{"id":5004,"date":"2026-01-14T15:09:46","date_gmt":"2026-01-14T14:09:46","guid":{"rendered":"https:\/\/snvsolutions.ch\/?page_id=5004"},"modified":"2026-01-15T11:33:55","modified_gmt":"2026-01-15T10:33:55","slug":"kundenaufnahmeformular-privatperson-fr","status":"publish","type":"page","link":"https:\/\/snvsolutions.ch\/en\/kundenaufnahmeformular-privatperson-fr\/","title":{"rendered":"KUNDENAUFNAHMEFORMULAR (Privatperson) FR"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5004\" class=\"elementor elementor-5004\">\n\t\t\t\t<div class=\"elementor-element elementor-element-13194e3 e-flex e-con-boxed e-con e-parent\" data-id=\"13194e3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d3f49fd elementor-widget elementor-widget-heading\" data-id=\"d3f49fd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">FORMULAIRE D\u2019INSCRIPTION CLIENT (Personne priv\u00e9e)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-22d5f5b e-flex e-con-boxed e-con e-parent\" data-id=\"22d5f5b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-40e7735 elementor-widget elementor-widget-shortcode\" data-id=\"40e7735\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style id=\"wpforms-css-vars-4964\">\n\t\t\t\t#wpforms-4964 {\n\t\t\t\t--wpforms-field-background-color: ;\n--wpforms-field-border-color: rgba(0, 0, 0, 0.25);\n--wpforms-field-border-color-spare: rgba(0, 0, 0, 0.25);\n--wpforms-field-text-color: rgba(0, 0, 0, 0.7);\n--wpforms-label-color: rgba(0, 0, 0, 0.85);\n--wpforms-label-sublabel-color: rgba(0, 0, 0, 0.55);\n--wpforms-button-background-color: #ffb400;\n--wpforms-button-text-color: #082250;\n--wpforms-container-border-radius: 1px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 18px;\n--wpforms-label-size-line-height: 21px;\n--wpforms-label-size-sublabel-font-size: 16px;\n--wpforms-label-size-sublabel-line-height: 19px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-4964\"><form id=\"wpforms-form-4964\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"4964\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/5004?wpforms_form_id=4964\" data-token=\"32632fa5c3ec2cb89d2b8b0cafebea1a\" data-token-time=\"1775373131\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"7\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 7<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:14.285714285714%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-4964-field_983-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"983\"><\/div>\t\t<div id=\"wpforms-4964-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-4964-field_1\" >Fonction Activit\u00e9 Num\u00e9ro<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-4964-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-4964-field_54-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"54\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t1\ufe0f\u20e3 Informations personnelles\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_64\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-4964-field_64-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_65-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_65\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_65\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][65]\" aria-errormessage=\"wpforms-4964-field_65-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_66\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_66\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][66]\" aria-errormessage=\"wpforms-4964-field_66-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_68-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_68\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" aria-errormessage=\"wpforms-4964-field_68-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_43-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_43\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_43\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][43]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_43-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_423-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"423\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_423\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_423\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][423][date]\" aria-errormessage=\"wpforms-4964-field_423-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_40\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-4964-field_40-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_385-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"385\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_385\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_385\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][385]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_385-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_57\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-4964-field_57-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_38\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-4964-field_38-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_59-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_59\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_59\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-4964-field_59-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_61\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_61\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-4964-field_61-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_424-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"424\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_424\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_424\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][424][date]\" aria-errormessage=\"wpforms-4964-field_424-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_138-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"138\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_138\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_138_1\" name=\"wpforms[fields][138][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_138_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_138_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_138_2\" name=\"wpforms[fields][138][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_138_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_138_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_44-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_44\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-4964-field_44-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_140-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"140\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_140\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_140\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][140]\" aria-errormessage=\"wpforms-4964-field_140-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_141-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"141\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_141\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_141\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][141]\" aria-errormessage=\"wpforms-4964-field_141-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_145-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"145\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_145\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_145\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][145]\" aria-errormessage=\"wpforms-4964-field_145-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_557-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"557\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_557\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_557\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][557][date]\" aria-errormessage=\"wpforms-4964-field_557-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_152-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"152\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_152\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_152_1\" name=\"wpforms[fields][152][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_152_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_152_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_152_2\" name=\"wpforms[fields][152][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_152_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_152_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_143-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"143\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_143\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_143\" class=\"wpforms-field-medium\" name=\"wpforms[fields][143]\" aria-errormessage=\"wpforms-4964-field_143-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_147-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"147\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_147\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_147\" class=\"wpforms-field-medium\" name=\"wpforms[fields][147]\" aria-errormessage=\"wpforms-4964-field_147-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_146-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"146\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_146\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_146\" class=\"wpforms-field-medium\" name=\"wpforms[fields][146]\" aria-errormessage=\"wpforms-4964-field_146-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_558-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"558\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_558\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_558\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][558][date]\" aria-errormessage=\"wpforms-4964-field_558-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_154-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"154\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_154\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_154_1\" name=\"wpforms[fields][154][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_154_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_154_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_154_2\" name=\"wpforms[fields][154][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_154_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_154_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_157-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"157\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_157\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_157\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][157]\" aria-errormessage=\"wpforms-4964-field_157-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_158-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"158\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_158\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_158\" class=\"wpforms-field-medium\" name=\"wpforms[fields][158]\" aria-errormessage=\"wpforms-4964-field_158-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_159-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"159\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_159\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_159\" class=\"wpforms-field-medium\" name=\"wpforms[fields][159]\" aria-errormessage=\"wpforms-4964-field_159-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_156-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"156\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_156\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_156_1\" name=\"wpforms[fields][156][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_156_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_156_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_156_2\" name=\"wpforms[fields][156][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_156_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_156_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_160-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"160\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_160\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_160_1\" name=\"wpforms[fields][160][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_160_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_160_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_160_2\" name=\"wpforms[fields][160][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_160_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_160_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_161-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"161\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_161\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_161_1\" name=\"wpforms[fields][161][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_161_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_161_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_161_2\" name=\"wpforms[fields][161][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_161_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_161_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_161_5\" name=\"wpforms[fields][161][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_161_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_161_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_161_6\" name=\"wpforms[fields][161][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_161_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_161_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_165-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"165\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_165\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_165_1\" name=\"wpforms[fields][165][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_165_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_165_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_165_2\" name=\"wpforms[fields][165][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_165_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_165_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_166-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"166\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_166\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_1\" name=\"wpforms[fields][166][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_166_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_2\" name=\"wpforms[fields][166][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_166_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_5\" name=\"wpforms[fields][166][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_166_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_6\" name=\"wpforms[fields][166][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_166_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_7\" name=\"wpforms[fields][166][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_166_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_10\" name=\"wpforms[fields][166][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_166_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_9\" name=\"wpforms[fields][166][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_166_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_8\" name=\"wpforms[fields][166][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_166_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_12\" name=\"wpforms[fields][166][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_166_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_11\" name=\"wpforms[fields][166][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_166_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_13\" name=\"wpforms[fields][166][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_166_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_14\" name=\"wpforms[fields][166][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_166_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_15\" name=\"wpforms[fields][166][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_166_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_16\" name=\"wpforms[fields][166][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_166_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_17\" name=\"wpforms[fields][166][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_166_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_166_18\" name=\"wpforms[fields][166][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_166_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_166_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_163-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"163\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_163\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_163_1\" name=\"wpforms[fields][163][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_163_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_163_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_163_2\" name=\"wpforms[fields][163][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_163_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_163_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_164-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"164\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_164\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_1\" name=\"wpforms[fields][164][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_164_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_2\" name=\"wpforms[fields][164][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_164_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_5\" name=\"wpforms[fields][164][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_164_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_6\" name=\"wpforms[fields][164][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_164_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_7\" name=\"wpforms[fields][164][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_164_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_10\" name=\"wpforms[fields][164][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_164_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_9\" name=\"wpforms[fields][164][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_164_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_8\" name=\"wpforms[fields][164][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_164_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_12\" name=\"wpforms[fields][164][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_164_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_11\" name=\"wpforms[fields][164][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_164_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_164_13\" name=\"wpforms[fields][164][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_164_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_164_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_167-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"167\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_167\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_167_1\" name=\"wpforms[fields][167][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_167_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_167_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_167_2\" name=\"wpforms[fields][167][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_167_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_167_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_990-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"990\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_990\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_990\" class=\"wpforms-field-medium\" name=\"wpforms[fields][990]\" aria-errormessage=\"wpforms-4964-field_990-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_169-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"169\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_169\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_1\" name=\"wpforms[fields][169][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_169_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_2\" name=\"wpforms[fields][169][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_169_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_5\" name=\"wpforms[fields][169][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_169_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_6\" name=\"wpforms[fields][169][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_169_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_7\" name=\"wpforms[fields][169][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_169_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_169_8\" name=\"wpforms[fields][169][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_169_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_169_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_170-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"170\"><fieldset><legend class=\"wpforms-field-label\">6. Documents \u00e0 joindre (si disponibles)<\/legend><ul id=\"wpforms-4964-field_170\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_1\" name=\"wpforms[fields][170][]\" value=\"Certificats de salaire\" aria-errormessage=\"wpforms-4964-field_170_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_1\">Certificats de salaire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_2\" name=\"wpforms[fields][170][]\" value=\"Attestation de rente ou d\u2019AI\" aria-errormessage=\"wpforms-4964-field_170_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_2\">Attestation de rente ou d\u2019AI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_5\" name=\"wpforms[fields][170][]\" value=\"Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats\" aria-errormessage=\"wpforms-4964-field_170_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_5\">Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_6\" name=\"wpforms[fields][170][]\" value=\"Attestations d\u2019assurance\" aria-errormessage=\"wpforms-4964-field_170_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_6\">Attestations d\u2019assurance<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_7\" name=\"wpforms[fields][170][]\" value=\"Derni\u00e8re taxation\" aria-errormessage=\"wpforms-4964-field_170_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_7\">Derni\u00e8re taxation<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_9\" name=\"wpforms[fields][170][]\" value=\"Primes maladie \/ remboursements\" aria-errormessage=\"wpforms-4964-field_170_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_9\">Primes maladie \/ remboursements<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_170_8\" name=\"wpforms[fields][170][]\" value=\"Autres documents\" aria-errormessage=\"wpforms-4964-field_170_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_170_8\">Autres documents<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_982-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"982\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-4964-field_764-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"764\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t2\ufe0f\u20e3 \u00c9poux \/ partenaire\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_765-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"765\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_765\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_765\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][765]\" aria-errormessage=\"wpforms-4964-field_765-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_775-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"775\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_775\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_775\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][775]\" aria-errormessage=\"wpforms-4964-field_775-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_785-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"785\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_785\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_785\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][785]\" aria-errormessage=\"wpforms-4964-field_785-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_795-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"795\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_795\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_795\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][795]\" aria-errormessage=\"wpforms-4964-field_795-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_766-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"766\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_766\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_766\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][766]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_766-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_776-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"776\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_776\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_776\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][776][date]\" aria-errormessage=\"wpforms-4964-field_776-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_786-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"786\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_786\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_786\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][786]\" aria-errormessage=\"wpforms-4964-field_786-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_796-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"796\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_796\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_796\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][796]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_796-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_767-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"767\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_767\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_767\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][767]\" aria-errormessage=\"wpforms-4964-field_767-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_777-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"777\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_777\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_777\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][777]\" aria-errormessage=\"wpforms-4964-field_777-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_787-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"787\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_787\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_787\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][787]\" aria-errormessage=\"wpforms-4964-field_787-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_797-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"797\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_797\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_797\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][797]\" aria-errormessage=\"wpforms-4964-field_797-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_768-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"768\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_768\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_768\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][768][date]\" aria-errormessage=\"wpforms-4964-field_768-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_778-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"778\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_778\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_778_1\" name=\"wpforms[fields][778][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_778_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_778_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_778_2\" name=\"wpforms[fields][778][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_778_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_778_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_788-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"788\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_788\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_788\" class=\"wpforms-field-medium\" name=\"wpforms[fields][788]\" aria-errormessage=\"wpforms-4964-field_788-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_798-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"798\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_798\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_798\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][798]\" aria-errormessage=\"wpforms-4964-field_798-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_769-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"769\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_769\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_769\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][769]\" aria-errormessage=\"wpforms-4964-field_769-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_779-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"779\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_779\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_779\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][779]\" aria-errormessage=\"wpforms-4964-field_779-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_789-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"789\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_789\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_789\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][789][date]\" aria-errormessage=\"wpforms-4964-field_789-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_799-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"799\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_799\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_799_1\" name=\"wpforms[fields][799][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_799_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_799_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_799_2\" name=\"wpforms[fields][799][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_799_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_799_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_770-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"770\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_770\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_770\" class=\"wpforms-field-medium\" name=\"wpforms[fields][770]\" aria-errormessage=\"wpforms-4964-field_770-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_780-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"780\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_780\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_780\" class=\"wpforms-field-medium\" name=\"wpforms[fields][780]\" aria-errormessage=\"wpforms-4964-field_780-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_790-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"790\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_790\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_790\" class=\"wpforms-field-medium\" name=\"wpforms[fields][790]\" aria-errormessage=\"wpforms-4964-field_790-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_800-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"800\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_800\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_800\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][800][date]\" aria-errormessage=\"wpforms-4964-field_800-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_771-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"771\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_771\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_771_1\" name=\"wpforms[fields][771][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_771_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_771_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_771_2\" name=\"wpforms[fields][771][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_771_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_771_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_781-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"781\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_781\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_781\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][781]\" aria-errormessage=\"wpforms-4964-field_781-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_791-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"791\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_791\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_791\" class=\"wpforms-field-medium\" name=\"wpforms[fields][791]\" aria-errormessage=\"wpforms-4964-field_791-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_801-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"801\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_801\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_801\" class=\"wpforms-field-medium\" name=\"wpforms[fields][801]\" aria-errormessage=\"wpforms-4964-field_801-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_772-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"772\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_772\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_772_1\" name=\"wpforms[fields][772][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_772_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_772_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_772_2\" name=\"wpforms[fields][772][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_772_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_772_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_782-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"782\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_782\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_782_1\" name=\"wpforms[fields][782][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_782_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_782_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_782_2\" name=\"wpforms[fields][782][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_782_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_782_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_792-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"792\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_792\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_792_1\" name=\"wpforms[fields][792][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_792_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_792_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_792_2\" name=\"wpforms[fields][792][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_792_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_792_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_792_5\" name=\"wpforms[fields][792][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_792_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_792_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_792_6\" name=\"wpforms[fields][792][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_792_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_792_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_802-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"802\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_802\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_802_1\" name=\"wpforms[fields][802][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_802_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_802_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_802_2\" name=\"wpforms[fields][802][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_802_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_802_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_773-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"773\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_773\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_1\" name=\"wpforms[fields][773][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_773_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_2\" name=\"wpforms[fields][773][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_773_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_5\" name=\"wpforms[fields][773][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_773_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_6\" name=\"wpforms[fields][773][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_773_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_7\" name=\"wpforms[fields][773][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_773_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_10\" name=\"wpforms[fields][773][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_773_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_9\" name=\"wpforms[fields][773][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_773_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_8\" name=\"wpforms[fields][773][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_773_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_12\" name=\"wpforms[fields][773][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_773_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_11\" name=\"wpforms[fields][773][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_773_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_13\" name=\"wpforms[fields][773][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_773_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_14\" name=\"wpforms[fields][773][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_773_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_15\" name=\"wpforms[fields][773][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_773_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_16\" name=\"wpforms[fields][773][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_773_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_17\" name=\"wpforms[fields][773][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_773_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_773_18\" name=\"wpforms[fields][773][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_773_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_773_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_783-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"783\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_783\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_783_1\" name=\"wpforms[fields][783][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_783_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_783_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_783_2\" name=\"wpforms[fields][783][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_783_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_783_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_793-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"793\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_793\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_1\" name=\"wpforms[fields][793][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_793_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_2\" name=\"wpforms[fields][793][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_793_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_5\" name=\"wpforms[fields][793][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_793_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_6\" name=\"wpforms[fields][793][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_793_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_7\" name=\"wpforms[fields][793][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_793_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_10\" name=\"wpforms[fields][793][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_793_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_9\" name=\"wpforms[fields][793][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_793_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_8\" name=\"wpforms[fields][793][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_793_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_12\" name=\"wpforms[fields][793][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_793_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_11\" name=\"wpforms[fields][793][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_793_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_793_13\" name=\"wpforms[fields][793][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_793_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_793_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_803-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"803\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_803\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_803_1\" name=\"wpforms[fields][803][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_803_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_803_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_803_2\" name=\"wpforms[fields][803][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_803_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_803_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_991-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"991\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_991\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_991\" class=\"wpforms-field-medium\" name=\"wpforms[fields][991]\" aria-errormessage=\"wpforms-4964-field_991-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_784-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"784\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_784\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_1\" name=\"wpforms[fields][784][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_784_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_2\" name=\"wpforms[fields][784][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_784_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_5\" name=\"wpforms[fields][784][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_784_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_6\" name=\"wpforms[fields][784][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_784_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_7\" name=\"wpforms[fields][784][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_784_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_784_8\" name=\"wpforms[fields][784][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_784_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_784_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_794-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"794\"><fieldset><legend class=\"wpforms-field-label\">6. Documents \u00e0 joindre (si disponibles)<\/legend><ul id=\"wpforms-4964-field_794\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_1\" name=\"wpforms[fields][794][]\" value=\"Certificats de salaire\" aria-errormessage=\"wpforms-4964-field_794_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_1\">Certificats de salaire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_2\" name=\"wpforms[fields][794][]\" value=\"Attestation de rente ou d\u2019AI\" aria-errormessage=\"wpforms-4964-field_794_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_2\">Attestation de rente ou d\u2019AI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_5\" name=\"wpforms[fields][794][]\" value=\"Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats\" aria-errormessage=\"wpforms-4964-field_794_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_5\">Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_6\" name=\"wpforms[fields][794][]\" value=\"Attestations d\u2019assurance\" aria-errormessage=\"wpforms-4964-field_794_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_6\">Attestations d\u2019assurance<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_7\" name=\"wpforms[fields][794][]\" value=\"Derni\u00e8re taxation\" aria-errormessage=\"wpforms-4964-field_794_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_7\">Derni\u00e8re taxation<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_9\" name=\"wpforms[fields][794][]\" value=\"Primes maladie \/ remboursements\" aria-errormessage=\"wpforms-4964-field_794_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_9\">Primes maladie \/ remboursements<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_794_8\" name=\"wpforms[fields][794][]\" value=\"Autres documents\" aria-errormessage=\"wpforms-4964-field_794_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_794_8\">Autres documents<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_985-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"985\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Retour<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-4964-field_804-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"804\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t3\ufe0f\u20e3 Enfant 1\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_805-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"805\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_805\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_805\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][805]\" aria-errormessage=\"wpforms-4964-field_805-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_815-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"815\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_815\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_815\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][815]\" aria-errormessage=\"wpforms-4964-field_815-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_825-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"825\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_825\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_825\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][825]\" aria-errormessage=\"wpforms-4964-field_825-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_835-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"835\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_835\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_835\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][835]\" aria-errormessage=\"wpforms-4964-field_835-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_806-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"806\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_806\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_806\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][806]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_806-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_816-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"816\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_816\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_816\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][816][date]\" aria-errormessage=\"wpforms-4964-field_816-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_826-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"826\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_826\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_826\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][826]\" aria-errormessage=\"wpforms-4964-field_826-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_836-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"836\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_836\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_836\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][836]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_836-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_807-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"807\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_807\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_807\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][807]\" aria-errormessage=\"wpforms-4964-field_807-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_817-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"817\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_817\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_817\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][817]\" aria-errormessage=\"wpforms-4964-field_817-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_827-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"827\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_827\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_827\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][827]\" aria-errormessage=\"wpforms-4964-field_827-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_837-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"837\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_837\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_837\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][837]\" aria-errormessage=\"wpforms-4964-field_837-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_808-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"808\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_808\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_808\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][808][date]\" aria-errormessage=\"wpforms-4964-field_808-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_818-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"818\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_818\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_818_1\" name=\"wpforms[fields][818][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_818_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_818_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_818_2\" name=\"wpforms[fields][818][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_818_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_818_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_828-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"828\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_828\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_828\" class=\"wpforms-field-medium\" name=\"wpforms[fields][828]\" aria-errormessage=\"wpforms-4964-field_828-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_838-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"838\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_838\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_838\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][838]\" aria-errormessage=\"wpforms-4964-field_838-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_809-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"809\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_809\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_809\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][809]\" aria-errormessage=\"wpforms-4964-field_809-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_819-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"819\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_819\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_819\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][819]\" aria-errormessage=\"wpforms-4964-field_819-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_829-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"829\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_829\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_829\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][829][date]\" aria-errormessage=\"wpforms-4964-field_829-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_839-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"839\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_839\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_839_1\" name=\"wpforms[fields][839][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_839_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_839_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_839_2\" name=\"wpforms[fields][839][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_839_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_839_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_810-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"810\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_810\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_810\" class=\"wpforms-field-medium\" name=\"wpforms[fields][810]\" aria-errormessage=\"wpforms-4964-field_810-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_820-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"820\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_820\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_820\" class=\"wpforms-field-medium\" name=\"wpforms[fields][820]\" aria-errormessage=\"wpforms-4964-field_820-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_830-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"830\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_830\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_830\" class=\"wpforms-field-medium\" name=\"wpforms[fields][830]\" aria-errormessage=\"wpforms-4964-field_830-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_840-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"840\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_840\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_840\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][840][date]\" aria-errormessage=\"wpforms-4964-field_840-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_811-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"811\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_811\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_811_1\" name=\"wpforms[fields][811][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_811_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_811_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_811_2\" name=\"wpforms[fields][811][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_811_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_811_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_821-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"821\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_821\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_821\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][821]\" aria-errormessage=\"wpforms-4964-field_821-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_831-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"831\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_831\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_831\" class=\"wpforms-field-medium\" name=\"wpforms[fields][831]\" aria-errormessage=\"wpforms-4964-field_831-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_841-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"841\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_841\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_841\" class=\"wpforms-field-medium\" name=\"wpforms[fields][841]\" aria-errormessage=\"wpforms-4964-field_841-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_812-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"812\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_812\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_812_1\" name=\"wpforms[fields][812][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_812_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_812_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_812_2\" name=\"wpforms[fields][812][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_812_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_812_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_822-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"822\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_822\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_822_1\" name=\"wpforms[fields][822][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_822_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_822_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_822_2\" name=\"wpforms[fields][822][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_822_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_822_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_832-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"832\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_832\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_832_1\" name=\"wpforms[fields][832][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_832_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_832_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_832_2\" name=\"wpforms[fields][832][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_832_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_832_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_832_5\" name=\"wpforms[fields][832][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_832_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_832_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_832_6\" name=\"wpforms[fields][832][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_832_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_832_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_842-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"842\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_842\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_842_1\" name=\"wpforms[fields][842][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_842_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_842_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_842_2\" name=\"wpforms[fields][842][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_842_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_842_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_813-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"813\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_813\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_1\" name=\"wpforms[fields][813][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_813_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_2\" name=\"wpforms[fields][813][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_813_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_5\" name=\"wpforms[fields][813][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_813_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_6\" name=\"wpforms[fields][813][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_813_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_7\" name=\"wpforms[fields][813][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_813_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_10\" name=\"wpforms[fields][813][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_813_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_9\" name=\"wpforms[fields][813][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_813_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_8\" name=\"wpforms[fields][813][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_813_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_12\" name=\"wpforms[fields][813][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_813_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_11\" name=\"wpforms[fields][813][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_813_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_13\" name=\"wpforms[fields][813][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_813_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_14\" name=\"wpforms[fields][813][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_813_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_15\" name=\"wpforms[fields][813][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_813_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_16\" name=\"wpforms[fields][813][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_813_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_17\" name=\"wpforms[fields][813][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_813_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_813_18\" name=\"wpforms[fields][813][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_813_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_813_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_823-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"823\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_823\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_823_1\" name=\"wpforms[fields][823][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_823_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_823_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_823_2\" name=\"wpforms[fields][823][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_823_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_823_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_833-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"833\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_833\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_1\" name=\"wpforms[fields][833][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_833_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_2\" name=\"wpforms[fields][833][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_833_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_5\" name=\"wpforms[fields][833][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_833_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_6\" name=\"wpforms[fields][833][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_833_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_7\" name=\"wpforms[fields][833][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_833_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_10\" name=\"wpforms[fields][833][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_833_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_9\" name=\"wpforms[fields][833][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_833_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_8\" name=\"wpforms[fields][833][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_833_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_12\" name=\"wpforms[fields][833][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_833_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_11\" name=\"wpforms[fields][833][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_833_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_833_13\" name=\"wpforms[fields][833][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_833_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_833_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_843-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"843\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_843\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_843_1\" name=\"wpforms[fields][843][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_843_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_843_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_843_2\" name=\"wpforms[fields][843][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_843_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_843_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_992-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"992\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_992\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_992\" class=\"wpforms-field-medium\" name=\"wpforms[fields][992]\" aria-errormessage=\"wpforms-4964-field_992-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_824-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"824\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_824\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_1\" name=\"wpforms[fields][824][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_824_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_2\" name=\"wpforms[fields][824][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_824_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_5\" name=\"wpforms[fields][824][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_824_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_6\" name=\"wpforms[fields][824][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_824_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_7\" name=\"wpforms[fields][824][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_824_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_824_8\" name=\"wpforms[fields][824][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_824_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_824_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_834-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"834\"><fieldset><legend class=\"wpforms-field-label\">6. Documents \u00e0 joindre (si disponibles)<\/legend><ul id=\"wpforms-4964-field_834\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_1\" name=\"wpforms[fields][834][]\" value=\"Certificats de salaire\" aria-errormessage=\"wpforms-4964-field_834_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_1\">Certificats de salaire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_2\" name=\"wpforms[fields][834][]\" value=\"Attestation de rente ou d\u2019AI\" aria-errormessage=\"wpforms-4964-field_834_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_2\">Attestation de rente ou d\u2019AI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_5\" name=\"wpforms[fields][834][]\" value=\"Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats\" aria-errormessage=\"wpforms-4964-field_834_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_5\">Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_6\" name=\"wpforms[fields][834][]\" value=\"Attestations d\u2019assurance\" aria-errormessage=\"wpforms-4964-field_834_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_6\">Attestations d\u2019assurance<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_7\" name=\"wpforms[fields][834][]\" value=\"Derni\u00e8re taxation\" aria-errormessage=\"wpforms-4964-field_834_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_7\">Derni\u00e8re taxation<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_9\" name=\"wpforms[fields][834][]\" value=\"Primes maladie \/ remboursements\" aria-errormessage=\"wpforms-4964-field_834_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_9\">Primes maladie \/ remboursements<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_834_8\" name=\"wpforms[fields][834][]\" value=\"Autres documents\" aria-errormessage=\"wpforms-4964-field_834_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_834_8\">Autres documents<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_986-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"986\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Retour<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-4964-field_844-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"844\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t4\ufe0f\u20e3 Enfant 2\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_845-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"845\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_845\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_845\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][845]\" aria-errormessage=\"wpforms-4964-field_845-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_855-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"855\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_855\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_855\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][855]\" aria-errormessage=\"wpforms-4964-field_855-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_865-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"865\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_865\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_865\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][865]\" aria-errormessage=\"wpforms-4964-field_865-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_875-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"875\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_875\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_875\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][875]\" aria-errormessage=\"wpforms-4964-field_875-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_846-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"846\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_846\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_846\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][846]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_846-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_856-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"856\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_856\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_856\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][856][date]\" aria-errormessage=\"wpforms-4964-field_856-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_866-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"866\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_866\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_866\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][866]\" aria-errormessage=\"wpforms-4964-field_866-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_876-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"876\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_876\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_876\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][876]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_876-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_847-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"847\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_847\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_847\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][847]\" aria-errormessage=\"wpforms-4964-field_847-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_857-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"857\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_857\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_857\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][857]\" aria-errormessage=\"wpforms-4964-field_857-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_867-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"867\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_867\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_867\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][867]\" aria-errormessage=\"wpforms-4964-field_867-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_877-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"877\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_877\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_877\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][877]\" aria-errormessage=\"wpforms-4964-field_877-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_848-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"848\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_848\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_848\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][848][date]\" aria-errormessage=\"wpforms-4964-field_848-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_858-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"858\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_858\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_858_1\" name=\"wpforms[fields][858][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_858_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_858_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_858_2\" name=\"wpforms[fields][858][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_858_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_858_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_868-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"868\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_868\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_868\" class=\"wpforms-field-medium\" name=\"wpforms[fields][868]\" aria-errormessage=\"wpforms-4964-field_868-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_878-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"878\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_878\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_878\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][878]\" aria-errormessage=\"wpforms-4964-field_878-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_849-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"849\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_849\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_849\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][849]\" aria-errormessage=\"wpforms-4964-field_849-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_859-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"859\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_859\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_859\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][859]\" aria-errormessage=\"wpforms-4964-field_859-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_869-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"869\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_869\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_869\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][869][date]\" aria-errormessage=\"wpforms-4964-field_869-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_879-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"879\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_879\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_879_1\" name=\"wpforms[fields][879][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_879_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_879_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_879_2\" name=\"wpforms[fields][879][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_879_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_879_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_850-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"850\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_850\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_850\" class=\"wpforms-field-medium\" name=\"wpforms[fields][850]\" aria-errormessage=\"wpforms-4964-field_850-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_860-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"860\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_860\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_860\" class=\"wpforms-field-medium\" name=\"wpforms[fields][860]\" aria-errormessage=\"wpforms-4964-field_860-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_870-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"870\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_870\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_870\" class=\"wpforms-field-medium\" name=\"wpforms[fields][870]\" aria-errormessage=\"wpforms-4964-field_870-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_880-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"880\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_880\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_880\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][880][date]\" aria-errormessage=\"wpforms-4964-field_880-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_851-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"851\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_851\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_851_1\" name=\"wpforms[fields][851][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_851_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_851_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_851_2\" name=\"wpforms[fields][851][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_851_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_851_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_861-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"861\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_861\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_861\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][861]\" aria-errormessage=\"wpforms-4964-field_861-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_871-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"871\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_871\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_871\" class=\"wpforms-field-medium\" name=\"wpforms[fields][871]\" aria-errormessage=\"wpforms-4964-field_871-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_881-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"881\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_881\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_881\" class=\"wpforms-field-medium\" name=\"wpforms[fields][881]\" aria-errormessage=\"wpforms-4964-field_881-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_852-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"852\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_852\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_852_1\" name=\"wpforms[fields][852][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_852_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_852_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_852_2\" name=\"wpforms[fields][852][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_852_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_852_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_862-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"862\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_862\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_862_1\" name=\"wpforms[fields][862][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_862_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_862_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_862_2\" name=\"wpforms[fields][862][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_862_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_862_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_872-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"872\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_872\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_872_1\" name=\"wpforms[fields][872][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_872_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_872_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_872_2\" name=\"wpforms[fields][872][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_872_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_872_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_872_5\" name=\"wpforms[fields][872][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_872_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_872_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_872_6\" name=\"wpforms[fields][872][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_872_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_872_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_882-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"882\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_882\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_882_1\" name=\"wpforms[fields][882][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_882_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_882_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_882_2\" name=\"wpforms[fields][882][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_882_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_882_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_853-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"853\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_853\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_1\" name=\"wpforms[fields][853][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_853_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_2\" name=\"wpforms[fields][853][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_853_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_5\" name=\"wpforms[fields][853][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_853_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_6\" name=\"wpforms[fields][853][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_853_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_7\" name=\"wpforms[fields][853][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_853_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_10\" name=\"wpforms[fields][853][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_853_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_9\" name=\"wpforms[fields][853][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_853_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_8\" name=\"wpforms[fields][853][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_853_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_12\" name=\"wpforms[fields][853][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_853_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_11\" name=\"wpforms[fields][853][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_853_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_13\" name=\"wpforms[fields][853][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_853_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_14\" name=\"wpforms[fields][853][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_853_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_15\" name=\"wpforms[fields][853][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_853_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_16\" name=\"wpforms[fields][853][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_853_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_17\" name=\"wpforms[fields][853][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_853_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_853_18\" name=\"wpforms[fields][853][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_853_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_853_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_863-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"863\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_863\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_863_1\" name=\"wpforms[fields][863][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_863_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_863_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_863_2\" name=\"wpforms[fields][863][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_863_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_863_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_873-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"873\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_873\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_1\" name=\"wpforms[fields][873][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_873_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_2\" name=\"wpforms[fields][873][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_873_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_5\" name=\"wpforms[fields][873][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_873_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_6\" name=\"wpforms[fields][873][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_873_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_7\" name=\"wpforms[fields][873][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_873_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_10\" name=\"wpforms[fields][873][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_873_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_9\" name=\"wpforms[fields][873][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_873_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_8\" name=\"wpforms[fields][873][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_873_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_12\" name=\"wpforms[fields][873][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_873_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_11\" name=\"wpforms[fields][873][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_873_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_873_13\" name=\"wpforms[fields][873][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_873_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_873_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_883-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"883\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_883\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_883_1\" name=\"wpforms[fields][883][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_883_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_883_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_883_2\" name=\"wpforms[fields][883][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_883_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_883_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_993-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"993\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_993\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_993\" class=\"wpforms-field-medium\" name=\"wpforms[fields][993]\" aria-errormessage=\"wpforms-4964-field_993-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_864-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"864\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_864\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_1\" name=\"wpforms[fields][864][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_864_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_2\" name=\"wpforms[fields][864][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_864_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_5\" name=\"wpforms[fields][864][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_864_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_6\" name=\"wpforms[fields][864][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_864_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_7\" name=\"wpforms[fields][864][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_864_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_864_8\" name=\"wpforms[fields][864][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_864_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_864_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_874-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"874\"><fieldset><legend class=\"wpforms-field-label\">6. Documents \u00e0 joindre (si disponibles)<\/legend><ul id=\"wpforms-4964-field_874\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_1\" name=\"wpforms[fields][874][]\" value=\"Certificats de salaire\" aria-errormessage=\"wpforms-4964-field_874_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_1\">Certificats de salaire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_2\" name=\"wpforms[fields][874][]\" value=\"Attestation de rente ou d\u2019AI\" aria-errormessage=\"wpforms-4964-field_874_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_2\">Attestation de rente ou d\u2019AI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_5\" name=\"wpforms[fields][874][]\" value=\"Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats\" aria-errormessage=\"wpforms-4964-field_874_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_5\">Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_6\" name=\"wpforms[fields][874][]\" value=\"Attestations d\u2019assurance\" aria-errormessage=\"wpforms-4964-field_874_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_6\">Attestations d\u2019assurance<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_7\" name=\"wpforms[fields][874][]\" value=\"Derni\u00e8re taxation\" aria-errormessage=\"wpforms-4964-field_874_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_7\">Derni\u00e8re taxation<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_9\" name=\"wpforms[fields][874][]\" value=\"Primes maladie \/ remboursements\" aria-errormessage=\"wpforms-4964-field_874_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_9\">Primes maladie \/ remboursements<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_874_8\" name=\"wpforms[fields][874][]\" value=\"Autres documents\" aria-errormessage=\"wpforms-4964-field_874_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_874_8\">Autres documents<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_987-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"987\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Retour<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-4964-field_884-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"884\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t5\ufe0f\u20e3 Enfant 3\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_885-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"885\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_885\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_885\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][885]\" aria-errormessage=\"wpforms-4964-field_885-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_895-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"895\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_895\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_895\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][895]\" aria-errormessage=\"wpforms-4964-field_895-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_905-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"905\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_905\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_905\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][905]\" aria-errormessage=\"wpforms-4964-field_905-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_915-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"915\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_915\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_915\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][915]\" aria-errormessage=\"wpforms-4964-field_915-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_886-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"886\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_886\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_886\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][886]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_886-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_896-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"896\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_896\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_896\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][896][date]\" aria-errormessage=\"wpforms-4964-field_896-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_906-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"906\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_906\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_906\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][906]\" aria-errormessage=\"wpforms-4964-field_906-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_916-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"916\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_916\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_916\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][916]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_916-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_887-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"887\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_887\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_887\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][887]\" aria-errormessage=\"wpforms-4964-field_887-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_897-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"897\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_897\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_897\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][897]\" aria-errormessage=\"wpforms-4964-field_897-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_907-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"907\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_907\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_907\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][907]\" aria-errormessage=\"wpforms-4964-field_907-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_917-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"917\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_917\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_917\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][917]\" aria-errormessage=\"wpforms-4964-field_917-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_888-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"888\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_888\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_888\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][888][date]\" aria-errormessage=\"wpforms-4964-field_888-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_898-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"898\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_898\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_898_1\" name=\"wpforms[fields][898][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_898_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_898_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_898_2\" name=\"wpforms[fields][898][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_898_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_898_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_908-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"908\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_908\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_908\" class=\"wpforms-field-medium\" name=\"wpforms[fields][908]\" aria-errormessage=\"wpforms-4964-field_908-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_918-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"918\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_918\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_918\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][918]\" aria-errormessage=\"wpforms-4964-field_918-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_889-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"889\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_889\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_889\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][889]\" aria-errormessage=\"wpforms-4964-field_889-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_899-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"899\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_899\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_899\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][899]\" aria-errormessage=\"wpforms-4964-field_899-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_909-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"909\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_909\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_909\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][909][date]\" aria-errormessage=\"wpforms-4964-field_909-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_919-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"919\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_919\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_919_1\" name=\"wpforms[fields][919][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_919_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_919_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_919_2\" name=\"wpforms[fields][919][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_919_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_919_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_890-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"890\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_890\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_890\" class=\"wpforms-field-medium\" name=\"wpforms[fields][890]\" aria-errormessage=\"wpforms-4964-field_890-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_900-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"900\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_900\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_900\" class=\"wpforms-field-medium\" name=\"wpforms[fields][900]\" aria-errormessage=\"wpforms-4964-field_900-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_910-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"910\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_910\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_910\" class=\"wpforms-field-medium\" name=\"wpforms[fields][910]\" aria-errormessage=\"wpforms-4964-field_910-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_920-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"920\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_920\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_920\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][920][date]\" aria-errormessage=\"wpforms-4964-field_920-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_891-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"891\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_891\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_891_1\" name=\"wpforms[fields][891][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_891_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_891_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_891_2\" name=\"wpforms[fields][891][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_891_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_891_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_901-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"901\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_901\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_901\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][901]\" aria-errormessage=\"wpforms-4964-field_901-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_911-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"911\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_911\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_911\" class=\"wpforms-field-medium\" name=\"wpforms[fields][911]\" aria-errormessage=\"wpforms-4964-field_911-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_921-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"921\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_921\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_921\" class=\"wpforms-field-medium\" name=\"wpforms[fields][921]\" aria-errormessage=\"wpforms-4964-field_921-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_892-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"892\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_892\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_892_1\" name=\"wpforms[fields][892][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_892_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_892_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_892_2\" name=\"wpforms[fields][892][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_892_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_892_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_902-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"902\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_902\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_902_1\" name=\"wpforms[fields][902][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_902_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_902_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_902_2\" name=\"wpforms[fields][902][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_902_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_902_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_912-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"912\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_912\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_912_1\" name=\"wpforms[fields][912][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_912_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_912_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_912_2\" name=\"wpforms[fields][912][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_912_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_912_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_912_5\" name=\"wpforms[fields][912][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_912_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_912_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_912_6\" name=\"wpforms[fields][912][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_912_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_912_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_922-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"922\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_922\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_922_1\" name=\"wpforms[fields][922][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_922_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_922_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_922_2\" name=\"wpforms[fields][922][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_922_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_922_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_893-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"893\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_893\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_1\" name=\"wpforms[fields][893][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_893_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_2\" name=\"wpforms[fields][893][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_893_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_5\" name=\"wpforms[fields][893][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_893_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_6\" name=\"wpforms[fields][893][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_893_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_7\" name=\"wpforms[fields][893][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_893_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_10\" name=\"wpforms[fields][893][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_893_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_9\" name=\"wpforms[fields][893][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_893_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_8\" name=\"wpforms[fields][893][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_893_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_12\" name=\"wpforms[fields][893][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_893_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_11\" name=\"wpforms[fields][893][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_893_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_13\" name=\"wpforms[fields][893][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_893_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_14\" name=\"wpforms[fields][893][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_893_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_15\" name=\"wpforms[fields][893][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_893_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_16\" name=\"wpforms[fields][893][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_893_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_17\" name=\"wpforms[fields][893][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_893_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_893_18\" name=\"wpforms[fields][893][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_893_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_893_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_903-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"903\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_903\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_903_1\" name=\"wpforms[fields][903][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_903_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_903_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_903_2\" name=\"wpforms[fields][903][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_903_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_903_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_913-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"913\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_913\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_1\" name=\"wpforms[fields][913][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_913_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_2\" name=\"wpforms[fields][913][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_913_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_5\" name=\"wpforms[fields][913][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_913_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_6\" name=\"wpforms[fields][913][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_913_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_7\" name=\"wpforms[fields][913][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_913_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_10\" name=\"wpforms[fields][913][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_913_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_9\" name=\"wpforms[fields][913][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_913_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_8\" name=\"wpforms[fields][913][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_913_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_12\" name=\"wpforms[fields][913][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_913_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_11\" name=\"wpforms[fields][913][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_913_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_913_13\" name=\"wpforms[fields][913][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_913_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_913_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_923-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"923\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_923\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_923_1\" name=\"wpforms[fields][923][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_923_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_923_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_923_2\" name=\"wpforms[fields][923][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_923_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_923_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_994-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"994\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_994\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_994\" class=\"wpforms-field-medium\" name=\"wpforms[fields][994]\" aria-errormessage=\"wpforms-4964-field_994-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_904-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"904\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_904\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_1\" name=\"wpforms[fields][904][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_904_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_2\" name=\"wpforms[fields][904][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_904_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_5\" name=\"wpforms[fields][904][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_904_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_6\" name=\"wpforms[fields][904][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_904_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_7\" name=\"wpforms[fields][904][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_904_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_904_8\" name=\"wpforms[fields][904][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_904_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_904_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_914-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"914\"><fieldset><legend class=\"wpforms-field-label\">6. Documents \u00e0 joindre (si disponibles)<\/legend><ul id=\"wpforms-4964-field_914\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_1\" name=\"wpforms[fields][914][]\" value=\"Certificats de salaire\" aria-errormessage=\"wpforms-4964-field_914_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_1\">Certificats de salaire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_2\" name=\"wpforms[fields][914][]\" value=\"Attestation de rente ou d\u2019AI\" aria-errormessage=\"wpforms-4964-field_914_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_2\">Attestation de rente ou d\u2019AI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_5\" name=\"wpforms[fields][914][]\" value=\"Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats\" aria-errormessage=\"wpforms-4964-field_914_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_5\">Relev\u00e9s de compte \/ attestations d\u2019int\u00e9r\u00eats<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_6\" name=\"wpforms[fields][914][]\" value=\"Attestations d\u2019assurance\" aria-errormessage=\"wpforms-4964-field_914_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_6\">Attestations d\u2019assurance<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_7\" name=\"wpforms[fields][914][]\" value=\"Derni\u00e8re taxation\" aria-errormessage=\"wpforms-4964-field_914_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_7\">Derni\u00e8re taxation<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_9\" name=\"wpforms[fields][914][]\" value=\"Primes maladie \/ remboursements\" aria-errormessage=\"wpforms-4964-field_914_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_9\">Primes maladie \/ remboursements<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_914_8\" name=\"wpforms[fields][914][]\" value=\"Autres documents\" aria-errormessage=\"wpforms-4964-field_914_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_914_8\">Autres documents<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_988-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"988\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Retour<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"4964\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-4964-field_924-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"924\"><h3 class=\"wpforms-field-label\">\n\t\t\t\t6\ufe0f\u20e3 Enfant 4\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_925-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"925\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_925\">2.2 Pr\u00e9nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_925\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][925]\" aria-errormessage=\"wpforms-4964-field_925-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_935-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"935\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_935\">2.3 Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_935\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][935]\" aria-errormessage=\"wpforms-4964-field_935-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_945-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"945\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_945\">2.4. Rue \/ N\u00b0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_945\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][945]\" aria-errormessage=\"wpforms-4964-field_945-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_955-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"955\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_955\">2.5 Code postal \/ Ville <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_955\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][955]\" aria-errormessage=\"wpforms-4964-field_955-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_926-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"926\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_926\">2.18 E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4964-field_926\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][926]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4964-field_926-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_936-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"936\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_936\">2.9 Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_936\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][936][date]\" aria-errormessage=\"wpforms-4964-field_936-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_946-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"946\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_946\">2.10 \u00c9tat civil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_946\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][946]\" aria-errormessage=\"wpforms-4964-field_946-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_956-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"956\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_956\">2.16 T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4964-field_956\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][956]\" value=\"077 777 77 77\" aria-label=\"2.16 T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-4964-field_956-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_927-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"927\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_927\">2.13 Permis de s\u00e9jour <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_927\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][927]\" aria-errormessage=\"wpforms-4964-field_927-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_937-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"937\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_937\">2.8 Num\u00e9ro AVS (AHVN13) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_937\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][937]\" aria-errormessage=\"wpforms-4964-field_937-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_947-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"947\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_947\">2.12 Lieu d\u2019origine <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_947\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][947]\" aria-errormessage=\"wpforms-4964-field_947-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_957-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"957\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_957\">2.11 Nationalit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_957\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][957]\" aria-errormessage=\"wpforms-4964-field_957-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_928-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"928\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_928\">2.22 S\u00e9par\u00e9(e) depuis (le cas \u00e9ch\u00e9ant)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_928\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][928][date]\" aria-errormessage=\"wpforms-4964-field_928-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_938-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"938\"><fieldset><legend class=\"wpforms-field-label\">2.20 Obligations alimentaires \/ pension alimentaire<\/legend><ul id=\"wpforms-4964-field_938\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_938_1\" name=\"wpforms[fields][938][]\" value=\"ja\" aria-errormessage=\"wpforms-4964-field_938_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_938_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_938_2\" name=\"wpforms[fields][938][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_938_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_938_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_948-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"948\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_948\">2.19 Site web \/ URLL<\/label><input type=\"url\" id=\"wpforms-4964-field_948\" class=\"wpforms-field-medium\" name=\"wpforms[fields][948]\" aria-errormessage=\"wpforms-4964-field_948-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_958-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"958\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_958\">3.2 Employeur \/ Entreprise 1 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_958\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][958]\" aria-errormessage=\"wpforms-4964-field_958-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_929-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"929\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_929\"> 3.3 Profession \/ Fonction 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_929\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][929]\" aria-errormessage=\"wpforms-4964-field_929-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_939-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"939\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_939\">3.4  Taux d\u2019occupation 1 (%) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_939\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][939]\" aria-errormessage=\"wpforms-4964-field_939-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_949-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"949\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_949\">3.5 Employ\u00e9(e) depuis (date) 1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_949\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][949][date]\" aria-errormessage=\"wpforms-4964-field_949-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_959-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"959\"><fieldset><legend class=\"wpforms-field-label\">3.6 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_959\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_959_1\" name=\"wpforms[fields][959][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_959_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_959_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_959_2\" name=\"wpforms[fields][959][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_959_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_959_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_930-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"930\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_930\">3.6 Employeur \/ Entreprise 2<\/label><input type=\"text\" id=\"wpforms-4964-field_930\" class=\"wpforms-field-medium\" name=\"wpforms[fields][930]\" aria-errormessage=\"wpforms-4964-field_930-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_940-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"940\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_940\">3.6.1 Profession \/ Fonction 2<\/label><input type=\"text\" id=\"wpforms-4964-field_940\" class=\"wpforms-field-medium\" name=\"wpforms[fields][940]\" aria-errormessage=\"wpforms-4964-field_940-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_950-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"950\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_950\"> 3.6.1 Taux d\u2019occupation 2 (%) <\/label><input type=\"text\" id=\"wpforms-4964-field_950\" class=\"wpforms-field-medium\" name=\"wpforms[fields][950]\" aria-errormessage=\"wpforms-4964-field_950-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_960-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"960\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_960\">3.6.1 Employ\u00e9(e) depuis (date) 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-4964-field_960\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][960][date]\" aria-errormessage=\"wpforms-4964-field_960-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_931-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"931\"><fieldset><legend class=\"wpforms-field-label\">3.6.1 Activit\u00e9 secondaire \/ Ind\u00e9pendant(e)<\/legend><ul id=\"wpforms-4964-field_931\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_931_1\" name=\"wpforms[fields][931][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_931_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_931_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_931_2\" name=\"wpforms[fields][931][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_931_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_931_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_941-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"941\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_941\">4.1 Banque <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4964-field_941\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][941]\" aria-errormessage=\"wpforms-4964-field_941-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_951-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"951\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_951\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_951\" class=\"wpforms-field-medium\" name=\"wpforms[fields][951]\" aria-errormessage=\"wpforms-4964-field_951-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_961-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"961\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_961\">4.1 Banque<\/label><input type=\"text\" id=\"wpforms-4964-field_961\" class=\"wpforms-field-medium\" name=\"wpforms[fields][961]\" aria-errormessage=\"wpforms-4964-field_961-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_932-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"932\"><fieldset><legend class=\"wpforms-field-label\">3.15-3.24 Rentes \/ AI \/ Indemnit\u00e9s journali\u00e8res \/ Ch\u00f4mage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_932\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_932_1\" name=\"wpforms[fields][932][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_932_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_932_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_932_2\" name=\"wpforms[fields][932][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_932_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_932_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_942-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"942\"><fieldset><legend class=\"wpforms-field-label\">Dettes financi\u00e8res existantes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_942\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_942_1\" name=\"wpforms[fields][942][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_942_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_942_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_942_2\" name=\"wpforms[fields][942][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_942_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_942_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_952-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"952\"><fieldset><legend class=\"wpforms-field-label\">4.2 -4.4 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_952\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_952_1\" name=\"wpforms[fields][952][]\" value=\"Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)\" aria-errormessage=\"wpforms-4964-field_952_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_952_1\">Hypoth\u00e8que (r\u00e9sidence principale \/ bien de rendement)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_952_2\" name=\"wpforms[fields][952][]\" value=\"Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation\" aria-errormessage=\"wpforms-4964-field_952_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_952_2\">Pr\u00eat priv\u00e9 \/ cr\u00e9dit \u00e0 la consommation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_952_5\" name=\"wpforms[fields][952][]\" value=\"Contrat de leasing (p. ex. v\u00e9hicule)\" aria-errormessage=\"wpforms-4964-field_952_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_952_5\">Contrat de leasing (p. ex. v\u00e9hicule)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_952_6\" name=\"wpforms[fields][952][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_952_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_952_6\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_962-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"962\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Patrimoine (personne priv\u00e9e) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_962\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_962_1\" name=\"wpforms[fields][962][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_962_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_962_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_962_2\" name=\"wpforms[fields][962][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_962_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_962_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_933-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"933\"><fieldset><legend class=\"wpforms-field-label\">4.8-4.10 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_933\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_1\" name=\"wpforms[fields][933][]\" value=\"Avoirs bancaires (comptes \/ comptes \u00e9pargne)\" aria-errormessage=\"wpforms-4964-field_933_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_1\">Avoirs bancaires (comptes \/ comptes \u00e9pargne)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_2\" name=\"wpforms[fields][933][]\" value=\"Argent liquide\" aria-errormessage=\"wpforms-4964-field_933_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_2\">Argent liquide<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_5\" name=\"wpforms[fields][933][]\" value=\"M\u00e9taux pr\u00e9cieux (or, argent, etc.)\" aria-errormessage=\"wpforms-4964-field_933_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_5\">M\u00e9taux pr\u00e9cieux (or, argent, etc.)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_6\" name=\"wpforms[fields][933][]\" value=\"Titres (actions, fonds, ETF, obligations)\" aria-errormessage=\"wpforms-4964-field_933_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_6\">Titres (actions, fonds, ETF, obligations)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_7\" name=\"wpforms[fields][933][]\" value=\"Fonds de placement \/ d\u00e9p\u00f4ts\" aria-errormessage=\"wpforms-4964-field_933_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_7\">Fonds de placement \/ d\u00e9p\u00f4ts<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_10\" name=\"wpforms[fields][933][]\" value=\"Cryptomonnaies\" aria-errormessage=\"wpforms-4964-field_933_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_10\">Cryptomonnaies<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_9\" name=\"wpforms[fields][933][]\" value=\"Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)\" aria-errormessage=\"wpforms-4964-field_933_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_9\">Biens immobiliers (r\u00e9sidence \/ maison de vacances \/ rendement)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_8\" name=\"wpforms[fields][933][]\" value=\"Terrain \u00e0 b\u00e2tir \/ parcelles\" aria-errormessage=\"wpforms-4964-field_933_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_8\">Terrain \u00e0 b\u00e2tir \/ parcelles<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_12\" name=\"wpforms[fields][933][]\" value=\"Avoirs de pr\u00e9voyance \/ Pilier 3a\" aria-errormessage=\"wpforms-4964-field_933_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_12\">Avoirs de pr\u00e9voyance \/ Pilier 3a<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_11\" name=\"wpforms[fields][933][]\" value=\"Compte \/ police de libre passage\" aria-errormessage=\"wpforms-4964-field_933_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_11\">Compte \/ police de libre passage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_13\" name=\"wpforms[fields][933][]\" value=\"V\u00e9hicules \u00e0 moteur (auto, moto)\" aria-errormessage=\"wpforms-4964-field_933_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_13\">V\u00e9hicules \u00e0 moteur (auto, moto)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_14\" name=\"wpforms[fields][933][]\" value=\"Objets de valeur (bijoux, art, montres)\" aria-errormessage=\"wpforms-4964-field_933_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_14\">Objets de valeur (bijoux, art, montres)<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_15\" name=\"wpforms[fields][933][]\" value=\"Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)\" aria-errormessage=\"wpforms-4964-field_933_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_15\">Cr\u00e9ances de pr\u00eats (pr\u00eats priv\u00e9s \u00e0 des tiers)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_16\" name=\"wpforms[fields][933][]\" value=\"Participations dans des entreprises (S\u00e0rl \/ SA)\" aria-errormessage=\"wpforms-4964-field_933_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_16\">Participations dans des entreprises (S\u00e0rl \/ SA)<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_17\" name=\"wpforms[fields][933][]\" value=\"Avoirs \u00e0 l\u2019\u00e9tranger\" aria-errormessage=\"wpforms-4964-field_933_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_17\">Avoirs \u00e0 l\u2019\u00e9tranger<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_933_18\" name=\"wpforms[fields][933][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_933_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_933_18\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_943-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"943\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Assurances <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_943\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_943_1\" name=\"wpforms[fields][943][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_943_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_943_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_943_2\" name=\"wpforms[fields][943][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_943_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_943_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_953-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"953\"><fieldset><legend class=\"wpforms-field-label\">4.5-4.7 Si oui, veuillez pr\u00e9ciser<\/legend><ul id=\"wpforms-4964-field_953\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_1\" name=\"wpforms[fields][953][]\" value=\"Assurance maladie (de base)\" aria-errormessage=\"wpforms-4964-field_953_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_1\">Assurance maladie (de base)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_2\" name=\"wpforms[fields][953][]\" value=\"Assurance compl\u00e9mentaire\" aria-errormessage=\"wpforms-4964-field_953_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_2\">Assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_5\" name=\"wpforms[fields][953][]\" value=\"Assurance accident\" aria-errormessage=\"wpforms-4964-field_953_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_5\">Assurance accident<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_6\" name=\"wpforms[fields][953][]\" value=\"Assurance responsabilit\u00e9 civile priv\u00e9e\" aria-errormessage=\"wpforms-4964-field_953_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_6\">Assurance responsabilit\u00e9 civile priv\u00e9e<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_7\" name=\"wpforms[fields][953][]\" value=\"Assurance m\u00e9nage\" aria-errormessage=\"wpforms-4964-field_953_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_7\">Assurance m\u00e9nage<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_10\" name=\"wpforms[fields][953][]\" value=\"Assurance protection juridique\" aria-errormessage=\"wpforms-4964-field_953_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_10\">Assurance protection juridique<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_9\" name=\"wpforms[fields][953][]\" value=\"Assurance v\u00e9hicule\" aria-errormessage=\"wpforms-4964-field_953_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_9\">Assurance v\u00e9hicule<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_8\" name=\"wpforms[fields][953][]\" value=\"Assurance vie (pilier 3a \/ 3b)\" aria-errormessage=\"wpforms-4964-field_953_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_8\">Assurance vie (pilier 3a \/ 3b)<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_12\" name=\"wpforms[fields][953][]\" value=\"Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain\" aria-errormessage=\"wpforms-4964-field_953_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_12\">Assurance invalidit\u00e9 \/ incapacit\u00e9 de gain<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_11\" name=\"wpforms[fields][953][]\" value=\"Assurance voyage\" aria-errormessage=\"wpforms-4964-field_953_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_11\">Assurance voyage<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_953_13\" name=\"wpforms[fields][953][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_953_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_953_13\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_963-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"963\"><fieldset><legend class=\"wpforms-field-label\">Autres dettes \/ obligations <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_963\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_963_1\" name=\"wpforms[fields][963][]\" value=\"Oui\" aria-errormessage=\"wpforms-4964-field_963_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_963_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_963_2\" name=\"wpforms[fields][963][]\" value=\"Non\" aria-errormessage=\"wpforms-4964-field_963_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_963_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_995-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"995\"><label class=\"wpforms-field-label\" for=\"wpforms-4964-field_995\">Si oui, veuillez pr\u00e9ciser<\/label><textarea id=\"wpforms-4964-field_995\" class=\"wpforms-field-medium\" name=\"wpforms[fields][995]\" aria-errormessage=\"wpforms-4964-field_995-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_944-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"944\"><fieldset><legend class=\"wpforms-field-label\">5. Services souhait\u00e9s <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_944\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_1\" name=\"wpforms[fields][944][]\" value=\"D\u00e9claration d\u2019imp\u00f4ts (personne physique)\" aria-errormessage=\"wpforms-4964-field_944_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_1\">D\u00e9claration d\u2019imp\u00f4ts (personne physique)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_2\" name=\"wpforms[fields][944][]\" value=\"Conseil fiscal \/ optimisation\" aria-errormessage=\"wpforms-4964-field_944_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_2\">Conseil fiscal \/ optimisation<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_5\" name=\"wpforms[fields][944][]\" value=\"Comptabilit\u00e9 \/ planification budg\u00e9taire\" aria-errormessage=\"wpforms-4964-field_944_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_5\">Comptabilit\u00e9 \/ planification budg\u00e9taire<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_6\" name=\"wpforms[fields][944][]\" value=\"Planification de pr\u00e9voyance et financi\u00e8re\" aria-errormessage=\"wpforms-4964-field_944_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_6\">Planification de pr\u00e9voyance et financi\u00e8re<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_7\" name=\"wpforms[fields][944][]\" value=\"Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales\" aria-errormessage=\"wpforms-4964-field_944_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_7\">Support aupr\u00e8s des autorit\u00e9s \/ assurances sociales<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_944_8\" name=\"wpforms[fields][944][]\" value=\"Autre\" aria-errormessage=\"wpforms-4964-field_944_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_944_8\">Autre<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-4964-field_954-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"954\"><fieldset><legend class=\"wpforms-field-label\">6. 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files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-4964-field_369\"\n\t\tname=\"wpforms_4964_369\" \t\tvalue=\"\">\n<\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-4964-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">D\u00e9claration <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4964-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4964-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Je confirme que les informations que j\u2019ai fournies sont compl\u00e8tes et exactes. Je suis conscient(e) que la r\u00e9tention ou la dissimulation d\u2019informations ainsi que la fourniture de renseignements inexacts sont passibles de sanctions. Je m\u2019engage \u00e0 signaler imm\u00e9diatement toute modification des informations fournies dans cette demande.\" aria-errormessage=\"wpforms-4964-field_23_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4964-field_23_1\">Je confirme que les informations que j\u2019ai fournies sont compl\u00e8tes et exactes. Je suis conscient(e) que la r\u00e9tention ou la dissimulation d\u2019informations ainsi que la fourniture de renseignements inexacts sont passibles de sanctions. 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