\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t<div class=\"pgcs_montant_duree\" style=\"text-align:center;\">\r\n\t\t\t\t\t\tOverview of your information\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"form2 pg_recap_form\" style=\"padding-top: 20px;  box-shadow: 1px 2px 5px darkgrey; border-radius: 10px;\">\r\n\t\t\t\t\t<div class=\"row\" style=\"border-bottom: 1px solid #f47b24!important; padding-left:0px; padding-right:0px; padding-bottom: 0px; box-shadow: 0px 2px 2px -2px black;\">\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_1\" class=\"pg_btn_confirm activ\">\r\n\t\t\t\t\t\t\t\tCredit and monthly payments\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_2\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tPersonal data\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_3\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tProfessions and income\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\" style=\"padding-left:0px; padding-right:0px;\">\r\n\t\t\t\t\t\t\t<div id=\"conf_btn_4\" class=\"pg_btn_confirm\">\r\n\t\t\t\t\t\t\t\tHousing and expenses\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Cr\u00e9dit et mensualit\u00e9s -->\r\n\t\t\t\t\t<div id=\"confirm_1\" style=\"display:block; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Cr\u00e9dit souhait\u00e9 -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tCredit Required\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDesired credit in CHF\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_simulator_ammount\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDuration in months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\"  id=\"display_pg_simulator_time\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Donn\u00e9es personnelles -->\r\n\t\t\t\t\t<div id=\"confirm_2\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Donn\u00e9es personnelles -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tPersonal data\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_titre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_titre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_nom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_nom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_prenom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tFirst name\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_prenom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_ec\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCivil status\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_ec\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_v_nj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_v_nj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_pays\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_pays\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_permis\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_permis\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_pj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_pj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_n_vj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_n_vj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Coordonn\u00e9es -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tContact details and address\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_ic_tel\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPhone number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_ic_tel\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_ic_mail\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tE-mail address\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_ic_mail\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_canton\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCanton\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_canton\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_dep_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResident at this address since\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_dep_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_d_sit_log\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHousing situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_d_sit_log\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Logement en propri\u00e9t\u00e9-->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">Housing\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_prop\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHousing type  \t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_prop\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_hyp\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMortgage in CHF\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_hyp\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOwner since  \t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_dom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHome ownership\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_dom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and house number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dp_l_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tZip code and location\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dp_l_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section = Donn\u00e9es personnelles - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tPersonal data - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_titre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_titre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_nom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_nom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_prenom\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tFirst name\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_prenom\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_v_nj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_v_nj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_pays\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_pays\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_permis\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tResidence permits\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_permis\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_pj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDate of entry into Switzerland\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_pj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_n_vj\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tValid until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_n_vj\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Coordonn\u00e9es - Conjoint-->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tContact details - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_ic_tel\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPhone number\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_ic_tel\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dpvc_ic_mail\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tE-mail address\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dpvc_ic_mail\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Professions et revenus -->\r\n\t\t\t\t\t<div id=\"confirm_3\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = Revenus -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_sp_ctr_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tEmployed until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_sp_ctr_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section SOIT = Employeur -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_sp_employeur\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployer \/ Company\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_e_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_e_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Si emplyeur ou ind\u00e9pendant = Moyen de transport -->\r\n\t\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_sp_transports\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_transp\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tHow to get to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_transp\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_auto\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tDo you have any reasons for\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_auto\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_g_km\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of km to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_g_km\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus nets -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tNet income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_sal\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMain income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_sal\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rp_bns\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rp_bns\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus Accessoires -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_aa_activity\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tSecondary activity \/ other employers\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rs\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rs\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tUntil when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rev\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rev\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_aa_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_aa_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus suppl\u00e9mentaire -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" id=\"showrow_pg_rd_rs_revenusup\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rs_sr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rs_sr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_rs_rn\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_rs_rn\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t\t<!-- section = Revenus - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployment status - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_sp_ctr_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tEmployed until\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_sp_ctr_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section SOIT = Employeur - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_sp_employeur\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tEmployer - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tStreet and no.\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_e_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_e_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section Autres = RIEN -->\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t\t<div style=\"display:none;\">\r\n\t\t\t\t\t\t\t<!-- Si emplyeur ou ind\u00e9pendant = Moyen de transport - Conjoint -->\r\n\t\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_sp_transports\">\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_transp\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tHow to get to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_transp\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_auto\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tDo you have any reasons for\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_auto\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_g_km\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t\tNumber of km to your workplace\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_g_km\"><\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<!-- section = Revenus nets - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" >\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tNet income - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_sal\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMain income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_sal\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rp_bns\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBonuses \/ gratuities over the past 11 months\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rp_bns\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus Accessoires - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_aa_activity\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tSecondary activity \/ other employers - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rs\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAdditional income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rs\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_sit\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProfessional situation\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_sit\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_ctr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tContract type\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_ctr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSince when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_f_mois\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tUntil when?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_f_mois\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rev\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rev\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_mens\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNumber of annual revenues?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_mens\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_name\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCompany \/ Employer\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_name\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_rue\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_rue\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_aa_npa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tPostcode and town\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_aa_npa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Revenus suppl\u00e9mentaire - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" id=\"showrow_pg_rdvc_rs_revenusup\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tAdditional income - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rs_sr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tSource of income\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rs_sr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_rs_rn\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tNet monthly income (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_rs_rn\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Logements et d\u00e9penses -->\r\n\t\t\t\t\t<div id=\"confirm_4\" style=\"display:none; padding-top: 20px; padding-left:10px; padding-right:10px; background-color:#fff;\">\r\n\t\t\t\t\t\t<!-- section = D\u00e9penses -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tExpenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_dp_pa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_dp_pa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rd_dp_adm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOther expenses (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rd_dp_adm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = D\u00e9penses - Conjoint -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form pg_showformrecap_conjoint\" style=\"display:none;\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tExpenses - Spouse\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_dp_pa\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAlimony (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_dp_pa\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rdvc_dp_adm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOther expenses (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rdvc_dp_adm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\t\t\t\t\r\n\r\n\r\n\t\t\t\t\t\t<!-- section = Enfants dans le foyer  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tChildren in the household\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tChildren under 25\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_1\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t1) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_1\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_2\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t2) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_2\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_3\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t3) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_3\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_4\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t4) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_4\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_5\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t5) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_5\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_6\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t6) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_6\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_7\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t7) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_7\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_ef_8\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\t8) Date of birth\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_ef_8\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t\t<!-- section = Autres d\u00e9penses  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tOther monthly expenses\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fg\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tChildcare expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fg\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fl\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tAccommodation expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fl\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_ft\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tBusiness travel expenses\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_ft\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_fr\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCatering costs\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_fr\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_adm_cm\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tHealth insurance\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_adm_cm\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\r\n\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Dettes et cr\u00e9dits  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tDebts and credits\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_cred\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tLoans or leases from other institutions?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_cred\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_cred_mont\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tMonthly payments in (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_cred_mont\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_off\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tOffer for your current credit?\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_off\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_nbp\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tProsecutions in the last three years\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_nbp\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_act\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tDefault deeds\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_act\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_dc_dc_mont\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tTotal amount pursued (CHF)\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_dc_dc_mont\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\r\n\t\t\t\t\t\t<!-- section = Remarques questions  -->\r\n\t\t\t\t\t\t<section class=\"pg_section_form\">\r\n\t\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t\t<div class=\"pg_form_recap_title\">\r\n\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rq_cadre\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tCredit utilization framework\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rq_cadre\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<div class=\"row\" id=\"showrow_pg_rq_remarque\">\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-8\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\">\r\n\t\t\t\t\t\t\t\t\t\tComments \/ questions\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\r\n\t\t\t\t\t\t\t\t\t<div class=\"pg_form_champ_recap\" id=\"display_pg_rq_remarque\"><\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<!-- input = send recap by post  -->\r\n\t\t\t\t\t\t\t<div>\r\n\t\t\t\t\t\t\t\t<input id=\"pg_send_form\" style=\"visibility:hidden;\" name=\"pg_send_form\" type=\"text\">\r\n\t\t\t\t\t\t\t\t<input id=\"pg_agt_number\" name=\"pg_agt_number\" style=\"visibility:hidden;\" type=\"text\">\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/section>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\r\n\t\t<button type=\"submit\" id=\"pg_send_button\" style=\"visibility:hidden !important;\"><\/button>\r\n\t<\/form>\r\n<\/div>\r\n\r\n<script src='https:\/\/www.hCaptcha.com\/1\/api.js' async defer><\/script>\r\nRoute des Arseaux 71700 FribourgMonday &#8211; Friday08:30-12:00 &#8211; 13h30-18h00026 424 48 88079 230 70 06Become a partnerinfo@alfinance.ch<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/pages\/730"}],"collection":[{"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/comments?post=730"}],"version-history":[{"count":3,"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/pages\/730\/revisions"}],"predecessor-version":[{"id":1047,"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/pages\/730\/revisions\/1047"}],"wp:attachment":[{"href":"https:\/\/alcredit.ch\/en\/wp-json\/wp\/v2\/media?parent=730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}