{"id":1141,"date":"2025-02-10T19:48:33","date_gmt":"2025-02-10T18:48:33","guid":{"rendered":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/?page_id=1141"},"modified":"2025-02-11T03:12:09","modified_gmt":"2025-02-11T02:12:09","slug":"convenzione-rc-e-tutela-legale-ageo","status":"publish","type":"page","link":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/convenzione-rc-e-tutela-legale-ageo\/","title":{"rendered":"Convenzione RC e Tutela Legale AGEO"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-form-abandonment wpforms-block wpforms-block-08d0d300-e900-4c60-8c11-2f31c342197f wpforms-render-modern\" id=\"wpforms-1111\"><form id=\"wpforms-form-1111\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1111\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages\/1141?wpforms_form_id=1111\" data-token=\"48d1b7df1590537bc2f63c38649313a8\" data-token-time=\"1788600365\"><noscript class=\"wpforms-error-noscript\">Abilita JavaScript nel browser per completare questo modulo.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Abilita JavaScript nel browser per completare questo modulo.<\/div><div class=\"wpforms-page-indicator connector\" data-indicator=\"connector\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"6\" tabindex=\"-1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#066aab\">1<span class=\"wpforms-page-indicator-page-triangle\" style=\"border-top-color:#066aab\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Dati Assicurato<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\">2<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Garanzia Responsabilit\u00e0 Civile Professionale<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\">3<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Garanzia Tutela Legale<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\">4<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Sinistrosit\u00e0 Pregressa, Altre Coperture E Precedenti Assicurativi<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-5\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\">5<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Riepilogo Premi e Garanzie Scelte<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-6\" style=\"width:16.666666666667%;\"><span class=\"wpforms-page-indicator-page-number\">6<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Consensi e Dichiarazioni Assicurato<\/span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-1111-field_405-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"405\"><\/div><div id=\"wpforms-1111-field_258-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"258\"><div id=\"wpforms-1111-field_258\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_258-error\"><h3><span style=\"color:#db4b95\"><strong>GINECOLOGO PROTETTO AGEO &#8211; Polizza di Responsabilit\u00e0 Civile Professionale, Tutela Legale e Colpa Grave del Medico Ginecologo socio AGEO<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_429-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"429\"><div id=\"wpforms-1111-field_429\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_429-error\"><h3><span style=\"text-decoration:underline\"><span style=\"color:#000000\"><strong>Prima della sottoscrizione leggere il Set Informativo e il dettaglio delle fascie di rischio<\/strong><\/span><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_428-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"428\"><div id=\"wpforms-1111-field_428\" aria-errormessage=\"wpforms-1111-field_428-error\"><a href=\"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-content\/uploads\/sites\/2\/2025\/03\/AGEO-Set-Informativo-CGA-RC-e-Tutela-Legale-2025-2030.pdf\" target=\"_blank\">Download Set Informativo<\/a><br \/>\r\n<a href=\"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-content\/uploads\/sites\/2\/2025\/03\/Dettaglio-Fasce-di-rischio-agg.-10032025.pdf\" target=\"_blank\">Download Dettaglio Fasce di rischio fino al 10.03.2026<\/a><br \/>\r\n\r\n<a href=\"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-content\/uploads\/sites\/2\/2026\/02\/Dettaglio-Fasce-di-rischio-agg.-10032026.pdf\" target=\"_blank\">Download Dettaglio Fasce di rischio dal 10.03.2026<\/a><\/div><\/div><div id=\"wpforms-1111-field_107-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"107\"><div id=\"wpforms-1111-field_107\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_107-error\"><h3><span style=\"color:#db4b95\"><strong>Dati Contraente \/ Assicurato<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_73-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"73\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_41-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_41\">Cognome e Nome <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_41\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-1111-field_41-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_59-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">Sesso <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_59_1\" name=\"wpforms[fields][59]\" value=\"Maschio\" aria-errormessage=\"wpforms-1111-field_59_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_59_1\">Maschio<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_59_2\" name=\"wpforms[fields][59]\" value=\"Femmina\" aria-errormessage=\"wpforms-1111-field_59_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_59_2\">Femmina<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_72-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"72\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_60-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_60\">Codice Fiscale <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_60\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"AAAAAA99A99A999A\" data-form-id=\"1111\" data-field-id=\"60\" data-text-limit=\"16\" name=\"wpforms[fields][60]\" placeholder=\"Codice fiscale\" aria-errormessage=\"wpforms-1111-field_60-error\" maxlength=\"16\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_61\">Partita IVA<\/label><input type=\"text\" id=\"wpforms-1111-field_61\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"99999999999\" data-form-id=\"1111\" data-field-id=\"61\" data-text-limit=\"11\" name=\"wpforms[fields][61]\" placeholder=\"Partita IVA\" aria-errormessage=\"wpforms-1111-field_61-error\" maxlength=\"11\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_70-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"70\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_62-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"62\"><fieldset><legend class=\"wpforms-field-label\">Data di nascita <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][62][date][d]\" id=\"wpforms-1111-field_62-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Giorno\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][62][date][m]\" id=\"wpforms-1111-field_62-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mese\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][62][date][y]\" id=\"wpforms-1111-field_62-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Anno\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><div id=\"wpforms-1111-field_299-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"299\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_299\">Et\u00e0 dell&#039;Assicurato<\/label><input type=\"text\" id=\"wpforms-1111-field_299\" class=\"wpforms-field-medium\" name=\"wpforms[fields][299]\" aria-errormessage=\"wpforms-1111-field_299-error\" ><\/div><div id=\"wpforms-1111-field_303-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"303\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_303\">Tipo Tariffa<\/label><input type=\"text\" id=\"wpforms-1111-field_303\" class=\"wpforms-field-medium\" name=\"wpforms[fields][303]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_303-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_116-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_116\">Comune di nascita <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_116\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][116]\" placeholder=\"Inserisci comune di nascita\" data-autocomplete=\"1\" aria-errormessage=\"wpforms-1111-field_116-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_37-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"37\"><fieldset><legend class=\"wpforms-field-label\">Indirizzo <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1111-field_37\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][37][address1]\" placeholder=\"Inserisci un indirizzo\" data-autocomplete=\"1\" aria-errormessage=\"wpforms-1111-field_37-error\" required><label for=\"wpforms-1111-field_37\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1111-field_37-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][37][address2]\" aria-errormessage=\"wpforms-1111-field_37-address2-error\" ><label for=\"wpforms-1111-field_37-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1111-field_37-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][37][city]\" aria-errormessage=\"wpforms-1111-field_37-city-error\" required><label for=\"wpforms-1111-field_37-city\" class=\"wpforms-field-sublabel after\">Citt\u00e0<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1111-field_37-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][37][state]\" aria-errormessage=\"wpforms-1111-field_37-state-error\" required><label for=\"wpforms-1111-field_37-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1111-field_37-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][37][postal]\" aria-errormessage=\"wpforms-1111-field_37-postal-error\" required><label for=\"wpforms-1111-field_37-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1111-field_37-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][37][country]\" aria-errormessage=\"wpforms-1111-field_37-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select country &#8212;<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antartide<\/option><option value=\"AG\" >Antigua e Barbuda<\/option><option value=\"SA\" >Arabia Saudita<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BE\" >Belgio<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BY\" >Bielorussia<\/option><option value=\"MM\" >Birmania<\/option><option value=\"BO\" >Bolivia (Stato plurinazionale della)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia-Erzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Brasile<\/option><option value=\"BN\" >Brunei Darrussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"KH\" >Cambogia<\/option><option value=\"CM\" >Camerun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Capo Verde<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Cile<\/option><option value=\"CN\" >Cina<\/option><option value=\"CY\" >Cipro<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comore<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Repubblica Democratica del)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CI\" >Costa d&#039;Avorio<\/option><option value=\"HR\" >Croazia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"DK\" >Danimarca<\/option><option value=\"DM\" >Dominica<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egitto<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"AE\" >Emirati Arabi Uniti<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Etiopia<\/option><option value=\"RU\" >Federazione Russa<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"PH\" >Filippine<\/option><option value=\"FI\" >Finlandia<\/option><option value=\"FR\" >Francia<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GS\" >Georgia del Sud e Isole Sandwich Australi<\/option><option value=\"DE\" >Germania<\/option><option value=\"GH\" >Ghana<\/option><option value=\"JM\" >Giamaica<\/option><option value=\"JP\" >Giappone<\/option><option value=\"GI\" >Gibilterra<\/option><option value=\"DJ\" >Gibuti<\/option><option value=\"JO\" >Giordania<\/option><option value=\"GR\" >Grecia<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GL\" >Groenlandia<\/option><option value=\"GP\" >Guadalupa<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GF\" >Guiana Francese<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GQ\" >Guinea Equatoriale<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Repubblica Islamica dell&#039;)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Irlanda (Repubblica dell&#039;)<\/option><option value=\"IS\" >Islanda<\/option><option value=\"BV\" >Isola di Bouvet<\/option><option value=\"IM\" >Isola di Man<\/option><option value=\"CX\" >Isola di Natale<\/option><option value=\"BL\" >Isola di Saint Barth\u00e9lemy<\/option><option value=\"AX\" >Isole Aland<\/option><option value=\"KY\" >Isole Cayman<\/option><option value=\"CC\" >Isole Cocos (Keeling)<\/option><option value=\"CK\" >Isole Cook<\/option><option value=\"FK\" >Isole Falkland (Malvinas)<\/option><option value=\"FO\" >Isole Faroe<\/option><option value=\"HM\" >Isole Heard e McDonald<\/option><option value=\"MP\" >Isole Marianne Settentrionali<\/option><option value=\"MH\" >Isole Marshall<\/option><option value=\"NF\" >Isole Norfolk<\/option><option value=\"PM\" >Isole Saint Pierre e Miquelon<\/option><option value=\"SB\" >Isole Salomone<\/option><option value=\"SJ\" >Isole Svalbard e Jan Mayen<\/option><option value=\"TC\" >Isole Turks e Caicos<\/option><option value=\"VI\" >Isole Vergini (americane)<\/option><option value=\"VG\" >Isole Vergini (britanniche)<\/option><option value=\"UM\" >Isole minori esterne degli Stati Uniti d&#039;America<\/option><option value=\"IL\" >Israele<\/option><option value=\"IT\" >Italia<\/option><option value=\"KZ\" >Kazakistan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KG\" >Kirghizistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Repubblica Democratica del Popolo della)<\/option><option value=\"KR\" >Korea (Repubblica della)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonia<\/option><option value=\"LB\" >Libano<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libia<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituania<\/option><option value=\"LU\" >Lussemburgo<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Macedonia del nord (Repubblica di)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"JE\" >Maglia<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldive<\/option><option value=\"MY\" >Malesia<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marocco<\/option><option value=\"MQ\" >Martinica<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Messico<\/option><option value=\"FM\" >Micronesia (Confederazione di stati della)<\/option><option value=\"MD\" >Moldova (Repubblica della)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambico<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norvegia<\/option><option value=\"NC\" >Nuova Caledonia<\/option><option value=\"NZ\" >Nuova Zelanda<\/option><option value=\"OM\" >Oman<\/option><option value=\"NL\" >Paesi Bassi<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina (Stato della)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua Nuova Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Per\u00f9<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Polonia<\/option><option value=\"PF\" >Polynesia Francese<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portogallo<\/option><option value=\"QA\" >Qatar<\/option><option value=\"GB\" >Regno Unito della Gran Bretagna e dell&#039;Irlanda del Nord<\/option><option value=\"SY\" >Repubblica Araba della Siria<\/option><option value=\"CZ\" >Repubblica Ceca<\/option><option value=\"CF\" >Repubblica Centrafricana<\/option><option value=\"LA\" >Repubblica Democratica Popolare del Laos<\/option><option value=\"DO\" >Repubblica Dominicana<\/option><option value=\"RE\" >Riunione (Isola della)<\/option><option value=\"RO\" >Romania<\/option><option value=\"RW\" >Ruanda<\/option><option value=\"EH\" >Sahara Occidentale<\/option><option value=\"KN\" >Saint Kitts e Nevis<\/option><option value=\"VC\" >Saint Vincent e Grenadine<\/option><option value=\"MF\" >Saint-Martin (parte Francese)<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa americane<\/option><option value=\"SM\" >San Marino<\/option><option value=\"SH\" >Sant&#039;Elena, Ascensione e Tristan da Cunha<\/option><option value=\"LC\" >Santa Lucia<\/option><option value=\"ST\" >Sao Tome e Pr\u00edncipe<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (parte dei Paesi Bassi)<\/option><option value=\"SK\" >Slovacchia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ES\" >Spagna<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"US\" >Stati Uniti d&#039;America<\/option><option value=\"VA\" >Stato della Citt\u00e0 del Vaticano<\/option><option value=\"ZA\" >Sudafrica<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SS\" >Sudan del Sud<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SE\" >Svezia<\/option><option value=\"CH\" >Svizzera<\/option><option value=\"TJ\" >Tagikistan<\/option><option value=\"TW\" >Taiwan, Repubblica di Cina<\/option><option value=\"TZ\" >Tanzania (Repubblica Unita della)<\/option><option value=\"TF\" >Terre Australi e Antartiche Francesi<\/option><option value=\"IO\" >Territorio Britannico nell&#039;Oceano Indiano<\/option><option value=\"TH\" >Thailandia<\/option><option value=\"TL\" >Timor Est<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad e Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TR\" >Turchia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UA\" >Ucraina<\/option><option value=\"UG\" >Uganda<\/option><option value=\"HU\" >Ungheria<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (Repubblica Bolliviana del)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis e Futuna<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"SZ\" >eSwatini (Regno di)<\/option><\/select><label for=\"wpforms-1111-field_37-country\" class=\"wpforms-field-sublabel after\">Nazione<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1111-field_75-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"75\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_27-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_27\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1111-field_27\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][27]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1111-field_27-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_147-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"147\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_147\">PEC<\/label><input type=\"email\" id=\"wpforms-1111-field_147\" class=\"wpforms-field-medium\" name=\"wpforms[fields][147]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1111-field_147-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_148-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"148\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_148\">Codice Fatturazione Elettronica SDI<\/label><input type=\"text\" id=\"wpforms-1111-field_148\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"1111\" data-field-id=\"148\" data-text-limit=\"7\" name=\"wpforms[fields][148]\" aria-errormessage=\"wpforms-1111-field_148-error\" maxlength=\"7\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_76-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_76\">Cellulare <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1111-field_76\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][76]\" placeholder=\"Inserisci numero di cellulare\" aria-label=\"Cellulare\" aria-errormessage=\"wpforms-1111-field_76-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_74-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_74\">Telefono<\/label><input type=\"tel\" id=\"wpforms-1111-field_74\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][74]\" placeholder=\"Inserisci numero fisso\" aria-label=\"Telefono\" aria-errormessage=\"wpforms-1111-field_74-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_79-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"79\"><div id=\"wpforms-1111-field_79\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_79-error\"><h3><span style=\"color:#db4b95\"><strong>Dati Albo Professionale<\/strong><\/span><\/h3>\n<p><strong>Inserire i dati relativi all&#8217;iscrizione all&#8217;Albo Professionale<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_71-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"71\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_68-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_68\">Iscritto all&#039;Albo di <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" aria-errormessage=\"wpforms-1111-field_68-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_69-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_69\">Numero di iscrizione Albo <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_69\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-1111-field_69-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_404-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"404\"><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=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-1111-field_275-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"275\"><div id=\"wpforms-1111-field_275\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_275-error\"><h3><span style=\"color:#db4b95\"><strong>Responsabilit\u00e0 Civile Professionale, Tutela Legale e Colpa Grave del Medico Ginecologo socio AGEO<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_357-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"357\"><fieldset><legend class=\"wpforms-field-label\">Per aderire alla convenzione Assicurativa AGEO \u00e8 obbligatorio essere Associati ed essere in regola con il pagamento della quota associativa dell&#039;anno in corso. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_357\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_357_1\" name=\"wpforms[fields][357]\" value=\"NON SONO ancora socio AGEO\" aria-errormessage=\"wpforms-1111-field_357_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_357_1\">NON SONO ancora socio AGEO<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_357_2\" name=\"wpforms[fields][357]\" value=\"SONO gi\u00e0 sono AGEO e sono in regola con il pagamento della quota Associativa\" aria-errormessage=\"wpforms-1111-field_357_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_357_2\">SONO gi\u00e0 sono AGEO e sono in regola con il pagamento della quota Associativa<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_356-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"356\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Quota Associativa AGEO <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_356\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_356_1\" class=\"wpforms-payment-price\" data-amount=\"80,00\" name=\"wpforms[fields][356]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_356_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_356_1\">Quota Associativa AGEO &#8211; <span class=\"wpforms-currency-symbol\">80,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_40-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"40\"><div id=\"wpforms-1111-field_40\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_40-error\"><h3><span style=\"color:#db4b95\"><strong>Scelta tipologia Attivit\u00e0 Professionale<\/strong><\/span><\/h3>\n<p><strong>Indicare l\u2019Attivit\u00e0 che il Proponente\/Assicurato svolge o ha svolto negli ultimi 10 anni e la Qualifica ricoperta (Dipendente Pubblico, Dipendente Privato, Libero Professionista).<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_293-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"293\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia di attivit\u00e0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_293\" class=\"wpforms-field-required\"><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_293_6\" name=\"wpforms[fields][293]\" value=\"Fascia 00 - Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali)\" aria-errormessage=\"wpforms-1111-field_293_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_6\">Fascia 00 &#8211; Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali)<\/label><\/li><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_293_1\" name=\"wpforms[fields][293]\" value=\"Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto\" aria-errormessage=\"wpforms-1111-field_293_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_1\">Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_293_2\" name=\"wpforms[fields][293]\" value=\"Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01)\" aria-errormessage=\"wpforms-1111-field_293_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_2\">Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_293_3\" name=\"wpforms[fields][293]\" value=\"Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a)\" aria-errormessage=\"wpforms-1111-field_293_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_3\">Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_293_5\" name=\"wpforms[fields][293]\" value=\"Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b)\" aria-errormessage=\"wpforms-1111-field_293_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_5\">Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_293_4\" name=\"wpforms[fields][293]\" value=\"Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03)\" aria-errormessage=\"wpforms-1111-field_293_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_293_4\">Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_329-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"329\"><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-1111-field_330-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"330\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_330\">Durata in giorni rateo<\/label><input type=\"text\" id=\"wpforms-1111-field_330\" class=\"wpforms-field-small\" name=\"wpforms[fields][330]\" aria-errormessage=\"wpforms-1111-field_330-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1111-field_318-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"318\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_318\">Durata in giorni della copertura<\/label><input type=\"text\" id=\"wpforms-1111-field_318\" class=\"wpforms-field-small\" name=\"wpforms[fields][318]\" aria-errormessage=\"wpforms-1111-field_318-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_188-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"188\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-100\"><div class=\"wpforms-layout-column wpforms-layout-column-100\" ><div id=\"wpforms-1111-field_105-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"105\"><div id=\"wpforms-1111-field_105\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_105-error\"><p><span style=\"color:#db4b95\"><strong>Scelta massimale<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_435-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"435\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_435\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_435_1\" class=\"wpforms-payment-price\" data-amount=\"2.600,00\" name=\"wpforms[fields][435]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_435_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_435_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_436-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"436\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_436\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_436_1\" class=\"wpforms-payment-price\" data-amount=\"2.600,00\" name=\"wpforms[fields][436]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_436_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_436_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_437-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"437\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_437\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_437_1\" class=\"wpforms-payment-price\" data-amount=\"2.600,00\" name=\"wpforms[fields][437]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_437_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_437_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_430-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"430\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_430\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_430_1\" class=\"wpforms-payment-price\" data-amount=\"3.740,00\" name=\"wpforms[fields][430]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_430_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_430_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_430_4\" class=\"wpforms-payment-price\" data-amount=\"3.971,00\" name=\"wpforms[fields][430]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_430_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_430_4\">1.500.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-1111-field_430_2\" class=\"wpforms-payment-price\" data-amount=\"4.297,00\" name=\"wpforms[fields][430]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_430_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_430_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_430_3\" class=\"wpforms-payment-price\" data-amount=\"5.074,00\" name=\"wpforms[fields][430]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_430_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_430_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_306-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"306\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_306\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_306_1\" class=\"wpforms-payment-price\" data-amount=\"3.036,00\" name=\"wpforms[fields][306]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_306_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_306_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_306_4\" class=\"wpforms-payment-price\" data-amount=\"3.223,00\" name=\"wpforms[fields][306]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_306_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_306_4\">1.500.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-1111-field_306_2\" class=\"wpforms-payment-price\" data-amount=\"3.485,00\" name=\"wpforms[fields][306]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_306_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_306_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_306_3\" class=\"wpforms-payment-price\" data-amount=\"4.115,00\" name=\"wpforms[fields][306]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_306_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_306_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_311-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"311\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_311\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_311_1\" class=\"wpforms-payment-price\" data-amount=\"3.631,00\" name=\"wpforms[fields][311]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_311_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_311_1\">1.000.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_311_4\" class=\"wpforms-payment-price\" data-amount=\"3.855,00\" name=\"wpforms[fields][311]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_311_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_311_4\">1.500.000 per sinistro\/3.000.000 per anno<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-1111-field_311_2\" class=\"wpforms-payment-price\" data-amount=\"4.171,00\" name=\"wpforms[fields][311]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_311_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_311_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_311_3\" class=\"wpforms-payment-price\" data-amount=\"4.926,00\" name=\"wpforms[fields][311]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_311_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_311_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_307-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"307\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_307\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_307_2\" class=\"wpforms-payment-price\" data-amount=\"3.631,00\" name=\"wpforms[fields][307]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_307_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_307_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_307_3\" class=\"wpforms-payment-price\" data-amount=\"4.445,00\" name=\"wpforms[fields][307]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_307_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_307_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_312-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"312\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_312\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_312_2\" class=\"wpforms-payment-price\" data-amount=\"4.346,00\" name=\"wpforms[fields][312]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_312_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_312_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_312_3\" class=\"wpforms-payment-price\" data-amount=\"5.323,00\" name=\"wpforms[fields][312]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_312_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_312_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_431-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"431\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_431\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_431_2\" class=\"wpforms-payment-price\" data-amount=\"4.477,00\" name=\"wpforms[fields][431]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_431_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_431_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_431_3\" class=\"wpforms-payment-price\" data-amount=\"5.483,00\" name=\"wpforms[fields][431]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_431_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_431_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_308-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"308\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_308\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_308_2\" class=\"wpforms-payment-price\" data-amount=\"3.988,00\" name=\"wpforms[fields][308]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_308_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_308_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_308_3\" class=\"wpforms-payment-price\" data-amount=\"4.702,00\" name=\"wpforms[fields][308]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_308_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_308_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_313-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"313\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_313\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_313_2\" class=\"wpforms-payment-price\" data-amount=\"4.590,00\" name=\"wpforms[fields][313]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_313_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_313_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_313_3\" class=\"wpforms-payment-price\" data-amount=\"5.413,00\" name=\"wpforms[fields][313]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_313_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_313_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_432-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"432\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_432\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_432_2\" class=\"wpforms-payment-price\" data-amount=\"4.728,00\" name=\"wpforms[fields][432]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_432_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_432_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_432_3\" class=\"wpforms-payment-price\" data-amount=\"5.576,00\" name=\"wpforms[fields][432]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_432_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_432_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_309-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"309\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_309\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_309_2\" class=\"wpforms-payment-price\" data-amount=\"5.834,00\" name=\"wpforms[fields][309]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_309_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_309_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_309_3\" class=\"wpforms-payment-price\" data-amount=\"6.989,00\" name=\"wpforms[fields][309]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_309_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_309_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_314-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"314\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_314\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_314_2\" class=\"wpforms-payment-price\" data-amount=\"6.696,00\" name=\"wpforms[fields][314]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_314_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_314_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_314_3\" class=\"wpforms-payment-price\" data-amount=\"8.024,00\" name=\"wpforms[fields][314]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_314_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_314_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_433-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"433\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_433\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_433_2\" class=\"wpforms-payment-price\" data-amount=\"6.897,00\" name=\"wpforms[fields][433]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_433_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_433_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_433_3\" class=\"wpforms-payment-price\" data-amount=\"8.265,00\" name=\"wpforms[fields][433]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_433_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_433_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_310-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"310\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO YOUNG &#8211; Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_310\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_310_2\" class=\"wpforms-payment-price\" data-amount=\"10.982,00\" name=\"wpforms[fields][310]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_310_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_310_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_310_3\" class=\"wpforms-payment-price\" data-amount=\"13.201,00\" name=\"wpforms[fields][310]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_310_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_310_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_315-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"315\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME &#8211; Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_315\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_315_2\" class=\"wpforms-payment-price\" data-amount=\"11.913,00\" name=\"wpforms[fields][315]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_315_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_315_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_315_3\" class=\"wpforms-payment-price\" data-amount=\"14.342,00\" name=\"wpforms[fields][315]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_315_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_315_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_434-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"434\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">AGEO PRIME SENIOR &#8211; Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_434\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_434_2\" class=\"wpforms-payment-price\" data-amount=\"12.271,00\" name=\"wpforms[fields][434]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_434_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_434_2\">2.000.000 per sinistro\/6.000.000 per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_434_3\" class=\"wpforms-payment-price\" data-amount=\"14.773,00\" name=\"wpforms[fields][434]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_434_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_434_3\">3.500.000 per sinistro\/6.000.000 per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_292-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"292\"><input type=\"hidden\" id=\"wpforms-1111-field_292\" name=\"wpforms[fields][292]\" value=\"ILLIMITATA\"><\/div><div id=\"wpforms-1111-field_95-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"95\"><div id=\"wpforms-1111-field_95\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_95-error\"><p><span style=\"color:#db4b95\"><strong>Estensioni di garanzia a Pagamento<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_19-container\" class=\"wpforms-field wpforms-field-payment-multiple\" data-field-type=\"payment-multiple\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Qualifiche Direttive <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_19_1\" class=\"wpforms-payment-price\" data-amount=\"400,00\" name=\"wpforms[fields][19]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_19_1\">Ruolo apicale e Direzione Sanitaria &#8211; CTU\/CTP &#8211; Perdite Patrimoniali &#8211; Massimale 200.000<\/label><\/li><li class=\"choice-5 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_19_5\" class=\"wpforms-payment-price\" data-amount=\"0,00\" name=\"wpforms[fields][19]\" value=\"5\" aria-errormessage=\"wpforms-1111-field_19_5-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_19_5\">Nessuna<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_407-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"407\"><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=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Precedente<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-1111-field_97-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"97\"><div id=\"wpforms-1111-field_97\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_97-error\"><div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_368-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"368\"><div id=\"wpforms-1111-field_368\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_368-error\"><h3><span style=\"color:#db4b95\"><strong>Tutela Legale GINECOLOGO PROTETTO AGEO<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_340-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"340\"><fieldset><legend class=\"wpforms-field-label\">Scelta Tutela Legale opzionale <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_340\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_340_1\" name=\"wpforms[fields][340]\" value=\"Voglio aggiungere la garanzia di TUTELA LEGALE\" aria-errormessage=\"wpforms-1111-field_340_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_340_1\">Voglio aggiungere la garanzia di TUTELA LEGALE<\/label><\/li><li class=\"choice-2 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_340_2\" name=\"wpforms[fields][340]\" value=\"Non voglio aggiungere la garanzia di TUTELA LEGALE\" aria-errormessage=\"wpforms-1111-field_340_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_340_2\">Non voglio aggiungere la garanzia di TUTELA LEGALE<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_339-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"339\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1111-field_334-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"334\" style=\"display:none;\"><div id=\"wpforms-1111-field_334\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_334-error\"><p><strong>Scelta Retroattivit\u00e0<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1111-field_333-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"333\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Retroattivit\u00e0 TUTELA LEGALE <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_333\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_333_1\" name=\"wpforms[fields][333]\" value=\"Nessuna\" aria-errormessage=\"wpforms-1111-field_333_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_333_1\">Nessuna<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_333_2\" name=\"wpforms[fields][333]\" value=\"2 anni\" aria-errormessage=\"wpforms-1111-field_333_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_333_2\">2 anni<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_333_3\" name=\"wpforms[fields][333]\" value=\"5 anni\" aria-errormessage=\"wpforms-1111-field_333_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_333_3\">5 anni<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_341-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"341\" style=\"display:none;\"><div id=\"wpforms-1111-field_341\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_341-error\"><p><span style=\"color:#000000\"><strong>Scelta massimale<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_438-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"438\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 00 Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_438\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_438_2\" class=\"wpforms-payment-price\" data-amount=\"176,00\" name=\"wpforms[fields][438]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_438_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_438_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_438_1\" class=\"wpforms-payment-price\" data-amount=\"188,00\" name=\"wpforms[fields][438]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_438_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_438_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_438_3\" class=\"wpforms-payment-price\" data-amount=\"228,00\" name=\"wpforms[fields][438]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_438_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_438_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_438_4\" class=\"wpforms-payment-price\" data-amount=\"236,00\" name=\"wpforms[fields][438]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_438_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_438_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_439-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"439\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 00 Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_439\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_439_2\" class=\"wpforms-payment-price\" data-amount=\"211,20\" name=\"wpforms[fields][439]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_439_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_439_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_439_1\" class=\"wpforms-payment-price\" data-amount=\"225,60\" name=\"wpforms[fields][439]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_439_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_439_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_439_3\" class=\"wpforms-payment-price\" data-amount=\"273,60\" name=\"wpforms[fields][439]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_439_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_439_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_439_4\" class=\"wpforms-payment-price\" data-amount=\"283,20\" name=\"wpforms[fields][439]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_439_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_439_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_440-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"440\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 00 Fascia Base \u2013 Ginecologia e Ostetricia (solo visite specialistiche e analisi prenatali) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_440\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_440_2\" class=\"wpforms-payment-price\" data-amount=\"236,00\" name=\"wpforms[fields][440]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_440_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_440_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_440_1\" class=\"wpforms-payment-price\" data-amount=\"248,00\" name=\"wpforms[fields][440]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_440_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_440_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_440_3\" class=\"wpforms-payment-price\" data-amount=\"312,00\" name=\"wpforms[fields][440]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_440_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_440_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_440_4\" class=\"wpforms-payment-price\" data-amount=\"324,00\" name=\"wpforms[fields][440]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_440_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_440_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_271-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"271\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_271\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_271_2\" class=\"wpforms-payment-price\" data-amount=\"176,00\" name=\"wpforms[fields][271]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_271_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_271_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_271_1\" class=\"wpforms-payment-price\" data-amount=\"188,00\" name=\"wpforms[fields][271]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_271_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_271_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_271_3\" class=\"wpforms-payment-price\" data-amount=\"228,00\" name=\"wpforms[fields][271]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_271_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_271_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_271_4\" class=\"wpforms-payment-price\" data-amount=\"236,00\" name=\"wpforms[fields][271]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_271_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_271_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_344-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"344\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_344\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_344_2\" class=\"wpforms-payment-price\" data-amount=\"211,20\" name=\"wpforms[fields][344]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_344_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_344_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_344_1\" class=\"wpforms-payment-price\" data-amount=\"225,60\" name=\"wpforms[fields][344]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_344_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_344_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_344_3\" class=\"wpforms-payment-price\" data-amount=\"273,60\" name=\"wpforms[fields][344]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_344_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_344_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_344_4\" class=\"wpforms-payment-price\" data-amount=\"283,20\" name=\"wpforms[fields][344]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_344_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_344_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_345-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"345\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 01 Ginecologia ed Ostetricia ambulatoriale con Attivit\u00e0 Invasiva senza attivit\u00e0 chirurgica n\u00e9 Chirurgia Minore, senza fecondazione assistita e senza assistenza al parto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_345\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_345_2\" class=\"wpforms-payment-price\" data-amount=\"236,00\" name=\"wpforms[fields][345]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_345_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_345_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_345_1\" class=\"wpforms-payment-price\" data-amount=\"248,00\" name=\"wpforms[fields][345]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_345_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_345_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_345_3\" class=\"wpforms-payment-price\" data-amount=\"312,00\" name=\"wpforms[fields][345]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_345_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_345_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_345_4\" class=\"wpforms-payment-price\" data-amount=\"324,00\" name=\"wpforms[fields][345]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_345_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_345_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_335-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"335\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_335\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_335_2\" class=\"wpforms-payment-price\" data-amount=\"264,00\" name=\"wpforms[fields][335]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_335_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_335_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_335_1\" class=\"wpforms-payment-price\" data-amount=\"280,00\" name=\"wpforms[fields][335]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_335_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_335_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_335_3\" class=\"wpforms-payment-price\" data-amount=\"336,00\" name=\"wpforms[fields][335]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_335_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_335_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_335_4\" class=\"wpforms-payment-price\" data-amount=\"352,00\" name=\"wpforms[fields][335]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_335_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_335_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_346-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"346\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_346\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_346_2\" class=\"wpforms-payment-price\" data-amount=\"316,80\" name=\"wpforms[fields][346]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_346_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_346_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_346_1\" class=\"wpforms-payment-price\" data-amount=\"336,00\" name=\"wpforms[fields][346]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_346_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_346_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_346_3\" class=\"wpforms-payment-price\" data-amount=\"403,20\" name=\"wpforms[fields][346]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_346_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_346_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_346_4\" class=\"wpforms-payment-price\" data-amount=\"422,40\" name=\"wpforms[fields][346]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_346_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_346_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_347-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"347\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02a Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, senza fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_347\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_347_2\" class=\"wpforms-payment-price\" data-amount=\"368,00\" name=\"wpforms[fields][347]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_347_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_347_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_347_1\" class=\"wpforms-payment-price\" data-amount=\"392,00\" name=\"wpforms[fields][347]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_347_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_347_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_347_3\" class=\"wpforms-payment-price\" data-amount=\"470,40\" name=\"wpforms[fields][347]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_347_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_347_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_347_4\" class=\"wpforms-payment-price\" data-amount=\"492,80\" name=\"wpforms[fields][347]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_347_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_347_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_336-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"336\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_336\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_336_2\" class=\"wpforms-payment-price\" data-amount=\"280,00\" name=\"wpforms[fields][336]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_336_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_336_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_336_1\" class=\"wpforms-payment-price\" data-amount=\"296,00\" name=\"wpforms[fields][336]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_336_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_336_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_336_3\" class=\"wpforms-payment-price\" data-amount=\"360,00\" name=\"wpforms[fields][336]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_336_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_336_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_336_4\" class=\"wpforms-payment-price\" data-amount=\"376,00\" name=\"wpforms[fields][336]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_336_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_336_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_348-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"348\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_348\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_348_2\" class=\"wpforms-payment-price\" data-amount=\"336,00\" name=\"wpforms[fields][348]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_348_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_348_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_348_1\" class=\"wpforms-payment-price\" data-amount=\"355,20\" name=\"wpforms[fields][348]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_348_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_348_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_348_3\" class=\"wpforms-payment-price\" data-amount=\"432,00\" name=\"wpforms[fields][348]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_348_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_348_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_348_4\" class=\"wpforms-payment-price\" data-amount=\"451,20\" name=\"wpforms[fields][348]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_348_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_348_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_349-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"349\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 02b Ginecologia ed Ostetricia ambulatoriale con attivit\u00e0 di Chirurgia Minore, con fecondazione assistita, senza attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01 e 02a) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_349\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_349_2\" class=\"wpforms-payment-price\" data-amount=\"392,00\" name=\"wpforms[fields][349]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_349_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_349_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_349_1\" class=\"wpforms-payment-price\" data-amount=\"414,00\" name=\"wpforms[fields][349]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_349_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_349_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_349_3\" class=\"wpforms-payment-price\" data-amount=\"504,00\" name=\"wpforms[fields][349]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_349_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_349_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_349_4\" class=\"wpforms-payment-price\" data-amount=\"526,40\" name=\"wpforms[fields][349]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_349_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_349_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_337-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"337\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_337\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_337_2\" class=\"wpforms-payment-price\" data-amount=\"304,00\" name=\"wpforms[fields][337]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_337_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_337_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_337_1\" class=\"wpforms-payment-price\" data-amount=\"320,00\" name=\"wpforms[fields][337]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_337_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_337_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_337_3\" class=\"wpforms-payment-price\" data-amount=\"392,00\" name=\"wpforms[fields][337]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_337_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_337_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_337_4\" class=\"wpforms-payment-price\" data-amount=\"408,00\" name=\"wpforms[fields][337]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_337_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_337_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_350-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"350\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_350\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_350_2\" class=\"wpforms-payment-price\" data-amount=\"364,80\" name=\"wpforms[fields][350]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_350_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_350_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_350_1\" class=\"wpforms-payment-price\" data-amount=\"384,00\" name=\"wpforms[fields][350]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_350_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_350_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_350_3\" class=\"wpforms-payment-price\" data-amount=\"470,40\" name=\"wpforms[fields][350]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_350_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_350_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_350_4\" class=\"wpforms-payment-price\" data-amount=\"489,60\" name=\"wpforms[fields][350]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_350_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_350_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_351-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"351\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 03 Ginecologia ed Ostetricia con attivit\u00e0 chirurgica e senza assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a e 02b) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_351\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_351_2\" class=\"wpforms-payment-price\" data-amount=\"425,60\" name=\"wpforms[fields][351]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_351_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_351_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_351_1\" class=\"wpforms-payment-price\" data-amount=\"448,00\" name=\"wpforms[fields][351]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_351_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_351_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_351_3\" class=\"wpforms-payment-price\" data-amount=\"548,80\" name=\"wpforms[fields][351]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_351_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_351_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_351_4\" class=\"wpforms-payment-price\" data-amount=\"571,20\" name=\"wpforms[fields][351]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_351_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_351_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_338-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"338\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_338\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_338_2\" class=\"wpforms-payment-price\" data-amount=\"388,00\" name=\"wpforms[fields][338]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_338_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_338_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_338_1\" class=\"wpforms-payment-price\" data-amount=\"408,00\" name=\"wpforms[fields][338]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_338_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_338_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_338_3\" class=\"wpforms-payment-price\" data-amount=\"500,00\" name=\"wpforms[fields][338]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_338_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_338_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_338_4\" class=\"wpforms-payment-price\" data-amount=\"520,00\" name=\"wpforms[fields][338]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_338_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_338_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_352-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"352\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_352\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_352_2\" class=\"wpforms-payment-price\" data-amount=\"465,60\" name=\"wpforms[fields][352]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_352_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_352_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_352_1\" class=\"wpforms-payment-price\" data-amount=\"489,60\" name=\"wpforms[fields][352]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_352_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_352_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_352_3\" class=\"wpforms-payment-price\" data-amount=\"600,00\" name=\"wpforms[fields][352]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_352_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_352_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_352_4\" class=\"wpforms-payment-price\" data-amount=\"624,00\" name=\"wpforms[fields][352]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_352_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_352_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_353-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"353\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Fascia 04 Ginecologia ed Ostetricia con assistenza al parto (Include le attivit\u00e0 di cui alla fascia 01, 02a, 02b e 03) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_353\" class=\"wpforms-field-required\"><li class=\"choice-2 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_353_2\" class=\"wpforms-payment-price\" data-amount=\"543,20\" name=\"wpforms[fields][353]\" value=\"2\" aria-errormessage=\"wpforms-1111-field_353_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_353_2\">15.000 per sinistro e per anno<\/label><\/li><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-1111-field_353_1\" class=\"wpforms-payment-price\" data-amount=\"571,20\" name=\"wpforms[fields][353]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_353_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_353_1\">30.000 per sinistro e per anno<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-1111-field_353_3\" class=\"wpforms-payment-price\" data-amount=\"700,00\" name=\"wpforms[fields][353]\" value=\"3\" aria-errormessage=\"wpforms-1111-field_353_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_353_3\">55.000 per sinistro e per anno<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-1111-field_353_4\" class=\"wpforms-payment-price\" data-amount=\"728,00\" name=\"wpforms[fields][353]\" value=\"4\" aria-errormessage=\"wpforms-1111-field_353_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_353_4\">85.000 per sinistro e per anno<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_408-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"408\"><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=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Precedente<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-1111-field_81-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"81\"><div id=\"wpforms-1111-field_81\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_81-error\"><h3><span style=\"color:#db4b95\"><strong>Sinistrosit\u00e0 pregressa<\/strong><\/span><\/h3>\n<p><strong>Indicare se sono state avanzate Richieste di Risarcimento o se siano state promosse azioni legali tese ad accertare la Responsabilit\u00e0 civile dell\u2019Assicurato negli ultimi 5 (cinque) anni:<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Sinistrosit\u00e0 pregressa <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_102\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_102_2\" name=\"wpforms[fields][102]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_102_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_102_2\">SI<\/label><\/li><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_102_1\" name=\"wpforms[fields][102]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_102_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_102_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_99-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"99\" style=\"display:none;\"><div id=\"wpforms-1111-field_99\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_99-error\"><p>In caso di risposta affermativa, indicare quante Richieste di Risarcimento:<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_104-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_104\">Numero di Richieste di risarcimento <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1111-field_104\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][104]\" required=\"required\"><option value=\"1\"  class=\"choice-1 depth-1\"  >1<\/option><option value=\"2\"  class=\"choice-2 depth-1\"  >2<\/option><option value=\"3\"  class=\"choice-3 depth-1\"  >3<\/option><\/select><\/div><div id=\"wpforms-1111-field_100-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"100\" style=\"display:none;\"><div id=\"wpforms-1111-field_100\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_100-error\"><p><span style=\"color:#ff0000\"><strong>AVVERTENZA:<\/strong><\/span><br \/>\n<span style=\"color:#ff0000\"><strong>Si precisa che in presenza di Sinistri pregressi, negli ultimi 5 (cinque) anni, la Compagnia si riserva di effettuare una quotazione ad hoc prevedendo una maggiorazione del Premio.<\/strong><\/span><\/p>\n<p><span style=\"color:#ff0000\"><strong>Per proseguire con la sottoscrizione della polizza la preghiamo di contattare i nostri consulenti al numero 02 25542160.<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_82-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"82\"><div id=\"wpforms-1111-field_82\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_82-error\"><h3><span style=\"color:#db4b95\"><strong>Altre coperture attive con altri Assicuratori per il medesimo rischio<\/strong><\/span><\/h3>\n<p><strong>Esistono altre polizze assicurative (anche precedenti e allo stato non pi\u00f9 attive qualora sia stata attivata la copertura postuma &#8211; Ultrattivit\u00e0) che coprono l\u2019Assicurato relativamente ai medesimi rischi assicurabili con la presente Polizza?<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Altre coperture medesimo rischio <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_88\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_88_2\" name=\"wpforms[fields][88]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_88_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_88_2\">SI<\/label><\/li><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_88_1\" name=\"wpforms[fields][88]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_88_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_88_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_89-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"89\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_90-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"90\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_90\">Impresa Assicuratrice <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_90\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-1111-field_90-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_91-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"91\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_91\">Numero di polizza <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_91\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-1111-field_91-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_92-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"92\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_92\">Data decorrenza polizza <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1111-field_92\" 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][92][date]\" aria-errormessage=\"wpforms-1111-field_92-error\" required><a title=\"Cancella la data\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Cancella la data\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_93-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"93\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_93\">Data scadenza polizza <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1111-field_93\" 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][93][date]\" aria-errormessage=\"wpforms-1111-field_93-error\" required><a title=\"Cancella la data\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Cancella la data\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_83-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"83\"><div id=\"wpforms-1111-field_83\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_83-error\"><h3><span style=\"color:#db4b95\"><strong>Precedenti assicurativi dell\u2019Assicurato con Societ\u00e0 del Gruppo AmTrust<\/strong><\/span><\/h3>\n<p><strong>Esistono altre polizze assicurative stipulate con una Societ\u00e0 del gruppo AmTrust (anche precedenti e allo stato non pi\u00f9 attive qualora sia stata attivata la copertura postuma \u2013 Ultrattivit\u00e0), che coprono l\u2019Assicurato relativamente ai medesimi rischi assicurabili con la presente polizza?<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_189-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"189\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Precedenti coperture assicurative AmTrust <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_189\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_189_2\" name=\"wpforms[fields][189]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_189_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_189_2\">SI<\/label><\/li><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_189_1\" name=\"wpforms[fields][189]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_189_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_189_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_409-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"409\"><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=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Precedente<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-1111-field_400-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"400\"><h3 id=\"wpforms-1111-field_400\" aria-errormessage=\"wpforms-1111-field_400-error\">Riepilogo garanzie <\/h3><\/div><div id=\"wpforms-1111-field_384-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"384\" style=\"display:none;\"><div id=\"wpforms-1111-field_384\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_384-error\"><h4><span style=\"color:#db4b95\"><strong>Garanzie selezionate:<\/strong><\/span><\/h4>\n<h4><strong>Responsabilit\u00e0 Civile<\/strong><\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_421-container\" class=\"wpforms-field wpforms-field-text wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"421\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_421\" aria-hidden=\"false\">MASSIMALE Selezionato Garanzia Responsabilit\u00e0 Civile  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_421\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][421]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_421-error\" required><\/div><div id=\"wpforms-1111-field_385-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"385\" style=\"display:none;\"><div id=\"wpforms-1111-field_385\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_385-error\"><h4><strong>Tutela Legale<\/strong><\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_422-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"422\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_422\" aria-hidden=\"false\">MASSIMALE Selezionato Garanzia Tutela Legale <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_422\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][422]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_422-error\" required><\/div><div id=\"wpforms-1111-field_386-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"386\" style=\"display:none;\"><div id=\"wpforms-1111-field_386\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_386-error\"><h4><strong>Ruolo apicale e Direzione Sanitaria &#8211; CTU\/CTP &#8211; Perdite Patrimoniali &#8211; Massimale 200.000<\/strong><\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_387-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"387\"><div id=\"wpforms-1111-field_387\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_387-error\"><h4><span style=\"color:#db4b95\"><strong>Garanzie sempre operanti:<\/strong><\/span><\/h4>\n<ul>\n<li>\n<h4>Omesso adempimento Crediti ECM<\/h4>\n<\/li>\n<li>\n<h4>Conduzione studio (RCT-RCO)<\/h4>\n<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_380-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"380\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_380\">Garanzia RC Inclusa\/Esclusa<\/label><input type=\"text\" id=\"wpforms-1111-field_380\" class=\"wpforms-field-small\" name=\"wpforms[fields][380]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_380-error\" ><\/div><div id=\"wpforms-1111-field_381-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"381\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_381\">Garanzia TUTELA LEGALE Inclusa\/Esclusa<\/label><input type=\"text\" id=\"wpforms-1111-field_381\" class=\"wpforms-field-small\" name=\"wpforms[fields][381]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_381-error\" ><\/div><div id=\"wpforms-1111-field_382-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"382\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_382\">Estensione Ruoli Apicali Inclusa\/Esclusa<\/label><input type=\"text\" id=\"wpforms-1111-field_382\" class=\"wpforms-field-small\" name=\"wpforms[fields][382]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_382-error\" ><\/div><div id=\"wpforms-1111-field_417-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"417\"><input type=\"hidden\" id=\"wpforms-1111-field_417\" name=\"wpforms[fields][417]\" value=\"Conduzione studio (RCT-RCO) - Omesso adempimento Crediti ECM\"><\/div><div id=\"wpforms-1111-field_399-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"399\"><h3 id=\"wpforms-1111-field_399\" aria-errormessage=\"wpforms-1111-field_399-error\">Dettaglio Premi, Contributo Fondo AGEO e Diritti di emissione<\/h3><\/div><div id=\"wpforms-1111-field_355-container\" class=\"wpforms-field wpforms-field-payment-multiple\" data-field-type=\"payment-multiple\" data-field-id=\"355\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Diritti di emissione e spese pratica <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_355\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1111-field_355_1\" class=\"wpforms-payment-price\" data-amount=\"250,00\" name=\"wpforms[fields][355]\" value=\"1\" aria-errormessage=\"wpforms-1111-field_355_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_355_1\">Diritti di emissione e spese pratica<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_375-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"375\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_322-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"322\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_322\">Frazionamento <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1111-field_322\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][322]\" required=\"required\"><option value=\"Seleziona Frazionamento\"  selected='selected' class=\"choice-3 depth-1\"  >Seleziona Frazionamento<\/option><option value=\"Annuale\"  class=\"choice-1 depth-1\"  >Annuale<\/option><option value=\"Semestrale\"  class=\"choice-2 depth-1\"  >Semestrale<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_85-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_85\">Data decorrenza polizza <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1111-field_85\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"d\/m\/Y\" data-limit-days=\"mon,tue,wed,thu,fri\" data-disable-past-dates=\"1\" data-disable-todays-date=\"1\" data-input=\"true\" name=\"wpforms[fields][85][date]\" placeholder=\"Seleziona data decorrenza polizza\" aria-errormessage=\"wpforms-1111-field_85-error\" required><a title=\"Cancella la data\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Cancella la data\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_316-container\" class=\"wpforms-field wpforms-field-text wpforms-fieldtotale wpforms-conditional-field wpforms-conditional-show wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"316\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_316\">Rata Alla Firma<\/label><input type=\"text\" id=\"wpforms-1111-field_316\" class=\"wpforms-field-small\" name=\"wpforms[fields][316]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_316-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_424-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"424\"><input type=\"hidden\" id=\"wpforms-1111-field_424\" name=\"wpforms[fields][424]\"><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_328-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"328\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_328\">Data Prossima scadenza rata<\/label><input type=\"text\" id=\"wpforms-1111-field_328\" class=\"wpforms-field-small\" name=\"wpforms[fields][328]\" aria-errormessage=\"wpforms-1111-field_328-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_321-container\" class=\"wpforms-field wpforms-field-text wpforms-fieldtotale wpforms-conditional-field wpforms-conditional-show wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"321\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_321\">Rata successiva<\/label><input type=\"text\" id=\"wpforms-1111-field_321\" class=\"wpforms-field-small\" name=\"wpforms[fields][321]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_321-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_425-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"425\"><input type=\"hidden\" id=\"wpforms-1111-field_425\" name=\"wpforms[fields][425]\"><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_317-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"text\" data-field-id=\"317\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_317\">Data scadenza polizza<\/label><input type=\"text\" id=\"wpforms-1111-field_317\" class=\"wpforms-field-small\" name=\"wpforms[fields][317]\" aria-errormessage=\"wpforms-1111-field_317-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1111-field_323-container\" class=\"wpforms-field wpforms-field-text wpforms-fieldtotale wpforms-conditional-field wpforms-conditional-show wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"323\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_323\">Costo Annuale<\/label><input type=\"text\" id=\"wpforms-1111-field_323\" class=\"wpforms-field-small\" name=\"wpforms[fields][323]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_323-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_395-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"395\"><h3 id=\"wpforms-1111-field_395\" aria-errormessage=\"wpforms-1111-field_395-error\" aria-describedby=\"wpforms-1111-field_395-description\">Avvertenze<\/h3><div id=\"wpforms-1111-field_395-description\" class=\"wpforms-field-description\">Prima della sottoscrizione dell\u2019adesione leggere\nla Documentazione Precontrattuale contenuta nel modulo di adesione e il Set Informativo.\n\nLa conferma di adesione \u00e8 sempre subordinata alla verifica da parte del nostro Ufficio Assunzioni della modulistica e dei dati inseriti.<\/div><\/div><div id=\"wpforms-1111-field_396-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"396\"><h3 id=\"wpforms-1111-field_396\" aria-errormessage=\"wpforms-1111-field_396-error\" aria-describedby=\"wpforms-1111-field_396-description\">Recapiti Ufficio e Consulente di riferimento<\/h3><div id=\"wpforms-1111-field_396-description\" class=\"wpforms-field-description\">Per qualsiasi informazione non esitare a contattare uno dei nostri consulenti.<\/div><\/div><div id=\"wpforms-1111-field_394-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"textarea\" data-field-id=\"394\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_394\" aria-hidden=\"false\">Recapiti Ufficio e Consulente di riferimento<\/label><textarea id=\"wpforms-1111-field_394\" class=\"wpforms-field-medium\" name=\"wpforms[fields][394]\" readonly=\"readonly\" aria-errormessage=\"wpforms-1111-field_394-error\" ><\/textarea><\/div><div id=\"wpforms-1111-field_410-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"410\"><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=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Precedente<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6 last \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-1111-field_146-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"146\"><div id=\"wpforms-1111-field_146\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_146-error\"><h3><span style=\"color:#db4b95\"><strong>Profilo Assicurativo Adeguatezza\/coerenza contratti danni e vita puro rischio<\/strong><\/span><\/h3>\n<h4><strong>Regolamento IVASS n. 5\/2006(ex ISVAP) art. 52 &#8211; Regolamento IVASS n. 40\/2018 \u2013 Modificato Provvedimento IVASS 97\/2020 e s.m.i<\/strong><\/h4>\n<p><strong>Il presente questionario, la cui compilazione necessita solo di pochi minuti del Suo tempo, \u00e8 indispensabile e obbligatorio ai sensi <\/strong><strong>e per gli effetti delle nuove disposizioni in materia di adeguatezza contrattuale ex art. 52 del Regolamento IVASS nr. 5 del 16.10.2006 e s.m.i., al <\/strong><strong>fine di raccogliere le informazioni utili e necessarie a proporLe un contratto adeguato e coerente alle Sue esigenze assicurative. La mancanza di <\/strong><strong>tali informazioni potrebbe ostacolare la corretta valutazione dei Suoi bisogni assicurativi.<\/strong><br \/>\n<strong>Rimane salvo, comunque, il Suo diritto a non fornire tali informazioni, nel qual caso, non sar\u00e0 possibile procedere con la <\/strong><strong>sottoscrizione del contratto.<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_211-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"211\"><div id=\"wpforms-1111-field_211\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_211-error\"><h3><span style=\"color:#db4b95\"><strong>Professione o attivit\u00e0<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_216-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"216\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_238-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"238\"><fieldset><legend class=\"wpforms-field-label\">Tipologia soggetto <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_238\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_238_1\" name=\"wpforms[fields][238]\" value=\"Persona Fisica\" aria-errormessage=\"wpforms-1111-field_238_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_238_1\">Persona Fisica<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_238_2\" name=\"wpforms[fields][238]\" value=\"Persona Giuridica\" aria-errormessage=\"wpforms-1111-field_238_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_238_2\">Persona Giuridica<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_235-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"235\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Attivit\u00e0 Persona Fisica <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_235\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_1\" name=\"wpforms[fields][235][]\" value=\"Lavoratore dipendente\" aria-errormessage=\"wpforms-1111-field_235_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_1\">Lavoratore dipendente<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_2\" name=\"wpforms[fields][235][]\" value=\"Lavoratore autonomo\" aria-errormessage=\"wpforms-1111-field_235_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_2\">Lavoratore autonomo<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_3\" name=\"wpforms[fields][235][]\" value=\"Studente\" aria-errormessage=\"wpforms-1111-field_235_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_3\">Studente<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_4\" name=\"wpforms[fields][235][]\" value=\"Pensionato\" aria-errormessage=\"wpforms-1111-field_235_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_4\">Pensionato<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_5\" name=\"wpforms[fields][235][]\" value=\"Disoccupato\" aria-errormessage=\"wpforms-1111-field_235_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_5\">Disoccupato<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_235_6\" name=\"wpforms[fields][235][]\" value=\"Altro\" aria-errormessage=\"wpforms-1111-field_235_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_235_6\">Altro<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_225-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"225\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_225\" aria-hidden=\"false\">Specificare altra attivit\u00e0 Persona Fisica <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_225\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][225]\" aria-errormessage=\"wpforms-1111-field_225-error\" required><\/div><div id=\"wpforms-1111-field_236-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"236\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Attivit\u00e0 Persona Giuridica <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_236\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_1\" name=\"wpforms[fields][236][]\" value=\"Attivit\u00e0 commerciale\" aria-errormessage=\"wpforms-1111-field_236_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_1\">Attivit\u00e0 commerciale<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_2\" name=\"wpforms[fields][236][]\" value=\"Attivit\u00e0 industriale\" aria-errormessage=\"wpforms-1111-field_236_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_2\">Attivit\u00e0 industriale<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_3\" name=\"wpforms[fields][236][]\" value=\"Attivit\u00e0 agricola\" aria-errormessage=\"wpforms-1111-field_236_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_3\">Attivit\u00e0 agricola<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_4\" name=\"wpforms[fields][236][]\" value=\"Attivit\u00e0 di servizi\" aria-errormessage=\"wpforms-1111-field_236_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_4\">Attivit\u00e0 di servizi<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_5\" name=\"wpforms[fields][236][]\" value=\"Associazione di volontariato\" aria-errormessage=\"wpforms-1111-field_236_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_5\">Associazione di volontariato<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_7\" name=\"wpforms[fields][236][]\" value=\"Associazione di altro genere\" aria-errormessage=\"wpforms-1111-field_236_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_7\">Associazione di altro genere<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_236_6\" name=\"wpforms[fields][236][]\" value=\"Altro\" aria-errormessage=\"wpforms-1111-field_236_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_236_6\">Altro<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_237-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"237\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_237\" aria-hidden=\"false\">Specificare altra attivit\u00e0 Persona Giuridica <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_237\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][237]\" aria-errormessage=\"wpforms-1111-field_237-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><\/div><\/div><\/div><div id=\"wpforms-1111-field_215-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"215\"><div id=\"wpforms-1111-field_215\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_215-error\"><h3><span style=\"color:#db4b95\"><strong>Quali sono le sue esigenze di protezione per le quali richiede la copertura attraverso una polizza assicurativa? (possibile risposta multipla)<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_191-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"191\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_192-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"192\"><fieldset><legend class=\"wpforms-field-label\">Esigenze Assicurative da tutelare <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_192\" class=\"wpforms-field-required\" data-choice-limit=\"6\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"beni o valori di propriet\u00e0 o non (Fabbricati,\u2026)\" aria-errormessage=\"wpforms-1111-field_192_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_1\">beni o valori di propriet\u00e0 o non (Fabbricati,\u2026)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"la propria persona e\/o familiari e\/o altri soggetti\" aria-errormessage=\"wpforms-1111-field_192_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_2\">la propria persona e\/o familiari e\/o altri soggetti<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"il proprio patrimonio per richieste di risarcimento per danni a terzi\" aria-errormessage=\"wpforms-1111-field_192_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_3\">il proprio patrimonio per richieste di risarcimento per danni a terzi<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"obbligazioni nei confronti di terzi\" aria-errormessage=\"wpforms-1111-field_192_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_4\">obbligazioni nei confronti di terzi<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"oneri derivanti da contenziosi legali\" aria-errormessage=\"wpforms-1111-field_192_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_5\">oneri derivanti da contenziosi legali<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_192_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][192][]\" value=\"altro\" aria-errormessage=\"wpforms-1111-field_192_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_192_6\">altro<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_240-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"240\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_240\" aria-hidden=\"false\">Specificare altre esigenze <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_240\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][240]\" aria-errormessage=\"wpforms-1111-field_240-error\" aria-describedby=\"wpforms-1111-field_240-description\" required><div id=\"wpforms-1111-field_240-description\" class=\"wpforms-field-description\">Indicare le altre esigenze che determinano la volont\u00e0 di sottoscrivere della presente copertura assicurativa.<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_239-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"239\"><fieldset><legend class=\"wpforms-field-label\">Altre polizze gi\u00e0 in corso<\/legend><ul id=\"wpforms-1111-field_239\" data-choice-limit=\"6\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"1 - SI\" aria-errormessage=\"wpforms-1111-field_239_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_1\">1 &#8211; SI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"2 - SI\" aria-errormessage=\"wpforms-1111-field_239_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_2\">2 &#8211; SI<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"3 - SI\" aria-errormessage=\"wpforms-1111-field_239_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_3\">3 &#8211; SI<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"4 - SI\" aria-errormessage=\"wpforms-1111-field_239_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_4\">4 &#8211; SI<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"5 - SI\" aria-errormessage=\"wpforms-1111-field_239_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_5\">5 &#8211; SI<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_239_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][239][]\" value=\"6 - SI\" aria-errormessage=\"wpforms-1111-field_239_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_239_6\">6 &#8211; SI<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1111-field_151-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"151\"><fieldset><legend class=\"wpforms-field-label\">L\u2019esigenza di copertura assicurativa \u00e8 determinata da: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_151\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_151_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][151][]\" value=\"Obblighi di legge\" aria-errormessage=\"wpforms-1111-field_151_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_151_1\">Obblighi di legge<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_151_7\" data-rule-check-limit=\"true\" name=\"wpforms[fields][151][]\" value=\"Impegni contrattuali\" aria-errormessage=\"wpforms-1111-field_151_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_151_7\">Impegni contrattuali<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_151_8\" data-rule-check-limit=\"true\" name=\"wpforms[fields][151][]\" value=\"Altro\" aria-errormessage=\"wpforms-1111-field_151_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_151_8\">Altro<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_161-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"161\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1111-field_161\" aria-hidden=\"false\">Altre obblighi <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_161\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][161]\" aria-errormessage=\"wpforms-1111-field_161-error\" aria-describedby=\"wpforms-1111-field_161-description\" required><div id=\"wpforms-1111-field_161-description\" class=\"wpforms-field-description\">Indicare le altre esigenze che determinano la volont\u00e0 di sottoscrivere della presente copertura assicurativa.<\/div><\/div><div id=\"wpforms-1111-field_153-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-type=\"checkbox\" data-field-id=\"153\"><fieldset><legend class=\"wpforms-field-label\">La durata per la quale \u00e8 interessato alla copertura dei Suoi rischi <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_153\" class=\"wpforms-field-required\" data-choice-limit=\"7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"A) 1 anno\" aria-errormessage=\"wpforms-1111-field_153_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_1\">A) 1 anno<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_18\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"A) con tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_18-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_18\">A) con tacito rinnovo<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_19\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"A) senza tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_19-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_19\">A) senza tacito rinnovo<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_20\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"B) Superiore ad 1 anno\" aria-errormessage=\"wpforms-1111-field_153_20-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_20\">B) Superiore ad 1 anno<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"B) con tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_22\">B) con tacito rinnovo<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_23\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"B) senza tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_23-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_23\">B) senza tacito rinnovo<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_24\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"C) Polinneale\" aria-errormessage=\"wpforms-1111-field_153_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_24\">C) Polinneale<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_25\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"C) con tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_25-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_25\">C) con tacito rinnovo<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_26\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"C) senza tacito rinnovo\" aria-errormessage=\"wpforms-1111-field_153_26-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_26\">C) senza tacito rinnovo<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_153_27\" data-rule-check-limit=\"true\" name=\"wpforms[fields][153][]\" value=\"D) temporanea con pagamento anticipato del premio per l&#039;intera durata\" aria-errormessage=\"wpforms-1111-field_153_27-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_153_27\">D) temporanea con pagamento anticipato del premio per l&#8217;intera durata<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_163-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"163\"><div id=\"wpforms-1111-field_163\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_163-error\"><h3><span style=\"color:#db4b95\"><strong>\u00c8 consapevole che la copertura assicurativa potrebbe prevedere contrattualmente<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_174-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"174\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_157-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"157\"><div id=\"wpforms-1111-field_157\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_157-error\"><p>Esclusioni e\/o limitazioni, scoperti e\/o franchigie<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_167-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"167\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Esclusioni e\/o limitazioni, scoperti e\/o franchigie <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_167\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_167_2\" name=\"wpforms[fields][167]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_167_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_167_2\">SI<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_167_1\" name=\"wpforms[fields][167]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_167_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_167_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_171-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"171\" style=\"display:none;\"><div id=\"wpforms-1111-field_171\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_171-error\"><p><span style=\"color:#ff0000\"><strong>Prima della sottoscrizione si prega di leggere attentamente il Set Informativo<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1111-field_175-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"175\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_165-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"165\"><div id=\"wpforms-1111-field_165\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_165-error\"><p>Possibilit\u00e0 di rivalsa nei suoi confronti da parte dell\u2019assicuratore<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_168-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"168\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Possibilit\u00e0 di rivalsa nei suoi confronti da parte dell\u2019assicuratore <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_168\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_168_2\" name=\"wpforms[fields][168]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_168_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_168_2\">SI<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_168_1\" name=\"wpforms[fields][168]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_168_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_168_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_172-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"172\" style=\"display:none;\"><div id=\"wpforms-1111-field_172\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_172-error\"><p><span style=\"color:#ff0000\"><strong>Prima della sottoscrizione si prega di leggere attentamente il Set Informativo<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1111-field_176-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"176\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1111-field_166-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"166\"><div id=\"wpforms-1111-field_166\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_166-error\"><p>Perdita parziale o totale dell\u2019indennizzo e\/o inefficacia della copertura assicurativa<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_169-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"169\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Perdita parziale o totale dell\u2019indennizzo e\/o inefficacia della copertura assicurativa <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_169\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_169_2\" name=\"wpforms[fields][169]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_169_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_169_2\">SI<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_169_1\" name=\"wpforms[fields][169]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_169_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_169_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1111-field_173-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"173\" style=\"display:none;\"><div id=\"wpforms-1111-field_173\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_173-error\"><p><span style=\"color:#ff0000\"><strong>Prima della sottoscrizione si prega di leggere attentamente il Set Informativo<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1111-field_149-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"149\"><div id=\"wpforms-1111-field_149\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_149-error\"><h3><span style=\"color:#db4b95\"><strong>Dichiarazioni del contraente<\/strong><\/span><\/h3>\n<p><strong>Il contraente dichiara che:<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_145-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"145\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">1 &#8211; Dichiarazioni del contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_145\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_145_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][145][]\" value=\"Ai sensi e per effetti delle disposizioni di leggi in materia di dichiarazioni false e mendaci, di aver risposto in modo completo e veritiero al questionario per la valutazione dell&#039;adeguatezza del contratto. Riconosce, altres\u00ec, che le dichiarazioni in esso rese sono esatte ance se sono state compilate di pugno dall&#039;intermediario su mia indicazione, e pertanto ne assume piena responsabilit\u00e0.\" aria-errormessage=\"wpforms-1111-field_145_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_145_1\">Ai sensi e per effetti delle disposizioni di leggi in materia di dichiarazioni false e mendaci, di aver risposto in modo completo e veritiero al questionario per la valutazione dell&#8217;adeguatezza del contratto. Riconosce, altres\u00ec, che le dichiarazioni in esso rese sono esatte ance se sono state compilate di pugno dall&#8217;intermediario su mia indicazione, e pertanto ne assume piena responsabilit\u00e0.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_155-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"155\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">2 &#8211; Dichiarazioni del contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_155\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_155_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][155][]\" value=\"Ai sensi e per gli effetti della vigente normativa e regolamentare il Contraente autorizza il broker a trasmettere tutta la documentazione, ivi inclusi la corrispondenza, le informazioni di cui al processo di adeguatezza dei contratti, l\u2019informativa precontrattuale e i documenti contrattuali per mezzo di strumenti informatici all&#039;indirizzo di posta elettronica indicato nel presente modulo e di essere stato informato dal Broker che la presente autorizzazione \u00e8 revocabile in qualunque momento, anche per mezzo di registrazione vocale e che tale revoca potr\u00e0 comportare l\u2019applicazione, a mio carico, degli oneri connessi alla stampa e all\u2019invio della documentazione necessaria alla conclusione e gestione dei contratti intermediati per il tramite del broker in esecuzione del presente incarico. La presente autorizzazione alla trasmissione della documentazione in formato elettronico comprende l\u2019invio di materiale promozionale, pubblicitario o di altre comunicazioni commerciali da parte del broker e\/o di altri soggetti che con lo stesso operino o collaborino.\" aria-errormessage=\"wpforms-1111-field_155_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_155_5\">Ai sensi e per gli effetti della vigente normativa e regolamentare il Contraente autorizza il broker a trasmettere tutta la documentazione, ivi inclusi la corrispondenza, le informazioni di cui al processo di adeguatezza dei contratti, l\u2019informativa precontrattuale e i documenti contrattuali per mezzo di strumenti informatici all&#8217;indirizzo di posta elettronica indicato nel presente modulo e di essere stato informato dal Broker che la presente autorizzazione \u00e8 revocabile in qualunque momento, anche per mezzo di registrazione vocale e che tale revoca potr\u00e0 comportare l\u2019applicazione, a mio carico, degli oneri connessi alla stampa e all\u2019invio della documentazione necessaria alla conclusione e gestione dei contratti intermediati per il tramite del broker in esecuzione del presente incarico. La presente autorizzazione alla trasmissione della documentazione in formato elettronico comprende l\u2019invio di materiale promozionale, pubblicitario o di altre comunicazioni commerciali da parte del broker e\/o di altri soggetti che con lo stesso operino o collaborino.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_154-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"154\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">3 &#8211; Dichiarazioni del contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_154\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_154_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][154][]\" value=\"La compilazione del presente Questionario di raccolta dati NON impegna alla stipulazione della Polizza di assicurazione\" aria-errormessage=\"wpforms-1111-field_154_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_154_4\">La compilazione del presente Questionario di raccolta dati NON impegna alla stipulazione della Polizza di assicurazione<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_241-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"241\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">4 &#8211; Dichiarazioni del contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_241\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_241_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][241][]\" value=\"Preso atto che la Vostra Societ\u00e0 \u00e8 iscritta alla Sezione B del Registro Unico Intermediari di Assicurazione (D.Lgs.N. 209\/2005) al numero B00218547, con effetto immediato, Vi conferiamo incarico di Broker assicurativi e Vi affidiamo la gestione tecnica ed amministrativa della Polizza Convenzione AGEO - Responsabilit\u00e0 Civile Professionale ed amministrativa, Tutela Legale e Colpa Grave. Ci impegniamo a fornirVi tutta la documentazione utile (copie dei contratti assicurativi in essere, sinistri precedenti ecc.) ed il supporto necessario per l\u2019analisi e la gestione dei rischi (compilazione di questionari, disponibilit\u00e0 per sopralluoghi ecc.). Durante la vigenza del Vostro incarico ci impegniamo, altres\u00ec, a non contattare, direttamente od indirettamente, nessun altra organizzazione del settore assicurativo (intermediari assicurativi di cui all\u2019Art. 109 comma 2 del D.Lgs 209\/05, in particolare altri Broker, e\/o Direzioni e\/o Gerenze e\/o Rappresentanze di Compagnie di Assicurazioni), n\u00e9 a sottoporre e\/o far visionare le vostre soluzioni a tali soggetti, senza il Vostro preventivo consenso scritto, ed a segnalarVi eventuali contatti da parte di tali soggetti. A tal proposito dichiariamo di non avere in corso alcun altro incarico di Brokeraggio, oppure aver provveduto alla relativa disdetta e di non essere nel relativo periodo di preavviso. In attuazione del predetto incarico, su nostra richiesta o su Vostra iniziativa ci fornirete la consulenza riferita ad uno o pi\u00f9 contratti di assicurazioni che, ai sensi dell\u2019art. 119 ter del Cap, prevede la consegna di una raccomandazione personalizzata da consegnare unitamente alla proposta assicurativa. Vi impegnate a ricercare e proporci le soluzioni assicurative pi\u00f9 adatte alle nostre esigenze, monitorare ed aggiornare, se del caso, il nostro Programma assicurativo. Vi conferiamo, quindi, l&#039;incarico di trattare per nostro conto le eventuali modifiche del contratto, nonch\u00e9 le nuove coperture assicurative che sar\u00e0 nostro interesse stipulare, in base alla identificazione ed analisi valutaria dei rischi su di noi gravanti, che effettuerete. Vi affidiamo, pertanto, la gestione tecnica ed amministrativa, ivi compreso l\u2019incasso e la rimessa dei premi relativi delle polizze in essere e futuri e mandato di rappresentarci nell&#039;aggiornamento, riforma, rinnovazione e storno del contratto stesso e nella gestione e definizione degli eventuali sinistri (sia attivi sia passivi) e, all&#039;occorrenza, nella indicazione di periti e di Legali di parte, che, se di nostro gradimento, nomineremo. Per l&#039;effetto, curerete per nostro conto il perfezionamento dei titoli, la trasmissione dei premi ed ogni comunicazione, denuncia di sinistro, reclami, od altra notizia, in relazione ai contratti stessi, considerandosi il tutto come se fosse da noi effettuato. Ai fini assicurativi oggetto del presente incarico eleggiamo domicilio presso i Vostri uffici, impegnandoci ad informarVi immediatamente di qualunque iniziativa che le compagnie assicuratrici assumessero direttamente nei nostri confronti ed impegnandoci sin da ora ad a rendervi puntualmente disponibili, nel rispetto dei termini contrattualmente previsti, gli importi corrispondenti ai premi delle polizze da Voi intermediate nel nostro interesse e da noi accettate. Il presente incarico ha durata a tempo indeterminato, entrambe le parti potranno disdire il presente incarico con preavviso di 90 gg. rispetto alla scadenza annuale, a mezzo raccomandata A\/R e\/o PEC. Il presente incarico in ogni caso si intender\u00e0 privo di efficacia automaticamente con la disdetta del mandato da parte dell\u2019associazione AGEO contraente della convenzione. Il presente incarico non comporter\u00e0 onere alcuno a nostro carico per compensi o rimborsi spese a Vostro favore, dando Voi espressamente atto di nulla avere a pretendere al riguardo nei nostri confronti per le prestazioni rese, trovando esse remunerazione nelle provvigioni riconosciute all\u2019intermediario dagli assicuratori, secondo gli usi consolidati del mercato. La consulenza personalizzata da fornire ai sensi dell\u2019art. 119 ter potr\u00e0 dare origine ad uno specifico compenso, cos\u00ec come gli eventuali patti diversi sul tema delle remunerazioni.\" aria-errormessage=\"wpforms-1111-field_241_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_241_5\">Preso atto che la Vostra Societ\u00e0 \u00e8 iscritta alla Sezione B del Registro Unico Intermediari di Assicurazione (D.Lgs.N. 209\/2005) al numero B00218547, con effetto immediato, Vi conferiamo incarico di Broker assicurativi e Vi affidiamo la gestione tecnica ed amministrativa della Polizza Convenzione AGEO &#8211; Responsabilit\u00e0 Civile Professionale ed amministrativa, Tutela Legale e Colpa Grave. Ci impegniamo a fornirVi tutta la documentazione utile (copie dei contratti assicurativi in essere, sinistri precedenti ecc.) ed il supporto necessario per l\u2019analisi e la gestione dei rischi (compilazione di questionari, disponibilit\u00e0 per sopralluoghi ecc.). Durante la vigenza del Vostro incarico ci impegniamo, altres\u00ec, a non contattare, direttamente od indirettamente, nessun altra organizzazione del settore assicurativo (intermediari assicurativi di cui all\u2019Art. 109 comma 2 del D.Lgs 209\/05, in particolare altri Broker, e\/o Direzioni e\/o Gerenze e\/o Rappresentanze di Compagnie di Assicurazioni), n\u00e9 a sottoporre e\/o far visionare le vostre soluzioni a tali soggetti, senza il Vostro preventivo consenso scritto, ed a segnalarVi eventuali contatti da parte di tali soggetti. A tal proposito dichiariamo di non avere in corso alcun altro incarico di Brokeraggio, oppure aver provveduto alla relativa disdetta e di non essere nel relativo periodo di preavviso. In attuazione del predetto incarico, su nostra richiesta o su Vostra iniziativa ci fornirete la consulenza riferita ad uno o pi\u00f9 contratti di assicurazioni che, ai sensi dell\u2019art. 119 ter del Cap, prevede la consegna di una raccomandazione personalizzata da consegnare unitamente alla proposta assicurativa. Vi impegnate a ricercare e proporci le soluzioni assicurative pi\u00f9 adatte alle nostre esigenze, monitorare ed aggiornare, se del caso, il nostro Programma assicurativo. Vi conferiamo, quindi, l&#8217;incarico di trattare per nostro conto le eventuali modifiche del contratto, nonch\u00e9 le nuove coperture assicurative che sar\u00e0 nostro interesse stipulare, in base alla identificazione ed analisi valutaria dei rischi su di noi gravanti, che effettuerete. Vi affidiamo, pertanto, la gestione tecnica ed amministrativa, ivi compreso l\u2019incasso e la rimessa dei premi relativi delle polizze in essere e futuri e mandato di rappresentarci nell&#8217;aggiornamento, riforma, rinnovazione e storno del contratto stesso e nella gestione e definizione degli eventuali sinistri (sia attivi sia passivi) e, all&#8217;occorrenza, nella indicazione di periti e di Legali di parte, che, se di nostro gradimento, nomineremo. Per l&#8217;effetto, curerete per nostro conto il perfezionamento dei titoli, la trasmissione dei premi ed ogni comunicazione, denuncia di sinistro, reclami, od altra notizia, in relazione ai contratti stessi, considerandosi il tutto come se fosse da noi effettuato. Ai fini assicurativi oggetto del presente incarico eleggiamo domicilio presso i Vostri uffici, impegnandoci ad informarVi immediatamente di qualunque iniziativa che le compagnie assicuratrici assumessero direttamente nei nostri confronti ed impegnandoci sin da ora ad a rendervi puntualmente disponibili, nel rispetto dei termini contrattualmente previsti, gli importi corrispondenti ai premi delle polizze da Voi intermediate nel nostro interesse e da noi accettate. Il presente incarico ha durata a tempo indeterminato, entrambe le parti potranno disdire il presente incarico con preavviso di 90 gg. rispetto alla scadenza annuale, a mezzo raccomandata A\/R e\/o PEC. Il presente incarico in ogni caso si intender\u00e0 privo di efficacia automaticamente con la disdetta del mandato da parte dell\u2019associazione AGEO contraente della convenzione. Il presente incarico non comporter\u00e0 onere alcuno a nostro carico per compensi o rimborsi spese a Vostro favore, dando Voi espressamente atto di nulla avere a pretendere al riguardo nei nostri confronti per le prestazioni rese, trovando esse remunerazione nelle provvigioni riconosciute all\u2019intermediario dagli assicuratori, secondo gli usi consolidati del mercato. La consulenza personalizzata da fornire ai sensi dell\u2019art. 119 ter potr\u00e0 dare origine ad uno specifico compenso, cos\u00ec come gli eventuali patti diversi sul tema delle remunerazioni.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_411-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"411\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">4 &#8211; Dichiarazioni del contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_411\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_411_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][411][]\" value=\"Preso atto che la Vostra Societ\u00e0 \u00e8 iscritta alla Sezione B del Registro Unico Intermediari di Assicurazione (D.Lgs.N. 209\/2005) al numero B000590700, con effetto immediato, Vi conferiamo incarico di Broker assicurativi e Vi affidiamo la gestione tecnica ed amministrativa della Polizza Convenzione AGEO - Responsabilit\u00e0 Civile Professionale ed amministrativa, Tutela Legale e Colpa Grave. Ci impegniamo a fornirVi tutta la documentazione utile (copie dei contratti assicurativi in essere, sinistri precedenti ecc.) ed il supporto necessario per l\u2019analisi e la gestione dei rischi (compilazione di questionari, disponibilit\u00e0 per sopralluoghi ecc.). Durante la vigenza del Vostro incarico ci impegniamo, altres\u00ec, a non contattare, direttamente od indirettamente, nessun altra organizzazione del settore assicurativo (intermediari assicurativi di cui all\u2019Art. 109 comma 2 del D.Lgs 209\/05, in particolare altri Broker, e\/o Direzioni e\/o Gerenze e\/o Rappresentanze di Compagnie di Assicurazioni), n\u00e9 a sottoporre e\/o far visionare le vostre soluzioni a tali soggetti, senza il Vostro preventivo consenso scritto, ed a segnalarVi eventuali contatti da parte di tali soggetti. A tal proposito dichiariamo di non avere in corso alcun altro incarico di Brokeraggio, oppure aver provveduto alla relativa disdetta e di non essere nel relativo periodo di preavviso. In attuazione del predetto incarico, su nostra richiesta o su Vostra iniziativa ci fornirete la consulenza riferita ad uno o pi\u00f9 contratti di assicurazioni che, ai sensi dell\u2019art. 119 ter del Cap, prevede la consegna di una raccomandazione personalizzata da consegnare unitamente alla proposta assicurativa. Vi impegnate a ricercare e proporci le soluzioni assicurative pi\u00f9 adatte alle nostre esigenze, monitorare ed aggiornare, se del caso, il nostro Programma assicurativo. Vi conferiamo, quindi, l&#039;incarico di trattare per nostro conto le eventuali modifiche del contratto, nonch\u00e9 le nuove coperture assicurative che sar\u00e0 nostro interesse stipulare, in base alla identificazione ed analisi valutaria dei rischi su di noi gravanti, che effettuerete. Vi affidiamo, pertanto, la gestione tecnica ed amministrativa, ivi compreso l\u2019incasso e la rimessa dei premi relativi delle polizze in essere e futuri e mandato di rappresentarci nell&#039;aggiornamento, riforma, rinnovazione e storno del contratto stesso e nella gestione e definizione degli eventuali sinistri (sia attivi sia passivi) e, all&#039;occorrenza, nella indicazione di periti e di Legali di parte, che, se di nostro gradimento, nomineremo. Per l&#039;effetto, curerete per nostro conto il perfezionamento dei titoli, la trasmissione dei premi ed ogni comunicazione, denuncia di sinistro, reclami, od altra notizia, in relazione ai contratti stessi, considerandosi il tutto come se fosse da noi effettuato. Ai fini assicurativi oggetto del presente incarico eleggiamo domicilio presso i Vostri uffici, impegnandoci ad informarVi immediatamente di qualunque iniziativa che le compagnie assicuratrici assumessero direttamente nei nostri confronti ed impegnandoci sin da ora ad a rendervi puntualmente disponibili, nel rispetto dei termini contrattualmente previsti, gli importi corrispondenti ai premi delle polizze da Voi intermediate nel nostro interesse e da noi accettate. Il presente incarico ha durata a tempo indeterminato, entrambe le parti potranno disdire il presente incarico con preavviso di 90 gg. rispetto alla scadenza annuale, a mezzo raccomandata A\/R e\/o PEC. Il presente incarico in ogni caso si intender\u00e0 privo di efficacia automaticamente con la disdetta del mandato da parte dell\u2019associazione AGEO contraente della convenzione. Il presente incarico non comporter\u00e0 onere alcuno a nostro carico per compensi o rimborsi spese a Vostro favore, dando Voi espressamente atto di nulla avere a pretendere al riguardo nei nostri confronti per le prestazioni rese, trovando esse remunerazione nelle provvigioni riconosciute all\u2019intermediario dagli assicuratori, secondo gli usi consolidati del mercato. La consulenza personalizzata da fornire ai sensi dell\u2019art. 119 ter potr\u00e0 dare origine ad uno specifico compenso, cos\u00ec come gli eventuali patti diversi sul tema delle remunerazioni.\" aria-errormessage=\"wpforms-1111-field_411_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_411_5\">Preso atto che la Vostra Societ\u00e0 \u00e8 iscritta alla Sezione B del Registro Unico Intermediari di Assicurazione (D.Lgs.N. 209\/2005) al numero B000590700, con effetto immediato, Vi conferiamo incarico di Broker assicurativi e Vi affidiamo la gestione tecnica ed amministrativa della Polizza Convenzione AGEO &#8211; Responsabilit\u00e0 Civile Professionale ed amministrativa, Tutela Legale e Colpa Grave. Ci impegniamo a fornirVi tutta la documentazione utile (copie dei contratti assicurativi in essere, sinistri precedenti ecc.) ed il supporto necessario per l\u2019analisi e la gestione dei rischi (compilazione di questionari, disponibilit\u00e0 per sopralluoghi ecc.). Durante la vigenza del Vostro incarico ci impegniamo, altres\u00ec, a non contattare, direttamente od indirettamente, nessun altra organizzazione del settore assicurativo (intermediari assicurativi di cui all\u2019Art. 109 comma 2 del D.Lgs 209\/05, in particolare altri Broker, e\/o Direzioni e\/o Gerenze e\/o Rappresentanze di Compagnie di Assicurazioni), n\u00e9 a sottoporre e\/o far visionare le vostre soluzioni a tali soggetti, senza il Vostro preventivo consenso scritto, ed a segnalarVi eventuali contatti da parte di tali soggetti. A tal proposito dichiariamo di non avere in corso alcun altro incarico di Brokeraggio, oppure aver provveduto alla relativa disdetta e di non essere nel relativo periodo di preavviso. In attuazione del predetto incarico, su nostra richiesta o su Vostra iniziativa ci fornirete la consulenza riferita ad uno o pi\u00f9 contratti di assicurazioni che, ai sensi dell\u2019art. 119 ter del Cap, prevede la consegna di una raccomandazione personalizzata da consegnare unitamente alla proposta assicurativa. Vi impegnate a ricercare e proporci le soluzioni assicurative pi\u00f9 adatte alle nostre esigenze, monitorare ed aggiornare, se del caso, il nostro Programma assicurativo. Vi conferiamo, quindi, l&#8217;incarico di trattare per nostro conto le eventuali modifiche del contratto, nonch\u00e9 le nuove coperture assicurative che sar\u00e0 nostro interesse stipulare, in base alla identificazione ed analisi valutaria dei rischi su di noi gravanti, che effettuerete. Vi affidiamo, pertanto, la gestione tecnica ed amministrativa, ivi compreso l\u2019incasso e la rimessa dei premi relativi delle polizze in essere e futuri e mandato di rappresentarci nell&#8217;aggiornamento, riforma, rinnovazione e storno del contratto stesso e nella gestione e definizione degli eventuali sinistri (sia attivi sia passivi) e, all&#8217;occorrenza, nella indicazione di periti e di Legali di parte, che, se di nostro gradimento, nomineremo. Per l&#8217;effetto, curerete per nostro conto il perfezionamento dei titoli, la trasmissione dei premi ed ogni comunicazione, denuncia di sinistro, reclami, od altra notizia, in relazione ai contratti stessi, considerandosi il tutto come se fosse da noi effettuato. Ai fini assicurativi oggetto del presente incarico eleggiamo domicilio presso i Vostri uffici, impegnandoci ad informarVi immediatamente di qualunque iniziativa che le compagnie assicuratrici assumessero direttamente nei nostri confronti ed impegnandoci sin da ora ad a rendervi puntualmente disponibili, nel rispetto dei termini contrattualmente previsti, gli importi corrispondenti ai premi delle polizze da Voi intermediate nel nostro interesse e da noi accettate. Il presente incarico ha durata a tempo indeterminato, entrambe le parti potranno disdire il presente incarico con preavviso di 90 gg. rispetto alla scadenza annuale, a mezzo raccomandata A\/R e\/o PEC. Il presente incarico in ogni caso si intender\u00e0 privo di efficacia automaticamente con la disdetta del mandato da parte dell\u2019associazione AGEO contraente della convenzione. Il presente incarico non comporter\u00e0 onere alcuno a nostro carico per compensi o rimborsi spese a Vostro favore, dando Voi espressamente atto di nulla avere a pretendere al riguardo nei nostri confronti per le prestazioni rese, trovando esse remunerazione nelle provvigioni riconosciute all\u2019intermediario dagli assicuratori, secondo gli usi consolidati del mercato. La consulenza personalizzata da fornire ai sensi dell\u2019art. 119 ter potr\u00e0 dare origine ad uno specifico compenso, cos\u00ec come gli eventuali patti diversi sul tema delle remunerazioni.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_273-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"273\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">5 &#8211; Dichiarazioni del Contraente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_273\" class=\"wpforms-field-required\" data-choice-limit=\"3\"><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1111-field_273_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][273][]\" value=\"Ad integrazione delle informazioni fornite nel DIP Danni si prende atto che, qualora il contratto sia stato promosso o collocato a distanza (c.d. vendita a distanza), il Contraente ha 14 (quattordici) giorni di tempo per esercitare il diritto di Recesso per ripensamento. Tale termine decorre dalla data di conclusione del contratto di Assicurazione. La volont\u00e0 di recedere dovr\u00e0 essere manifestata attraverso comunicazione scritta a mezzo lettera raccomandata A\/R (o mezzi legalmente equivalenti quali PEC o Raccomandata a mano), inviata all\u2019Intermediario incaricato o alla Societ\u00e0.\" aria-errormessage=\"wpforms-1111-field_273_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_273_5\">Ad integrazione delle informazioni fornite nel DIP Danni si prende atto che, qualora il contratto sia stato promosso o collocato a distanza (c.d. vendita a distanza), il Contraente ha 14 (quattordici) giorni di tempo per esercitare il diritto di Recesso per ripensamento. Tale termine decorre dalla data di conclusione del contratto di Assicurazione. La volont\u00e0 di recedere dovr\u00e0 essere manifestata attraverso comunicazione scritta a mezzo lettera raccomandata A\/R (o mezzi legalmente equivalenti quali PEC o Raccomandata a mano), inviata all\u2019Intermediario incaricato o alla Societ\u00e0.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_143-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"143\"><div id=\"wpforms-1111-field_143\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_143-error\"><h4><span style=\"color:#db4b95\"><strong>Informativa trattamento dati personali ai sensi del Regolamento UE 2016\/679 del Parlamento Europeo e del consiglio del 27 aprile 2016<\/strong><\/span><\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_164-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"164\" style=\"display:none;\"><div id=\"wpforms-1111-field_164\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_164-error\"><p><span style=\"color:#000000\">Le chiediamo di esprimere il consenso per il trattamento dei Suoi dati, anche di natura sensibile, e per la comunicazione alle categorie di soggetti indicati ai commi A e B del punto n. 5 della \u201cInformativa trattamento dati personali ai sensi del Regolamento UE 2016\/679 del parlamento Europeo e del Consiglio del 27 aprile 2016\u201d e per le finalit\u00e0 di cui alle lettere a), b) e c) del punto n. 2. Tale consenso \u00e8 obbligatorio per la prosecuzione del rapporto, l\u2019eventuale rifiuto impedirebbe di soddisfare la ricerca di eventuali ed adeguati contratti assicurativi; impedirebbe di soddisfare i contratti eventualmente gi\u00e0 in essere e la fornitura dei servizi offerti da GI.R.VA. INTERNATIONAL BROKER S.r.l.. La revoca del consenso successiva alla richiesta di servizi o alla sottoscrizione del contratto potrebbe non interrompere il trattamento dei dati personali gi\u00e0 acquisiti per gli adempimenti contrattuali e i relativi adempimenti legali, ma porterebbe al blocco degli adempimenti non ancora compiuti e non legalmente obbligatori.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_412-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"412\" style=\"display:none;\"><div id=\"wpforms-1111-field_412\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_412-error\"><p><span style=\"color:#000000\">Le chiediamo di esprimere il consenso per il trattamento dei Suoi dati, anche di natura sensibile, e per la comunicazione alle categorie di soggetti indicati ai commi A e B del punto n. 5 della \u201cInformativa trattamento dati personali ai sensi del Regolamento UE 2016\/679 del parlamento Europeo e del Consiglio del 27 aprile 2016\u201d e per le finalit\u00e0 di cui alle lettere a), b) e c) del punto n. 2. Tale consenso \u00e8 obbligatorio per la prosecuzione del rapporto, l\u2019eventuale rifiuto impedirebbe di soddisfare la ricerca di eventuali ed adeguati contratti assicurativi; impedirebbe di soddisfare i contratti eventualmente gi\u00e0 in essere e la fornitura dei servizi offerti da CVA INSURANCE BROKER S.r.l.. La revoca del consenso successiva alla richiesta di servizi o alla sottoscrizione del contratto potrebbe non interrompere il trattamento dei dati personali gi\u00e0 acquisiti per gli adempimenti contrattuali e i relativi adempimenti legali, ma porterebbe al blocco degli adempimenti non ancora compiuti e non legalmente obbligatori.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_156-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"156\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Consenso Privacy per la comunicazione alle categorie di soggetti indicati ai commi A e B del punto n. 5 della \u201cInformativa trattamento dati personali ai sensi del Regolamento UE 2016\/679 del parlamento Europeo e del Consiglio del 27 aprile 2016\u201d e per le finalit\u00e0 di cui alle lettere a), b) e c) del punto n. 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_156\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_156_2\" name=\"wpforms[fields][156]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_156_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_156_2\">SI<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_156_1\" name=\"wpforms[fields][156]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_156_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_156_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_160-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"160\" style=\"display:none;\"><div id=\"wpforms-1111-field_160\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_160-error\"><p><span style=\"color:#ff0000\"><strong>Tale consenso \u00e8 obbligatorio per la prosecuzione del rapporto, l\u2019eventuale rifiuto impedirebbe di soddisfare la ricerca di eventuali ed adeguati contratti assicurativi; impedirebbe di soddisfare i contratti eventualmente gi\u00e0 in essere e la fornitura dei servizi offerti.<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_158-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"158\" style=\"display:none;\"><div id=\"wpforms-1111-field_158\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_158-error\"><p><span style=\"color:#000000\">Le chiediamo, inoltre, di esprimere il consenso per il trattamento dei Suoi dati, per le comunicazioni commerciali e per la comunicazione e diffusione alle categorie di soggetti indicati alla lett. C del punto n. 5 e per le finalit\u00e0 di cui alla lett. d) del punto n. 2, anche attraverso l\u2019utilizzo di mezzi telematici, quali la Sua e-mail ed il Suo fax. Tale consenso \u00e8 facoltativo e non impedisce la prosecuzione del rapporto contrattuale e la fornitura dei servizi offerti da GI.R.VA. INTERNATIONAL BROKER S.r.l.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_413-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"413\" style=\"display:none;\"><div id=\"wpforms-1111-field_413\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_413-error\"><p><span style=\"color:#000000\">Le chiediamo, inoltre, di esprimere il consenso per il trattamento dei Suoi dati, per le comunicazioni commerciali e per la comunicazione e diffusione alle categorie di soggetti indicati alla lett. C del punto n. 5 e per le finalit\u00e0 di cui alla lett. d) del punto n. 2, anche attraverso l\u2019utilizzo di mezzi telematici, quali la Sua e-mail ed il Suo fax. Tale consenso \u00e8 facoltativo e non impedisce la prosecuzione del rapporto contrattuale e la fornitura dei servizi offerti da CVA INSURANCE BROKER S.r.l..<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_159-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"159\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Consenso Privacy per la comunicazione e diffusione alle categorie di soggetti indicati alla lett. C del punto n. 5 e per le finalit\u00e0 di cui alla lett. d) del punto n. 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1111-field_159\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_159_2\" name=\"wpforms[fields][159]\" value=\"SI\" aria-errormessage=\"wpforms-1111-field_159_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_159_2\">SI<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1111-field_159_1\" name=\"wpforms[fields][159]\" value=\"NO\" aria-errormessage=\"wpforms-1111-field_159_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1111-field_159_1\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1111-field_84-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"84\"><div id=\"wpforms-1111-field_84\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_84-error\"><h3><span style=\"color:#db4b95\"><strong>Caricamento allegati<\/strong><\/span><\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_28-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_28\">Upload Documento d&#039;identit\u00e0 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"28\"\n\t\tdata-form-id=\"1111\"\n\t\tdata-input-name=\"wpforms_1111_28\"\n\t\tdata-extensions=\"pdf,jpg\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"15360000\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\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-1111-field_28\"\n\t\tname=\"wpforms_1111_28\" required\t\tvalue=\"\">\n<div id=\"wpforms-1111-field_28-description\" class=\"wpforms-field-description\">Caricare copia di un documento d&#8217;identit\u00e0 in corso di validit\u00e0<\/div><\/div><div id=\"wpforms-1111-field_35-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1111-field_35\">Firma <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1111-field_35\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][35]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-1111-field_35-error\" aria-describedby=\"wpforms-1111-field_35-description\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1111-field_35-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Cancella la firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Cancella la firma<\/div>\n\t\t\t<\/div><\/div><div id=\"wpforms-1111-field_35-description\" class=\"wpforms-field-description\">Utilizzare il mouse o il touch per apporre la propria firma.<\/div><\/div><div id=\"wpforms-1111-field_256-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"256\" style=\"display:none;\"><div id=\"wpforms-1111-field_256\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1111-field_256-error\"><p><span style=\"color:#ff0000\"><strong>AVVERTENZA:<\/strong><\/span><br \/>\n<span style=\"color:#ff0000\"><strong>Si precisa che in presenza di Sinistri pregressi, negli ultimi 5 (cinque) anni, la Compagnia si riserva di effettuare una quotazione ad hoc prevedendo una maggiorazione del Premio.<\/strong><\/span><\/p>\n<p><span style=\"color:#ff0000\"><strong>Per proseguire con la sottoscrizione della polizza la preghiamo di contattare i nostri consulenti al numero 02 25542100.<\/strong><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1111-field_6-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-fieldtotale wpforms-field-medium\" data-field-type=\"payment-total\" data-field-id=\"6\" aria-live=\"polite\" aria-atomic=\"true\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Importo da pagare<\/label><div class=\"wpforms-payment-total\" style=\"\">0,00 &euro;<\/div><input type=\"hidden\" id=\"wpforms-1111-field_6\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][6]\" value=\"0\"><\/div><div id=\"wpforms-1111-field_403-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"403\"><input type=\"hidden\" id=\"wpforms-1111-field_403\" name=\"wpforms[fields][403]\" value=\"Proposta n. LlgOAhH9csRoErFp-05092026\"><\/div><div id=\"wpforms-1111-field_112-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"112\"><input type=\"hidden\" id=\"wpforms-1111-field_112\" name=\"wpforms[fields][112]\" value=\"05\/09\/2026\"><\/div><div id=\"wpforms-1111-field_117-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"117\"><input type=\"hidden\" id=\"wpforms-1111-field_117\" name=\"wpforms[fields][117]\" value=\"Milano\"><\/div><div id=\"wpforms-1111-field_288-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"288\"><input type=\"hidden\" id=\"wpforms-1111-field_288\" name=\"wpforms[fields][288]\" value=\"AmTrust Assicurazioni Spa\"><\/div><div id=\"wpforms-1111-field_289-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"289\"><input type=\"hidden\" id=\"wpforms-1111-field_289\" name=\"wpforms[fields][289]\" value=\"AmTrust Convenzione AGEO\"><\/div><div id=\"wpforms-1111-field_406-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"406\"><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=\"6\" data-formid=\"1111\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Precedente<\/button><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"1111\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages\/1141\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1111\" class=\"wpforms-submit\" data-alt-text=\"Invio in corso...\" data-submit-text=\"SALVA PROPOSTA\" aria-live=\"assertive\" value=\"wpforms-submit\">SALVA PROPOSTA<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Caricamento\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":1143,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1141","page","type-page","status-publish","has-post-thumbnail","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages\/1141","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/comments?post=1141"}],"version-history":[{"count":2,"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages\/1141\/revisions"}],"predecessor-version":[{"id":1272,"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/pages\/1141\/revisions\/1272"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/media\/1143"}],"wp:attachment":[{"href":"https:\/\/www.girva.it\/wp1\/ginecologoprotetto\/wp-json\/wp\/v2\/media?parent=1141"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}