{"id":13353,"date":"2017-11-10T12:16:58","date_gmt":"2017-11-10T10:16:58","guid":{"rendered":"https:\/\/www.incar.fi\/electronic-accident-declaration-2\/"},"modified":"2025-09-28T20:53:50","modified_gmt":"2025-09-28T17:53:50","slug":"accident-declaration","status":"publish","type":"page","link":"https:\/\/www.incar.fi\/en\/accident-declaration\/","title":{"rendered":"Electronic accident declaration"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_65' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_65' class='gf_confirmation_green_gradient' action='\/en\/wp-json\/wp\/v2\/pages\/13353#gf_65' data-formid='65' novalidate><input type=\"hidden\" name=\"gpuid_existing_value_132\" id=\"gpuid_existing_value_132\" value=\"5472f19bf6c1c2da2891bf39e4d3f236\" \/><input type=\"hidden\" value=\"0\" name=\"gpps_page_progression_65\" \/>\n        <div id='gf_progressbar_wrapper_65' class='gf_progressbar_wrapper' data-start-at-zero='1'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>10<\/span><span class='gf_step_page_name'> &#8211; Basic information<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blues' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blues percentbar_0' style='width:0%;'><span>0%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_65_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_65' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_421\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.incar.fi\/media\/2024\/09\/ayvens-nffleet-logo.jpg\"><\/div><div id=\"field_65_244\" class=\"gfield gfield--type-html gfield--input-type-html gf_alert_blue gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Welcome to InCar Oy&#8217;s Accident Declaration Service!<\/h3>\n<p>With this service, you can provide all the information required by insurance companies regarding your traffic accident, both for yourself and for other parties involved.<\/p>\n\n<p>If you are not at fault for the damage, you may be entitled to compensation for the costs of using a replacement car. In addition to the damage details, you can also complete the car\u2019s statement of need for use\u2014that is, apply for compensation for using a replacement car in a traffic accident case. <\/p><\/div><div id=\"field_65_132\" class=\"gfield gfield--type-uid gfield--input-type-uid field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_65_132'>Form ID<\/label><div class='ginput_container ginput_container_hidden'><input name='input_132' id='input_65_132' type='hidden' value=''  \/><\/div><\/div><fieldset id=\"field_65_412\" class=\"gfield gfield--type-name gfield--input-type-name copy-412-to-1 copy-412-to-275 gwcopy gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Reporter\u2019s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_412'>\n                            \n                            <span id='input_65_412_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_412.3' id='input_65_412_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_65_412_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_412_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_412.6' id='input_65_412_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_65_412_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_413\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half copy-413-to-7 copy-413-to-122 gwcopy gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_413'>Reporter\u2019s phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_413' id='input_65_413' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><div id=\"field_65_414\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half copy-414-to-3 copy-414-to-123 copy-414-to-258 gwcopy gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_414'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_414' id='input_65_414' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_65_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle owner and leasing company<\/h3><\/div><fieldset id=\"field_65_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle Owner<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_26'>\n\t\t\t<div class='gchoice gchoice_65_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Ayvens (ent. ALD)'  id='choice_65_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_26_0' id='label_65_26_0' class='gform-field-label gform-field-label--type-inline'>Ayvens (formerly ALD)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='NF Fleet Oy'  id='choice_65_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_26_1' id='label_65_26_1' class='gform-field-label gform-field-label--type-inline'>NF Fleet Oy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='jokin muu omistaja'  id='choice_65_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_26_2' id='label_65_26_2' class='gform-field-label gform-field-label--type-inline'>Some other owner<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_440\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >This damage report is intended for Ayvens and NF Fleet leasing cars. If the vehicle is not owned by these leasing companies, please <strong><a href=\"https:\/\/www.incar.fi\/en\/electronic-accident-declaration\/\">fill in the damage report here<\/a><\/strong>.  <\/div><div id=\"field_65_408\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_408'>Owner details (Ayvens)<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_408' id='input_65_408' type='text' value='Axus Finland Oy, Business ID: 0643850-5, tel. 010 404 2400' class='large'  aria-describedby=\"gfield_description_65_408\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_408'>Details prefilled based on your selection.<\/div><\/div><div id=\"field_65_409\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_409'>Owner details (NF Fleet)<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_409' id='input_65_409' type='text' value='NF Fleet Oy, Business ID: 2006935-5, tel. 010 404 2400' class='large'  aria-describedby=\"gfield_description_65_409\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_409'>Details prefilled based on your selection.<\/div><\/div><div id=\"field_65_415\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half copy-415-to-33 gwcopy gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_415'>Vehicle registration number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_415' id='input_65_415' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_415\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_415'>Enter the license plate in the format: ABC-123.<\/div><\/div><fieldset id=\"field_65_444\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half other-registration-checkbox field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Other registration number<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_444'><div class='gchoice gchoice_65_444_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_444.1' type='checkbox'  value='Muu rekisteritunnus'  id='choice_65_444_1'   aria-describedby=\"gfield_description_65_444\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_444_1' id='label_65_444_1' class='gform-field-label gform-field-label--type-inline'>Other registration number<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_444'>Select if the registration number is not in the format ABC-123.<\/div><\/fieldset><div id=\"field_65_445\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full copy-445-to-33 gwcopy gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_445'>Vehicle registration number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_445' id='input_65_445' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_416\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half copy-416-to-439 gwcopy gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_416'>Motor Liability Insurance Company<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_416' id='input_65_416' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_439\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_439'>Car Insurance Company<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_439' id='input_65_439' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><fieldset id=\"field_65_454\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vahingon aiheuttaja<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_454'>\n\t\t\t<div class='gchoice gchoice_65_454_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Olen syyt\u00f6n osapuoli liikennevahingossa. Vahingon aiheuttaja on tiedossa.'  id='choice_65_454_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_454_0' id='label_65_454_0' class='gform-field-label gform-field-label--type-inline'>Olen syyt\u00f6n osapuoli liikennevahingossa. Vahingon aiheuttaja on tiedossa.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_454_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Olen syyt\u00f6n osapuoli liikennevahingossa. Vahingon aiheuttaja ei ole tiedossa.'  id='choice_65_454_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_454_1' id='label_65_454_1' class='gform-field-label gform-field-label--type-inline'>Olen syyt\u00f6n osapuoli liikennevahingossa. Vahingon aiheuttaja ei ole tiedossa.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_454_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Olen itse vahingon aiheuttaja'  id='choice_65_454_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_454_2' id='label_65_454_2' class='gform-field-label gform-field-label--type-inline'>Olen itse vahingon aiheuttaja<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_435\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If you don\u2019t know your insurance company, please contact <strong><a href=\"https:\/\/www.ayvens.com\/fi-fi\/ota-yhteytta\/\" target=\"_blank\">Ayvens customer service<\/a><\/strong> directly.<\/div><div id=\"field_65_436\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If you don\u2019t know your insurance company, please contact <strong><a href=\"https:\/\/nffleet.fi\/nf-fleet\/yhteystiedot\/\" target=\"_blank\">NF Fleet customer service<\/a><\/strong> directly.<\/div><div id=\"field_65_401\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Validity of the leasing agreement<\/h3><\/div><fieldset id=\"field_65_406\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Status of the leasing agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_406'>\n\t\t\t<div class='gchoice gchoice_65_406_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='Leasingsopimus on voimassa'  id='choice_65_406_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_65_406\"   \/>\n\t\t\t\t\t<label for='choice_65_406_0' id='label_65_406_0' class='gform-field-label gform-field-label--type-inline'>Leasing agreement is valid<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_406_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='Leasingsopimus on p\u00e4\u00e4ttynyt'  id='choice_65_406_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_406_1' id='label_65_406_1' class='gform-field-label gform-field-label--type-inline'>Leasing agreement has ended<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_406'>Is the agreement valid or terminated at the time of submitting the damage report for the vehicle concerned?<\/div><\/fieldset><div id=\"field_65_394\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle repair or return<\/h3><\/div><fieldset id=\"field_65_395\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle repair or return<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_65_395'>Vehicle repair always starts with a Damage inspection. The Damage inspection is carried out at an InCar repair shop or, for minor damage, using the InCar Camera. If your car is already at a repair shop, choose \u2018Damage inspection booked or completed\u2019.  <\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_395'>\n\t\t\t<div class='gchoice gchoice_65_395_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Damage inspection booked or completed'  id='choice_65_395_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_65_395\"   \/>\n\t\t\t\t\t<label for='choice_65_395_0' id='label_65_395_0' class='gform-field-label gform-field-label--type-inline'>Damage inspection booked or completed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_395_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Damage inspection with InCar camera'  id='choice_65_395_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_395_1' id='label_65_395_1' class='gform-field-label gform-field-label--type-inline'>Damage inspection with InCar camera<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_395_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='I&#039;ll book the damage inspection time myself'  id='choice_65_395_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_395_2' id='label_65_395_2' class='gform-field-label gform-field-label--type-inline'>I&#8217;ll book the damage inspection time myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_395_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Car already returned'  id='choice_65_395_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_395_3' id='label_65_395_3' class='gform-field-label gform-field-label--type-inline'>Car already returned<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_395_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Return inspection time booked or return agreed'  id='choice_65_395_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_395_4' id='label_65_395_4' class='gform-field-label gform-field-label--type-inline'>Return inspection time booked or return agreed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_395_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='No damage inspection time, I want InCar to contact me'  id='choice_65_395_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_395_5' id='label_65_395_5' class='gform-field-label gform-field-label--type-inline'>No damage inspection time, I want InCar to contact me<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_438\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle repair or return<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_65_438'>Vehicle repair always starts with a Damage inspection. The Damage inspection can be carried out at an InCar, Veho or Bilia repair shop, or for minor damage using the InCar Camera. If your car is already at a repair shop, choose \u2018Damage inspection booked or completed\u2019.  <\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_438'>\n\t\t\t<div class='gchoice gchoice_65_438_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Damage inspection booked or completed'  id='choice_65_438_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_65_438\"   \/>\n\t\t\t\t\t<label for='choice_65_438_0' id='label_65_438_0' class='gform-field-label gform-field-label--type-inline'>Damage inspection booked or completed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_438_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Damage inspection with InCar camera'  id='choice_65_438_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_438_1' id='label_65_438_1' class='gform-field-label gform-field-label--type-inline'>Damage inspection with InCar camera<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_438_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='I&#039;ll book the damage inspection time myself'  id='choice_65_438_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_438_2' id='label_65_438_2' class='gform-field-label gform-field-label--type-inline'>I&#8217;ll book the damage inspection time myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_438_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Car already returned'  id='choice_65_438_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_438_3' id='label_65_438_3' class='gform-field-label gform-field-label--type-inline'>Car already returned<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_438_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Return inspection time booked or return agreed'  id='choice_65_438_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_438_4' id='label_65_438_4' class='gform-field-label gform-field-label--type-inline'>Return inspection time booked or return agreed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_438_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='No damage inspection time, I want InCar to contact me'  id='choice_65_438_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_438_5' id='label_65_438_5' class='gform-field-label gform-field-label--type-inline'>No damage inspection time, I want InCar to contact me<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_434\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>We will carry out the Damage inspection based on the photos sent via the InCar Camera and prepare a repair plan, which will be delivered to your insurance company for processing the damage report. <\/p>\n<p><strong>You will receive a link to the InCar Camera by text message to the phone number you provide on this page in the \u201cReporter\u2019s phone\u201d field. Enter the number in the format 0401234567\u2014without country code, spaces, or other characters. <\/strong><\/p>\n<p>Photographing the damage is easy and quick\u2014you save time and handle the matter without visiting a repair shop. You can use the InCar Camera every day of the week, regardless of time and our locations\u2019 opening hours. <\/p>\n<p>Please note that ordering the damage camera link does not oblige you to send photos, and InCar Oy does not commit to giving a final cost estimate based on photos alone.<\/p><\/div><div id=\"field_65_437\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You will receive a link for booking an appointment in the confirmation message after submitting the damage report.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_65_417' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_2' class='gform_page' data-js='page-field-id-417' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_418\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Type of report<\/h3><\/div><div id=\"field_65_441\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Select Vehicle damage in all cases other than glass-only damage. You can also submit only the statement of need for use. <\/div><fieldset id=\"field_65_400\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Select the type of report<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_400'>\n\t\t\t<div class='gchoice gchoice_65_400_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_400' type='radio' value='Vehicle damage'  id='choice_65_400_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_400_0' id='label_65_400_0' class='gform-field-label gform-field-label--type-inline'>Vehicle damage<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_400_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_400' type='radio' value='Windshield Damage Only'  id='choice_65_400_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_400_1' id='label_65_400_1' class='gform-field-label gform-field-label--type-inline'>Windshield Damage Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_400_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_400' type='radio' value='Usage needs report'  id='choice_65_400_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_400_2' id='label_65_400_2' class='gform-field-label gform-field-label--type-inline'>Usage needs report<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_241\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Number of vehicles involved<\/h3><\/div><div id=\"field_65_442\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >First, state the number of vehicles involved in the traffic accident.<\/div><fieldset id=\"field_65_243\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicles involved in the accident?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_243'>\n\t\t\t<div class='gchoice gchoice_65_243_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_243' type='radio' value='1'  id='choice_65_243_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_65_243\"   \/>\n\t\t\t\t\t<label for='choice_65_243_0' id='label_65_243_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_243_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_243' type='radio' value='2'  id='choice_65_243_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_243_1' id='label_65_243_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_243_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_243' type='radio' value='3'  id='choice_65_243_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_243_2' id='label_65_243_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_243_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_243' type='radio' value='4'  id='choice_65_243_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_243_3' id='label_65_243_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_243'>Select the number of vehicles involved. Then fill in the details of your own and the other vehicles according to the number you selected, using the form\u2019s <strong>Next<\/strong> and <strong>Previous<\/strong> buttons. <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_255' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_255' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_3' class='gform_page' data-js='page-field-id-255' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Driver (Own vehicle)<\/h3><\/div><fieldset id=\"field_65_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Driver\u2019s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_1'>\n                            \n                            <span id='input_65_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_65_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_65_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_2'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_65_2' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_2\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_2'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_7'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_65_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><div id=\"field_65_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_3'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_65_3' type='email' value='' class='large'     aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><fieldset id=\"field_65_4\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_65_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_65_4_1' value=''    aria-required='false'   autocomplete=\"street-address\" \/>\n                                        <label for='input_65_4_1' id='input_65_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_65_4_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_65_4_3' id='input_65_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_4.4' id='input_65_4_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_65_4_5' value=''    aria-required='false'   autocomplete=\"postal-code\" \/>\n                                    <label for='input_65_4_5' id='input_65_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_65_4_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_65_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Driver&#039;s License<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_14'>\n\t\t\t<div class='gchoice gchoice_65_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_65_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_14_0' id='label_65_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_65_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_14_1' id='label_65_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_426\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_426'>Year of Issue<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_426' id='input_65_426' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_17\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_17'>Class<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_65_17' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='A1' >A1<\/option><option value='A' >A<\/option><option value='B' >B<\/option><option value='C1' >C1<\/option><option value='C' >C<\/option><option value='D1' >D1<\/option><option value='D' >D<\/option><option value='BE' >BE<\/option><option value='C1E' >C1E<\/option><option value='CE' >CE<\/option><option value='D1E' >D1E<\/option><option value='DE' >DE<\/option><option value='M' >M<\/option><option value='T' >T<\/option><\/select><\/div><\/div><div id=\"field_65_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Holder (Own vehicle)<\/h3><\/div><fieldset id=\"field_65_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is the driver the vehicle&#039;s holder?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_25'>\n\t\t\t<div class='gchoice gchoice_65_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_65_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_25_0' id='label_65_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_65_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_25_1' id='label_65_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_402\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The holder is the vehicle&#039;s<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_402'>\n\t\t\t<div class='gchoice gchoice_65_402_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_402' type='radio' value='1st holder'  id='choice_65_402_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_402_0' id='label_65_402_0' class='gform-field-label gform-field-label--type-inline'>1st holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_402_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_402' type='radio' value='2nd holder'  id='choice_65_402_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_402_1' id='label_65_402_1' class='gform-field-label gform-field-label--type-inline'>2nd holder<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_24'>Holder&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_65_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_20'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_65_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_21'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_65_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_22\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_22'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_22' id='input_65_22' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_23\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_23' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_23_1_container' >\n                                        <input type='text' name='input_23.1' id='input_65_23_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_23_1' id='input_65_23_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_23_3_container' >\n                                    <input type='text' name='input_23.3' id='input_65_23_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_23_3' id='input_65_23_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_23.4' id='input_65_23_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_23_5_container' >\n                                    <input type='text' name='input_23.5' id='input_65_23_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_23_5' id='input_65_23_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_23.6' id='input_65_23_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle details (Own vehicle)<\/h3><\/div><div id=\"field_65_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_33'>Registration number (Own vehicle)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_65_33' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_33\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_33'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_34\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_34'>Type<\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_65_34' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Passenger Car' >Passenger Car<\/option><option value='Van' >Van<\/option><option value='Light Truck' >Light Truck<\/option><option value='Truck' >Truck<\/option><option value='Minibus' >Minibus<\/option><option value='Motorhome' >Motorhome<\/option><option value='Motorcycle' >Motorcycle<\/option><option value='Snowmobile' >Snowmobile<\/option><option value='Moped Car' >Moped Car<\/option><\/select><\/div><\/div><div id=\"field_65_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_35'>Make and model<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_65_35' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_35\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_35'>e.g., Volvo V40 <\/div><\/div><div id=\"field_65_429\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_429'>First Year of Use<\/label><div class='ginput_container ginput_container_select'><select name='input_429' id='input_65_429' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><fieldset id=\"field_65_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Company Car<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_40'>\n\t\t\t<div class='gchoice gchoice_65_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Yes'  id='choice_65_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_40_0' id='label_65_40_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='No'  id='choice_65_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_40_1' id='label_65_40_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_127\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle VAT deductible<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_127'>\n\t\t\t<div class='gchoice gchoice_65_127_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='Yes'  id='choice_65_127_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_127_0' id='label_65_127_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_127_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='No'  id='choice_65_127_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_127_1' id='label_65_127_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div data-fieldId=\"127\" class=\"spacer gfield\" style=\"grid-column: span 6;\" data-groupId=\"2804cd41\"><\/div><div id=\"field_65_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Trailer details<\/h3><\/div><fieldset id=\"field_65_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a trailer used?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_42'>\n\t\t\t<div class='gchoice gchoice_65_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Yes'  id='choice_65_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_42_0' id='label_65_42_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='No' checked='checked' id='choice_65_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_42_1' id='label_65_42_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_43'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_65_43' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_44\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_44'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_44' id='input_65_44' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_45'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_65_45' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_4' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_389\" class=\"gfield gfield--type-html gfield--input-type-html gf_alert_blue gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Please fill in at least the driver&#8217;s name and vehicle registration number for other participants. Other fields are not mandatory, but we recommend filling in all available information at the time of completing the damage report. <\/p><\/div><div id=\"field_65_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Driver (Other Vehicle #1)<\/h3><\/div><fieldset id=\"field_65_48\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Driver\u2019s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_48'>\n                            \n                            <span id='input_65_48_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_48.3' id='input_65_48_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_48_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_48_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_48.6' id='input_65_48_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_48_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_49'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_65_49' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_49\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_49'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_50\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_50'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_50' id='input_65_50' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_51\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_51'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_51' id='input_65_51' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_52\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_65_52' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_52_1_container' >\n                                        <input type='text' name='input_52.1' id='input_65_52_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_52_1' id='input_65_52_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_52_3_container' >\n                                    <input type='text' name='input_52.3' id='input_65_52_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_52_3' id='input_65_52_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_52.4' id='input_65_52_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_52_5_container' >\n                                    <input type='text' name='input_52.5' id='input_65_52_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_52_5' id='input_65_52_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_52.6' id='input_65_52_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_65_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Driver&#039;s License<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_53'>\n\t\t\t<div class='gchoice gchoice_65_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_65_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_53_0' id='label_65_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_65_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_53_1' id='label_65_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_425\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_425'>Year of Issue<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_425' id='input_65_425' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_55\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_55'>Class<\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_65_55' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='A1' >A1<\/option><option value='A' >A<\/option><option value='B' >B<\/option><option value='C1' >C1<\/option><option value='C' >C<\/option><option value='D1' >D1<\/option><option value='D' >D<\/option><option value='BE' >BE<\/option><option value='C1E' >C1E<\/option><option value='CE' >CE<\/option><option value='D1E' >D1E<\/option><option value='DE' >DE<\/option><option value='M' >M<\/option><option value='T' >T<\/option><\/select><\/div><\/div><div id=\"field_65_56\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Holder (Other Vehicle #1)<\/h3><\/div><fieldset id=\"field_65_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is the driver the vehicle&#039;s holder?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_57'>\n\t\t\t<div class='gchoice gchoice_65_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_65_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_57_0' id='label_65_57_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_65_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_57_1' id='label_65_57_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_403\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The holder is the vehicle&#039;s<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_403'>\n\t\t\t<div class='gchoice gchoice_65_403_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_403' type='radio' value='1st holder'  id='choice_65_403_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_403_0' id='label_65_403_0' class='gform-field-label gform-field-label--type-inline'>1st holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_403_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_403' type='radio' value='2nd holder'  id='choice_65_403_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_403_1' id='label_65_403_1' class='gform-field-label gform-field-label--type-inline'>2nd holder<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_58'>Holder&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_65_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_59'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_65_59' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_60\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_60'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_60' id='input_65_60' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_61\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_61'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_61' id='input_65_61' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_62\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_62' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_62_1_container' >\n                                        <input type='text' name='input_62.1' id='input_65_62_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_62_1' id='input_65_62_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_62_3_container' >\n                                    <input type='text' name='input_62.3' id='input_65_62_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_62_3' id='input_65_62_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_62.4' id='input_65_62_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_62_5_container' >\n                                    <input type='text' name='input_62.5' id='input_65_62_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_62_5' id='input_65_62_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_62.6' id='input_65_62_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Owner (Other Vehicle #1)<\/h3><\/div><fieldset id=\"field_65_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle Owner<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_64'>\n\t\t\t<div class='gchoice gchoice_65_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='is the same as the driver'  id='choice_65_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_64_0' id='label_65_64_0' class='gform-field-label gform-field-label--type-inline'>is the same as the driver<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='is the same as the holder'  id='choice_65_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_64_1' id='label_65_64_1' class='gform-field-label gform-field-label--type-inline'>is the same as the holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='is neither of the above'  id='choice_65_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_64_2' id='label_65_64_2' class='gform-field-label gform-field-label--type-inline'>is neither of the above<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_65'>Owner&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_65_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_66'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_65_66' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_67\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_67'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_67' id='input_65_67' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_68\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_68'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_68' id='input_65_68' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_65_69\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle Information (Other Vehicle #1)<\/h3><\/div><div id=\"field_65_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_70'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_65_70' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_70\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_70'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_71\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_71'>Type<\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_65_71' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Passenger Car' >Passenger Car<\/option><option value='Van' >Van<\/option><option value='Light Truck' >Light Truck<\/option><option value='Truck' >Truck<\/option><option value='Minibus' >Minibus<\/option><option value='Motorhome' >Motorhome<\/option><option value='Motorcycle' >Motorcycle<\/option><option value='Snowmobile' >Snowmobile<\/option><option value='Moped Car' >Moped Car<\/option><\/select><\/div><\/div><div id=\"field_65_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_72'>Make and model<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_65_72' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_72\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_72'>e.g., Volvo V40 <\/div><\/div><div id=\"field_65_430\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_430'>First Year of Use<\/label><div class='ginput_container ginput_container_select'><select name='input_430' id='input_65_430' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_74\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_74'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_65_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_75\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_75'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_75' id='input_65_75' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><fieldset id=\"field_65_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter gf_left_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Leased Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_76'>\n\t\t\t<div class='gchoice gchoice_65_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_65_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_76_0' id='label_65_76_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_65_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_76_1' id='label_65_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Company Car<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_77'>\n\t\t\t<div class='gchoice gchoice_65_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_65_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_77_0' id='label_65_77_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No'  id='choice_65_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_77_1' id='label_65_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_128\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_right_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle VAT deductible<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_128'>\n\t\t\t<div class='gchoice gchoice_65_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='Yes'  id='choice_65_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_128_0' id='label_65_128_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='No'  id='choice_65_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_128_1' id='label_65_128_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_78\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Trailer Information (Other Vehicle #1)<\/h3><\/div><fieldset id=\"field_65_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a trailer used?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_79'>\n\t\t\t<div class='gchoice gchoice_65_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_65_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_79_0' id='label_65_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No' checked='checked' id='choice_65_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_79_1' id='label_65_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_80'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_65_80' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_80\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_80'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_81\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_81'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_81' id='input_65_81' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_82\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_82'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_82' id='input_65_82' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_135' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_135' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_5' class='gform_page' data-js='page-field-id-135' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_390\" class=\"gfield gfield--type-html gfield--input-type-html gf_alert_blue gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Please fill in at least the driver&#8217;s name and vehicle registration number for other participants. Other fields are not mandatory, but we recommend filling in all available information at the time of completing the damage report. <\/p><\/div><div id=\"field_65_134\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Driver (Other Vehicle #2)<\/h3><\/div><fieldset id=\"field_65_141\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Driver\u2019s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_141'>\n                            \n                            <span id='input_65_141_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_141.3' id='input_65_141_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_141_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_141_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_141.6' id='input_65_141_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_141_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_143\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_143'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_65_143' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_143\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_143'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_145\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_145'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_145' id='input_65_145' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_147\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_147'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_147' id='input_65_147' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_149\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_149' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_149_1_container' >\n                                        <input type='text' name='input_149.1' id='input_65_149_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_149_1' id='input_65_149_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_149_3_container' >\n                                    <input type='text' name='input_149.3' id='input_65_149_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_149_3' id='input_65_149_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_149.4' id='input_65_149_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_149_5_container' >\n                                    <input type='text' name='input_149.5' id='input_65_149_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_149_5' id='input_65_149_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_149.6' id='input_65_149_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_65_151\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Driver&#039;s License<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_151'>\n\t\t\t<div class='gchoice gchoice_65_151_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='Yes'  id='choice_65_151_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_151_0' id='label_65_151_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_151_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='No'  id='choice_65_151_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_151_1' id='label_65_151_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_427\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_427'>Year of Issue<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_427' id='input_65_427' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_155\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_155'>Class<\/label><div class='ginput_container ginput_container_select'><select name='input_155' id='input_65_155' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='A1' >A1<\/option><option value='A' >A<\/option><option value='B' >B<\/option><option value='C1' >C1<\/option><option value='C' >C<\/option><option value='D1' >D1<\/option><option value='D' >D<\/option><option value='BE' >BE<\/option><option value='C1E' >C1E<\/option><option value='CE' >CE<\/option><option value='D1E' >D1E<\/option><option value='DE' >DE<\/option><option value='M' >M<\/option><option value='T' >T<\/option><\/select><\/div><\/div><div id=\"field_65_157\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Holder (Other Vehicle #2)<\/h3><\/div><fieldset id=\"field_65_159\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is the driver the vehicle&#039;s holder?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_159'>\n\t\t\t<div class='gchoice gchoice_65_159_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_159' type='radio' value='Yes'  id='choice_65_159_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_159_0' id='label_65_159_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_159_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_159' type='radio' value='No'  id='choice_65_159_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_159_1' id='label_65_159_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_404\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The holder is the vehicle&#039;s<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_404'>\n\t\t\t<div class='gchoice gchoice_65_404_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='1st holder'  id='choice_65_404_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_404_0' id='label_65_404_0' class='gform-field-label gform-field-label--type-inline'>1st holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_404_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='2nd holder'  id='choice_65_404_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_404_1' id='label_65_404_1' class='gform-field-label gform-field-label--type-inline'>2nd holder<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_160\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_160'>Holder&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_160' id='input_65_160' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_163\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_163'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_65_163' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_165\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_165'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_165' id='input_65_165' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_167\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_167'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_167' id='input_65_167' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_169\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_169' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_169_1_container' >\n                                        <input type='text' name='input_169.1' id='input_65_169_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_169_1' id='input_65_169_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_169_3_container' >\n                                    <input type='text' name='input_169.3' id='input_65_169_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_169_3' id='input_65_169_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_169.4' id='input_65_169_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_169_5_container' >\n                                    <input type='text' name='input_169.5' id='input_65_169_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_169_5' id='input_65_169_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_169.6' id='input_65_169_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_171\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Owner (Other Vehicle #2)<\/h3><\/div><fieldset id=\"field_65_173\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle Owner<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_173'>\n\t\t\t<div class='gchoice gchoice_65_173_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_173' type='radio' value='is the same as the driver'  id='choice_65_173_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_173_0' id='label_65_173_0' class='gform-field-label gform-field-label--type-inline'>is the same as the driver<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_173_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_173' type='radio' value='is the same as the holder'  id='choice_65_173_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_173_1' id='label_65_173_1' class='gform-field-label gform-field-label--type-inline'>is the same as the holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_173_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_173' type='radio' value='is neither of the above'  id='choice_65_173_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_173_2' id='label_65_173_2' class='gform-field-label gform-field-label--type-inline'>is neither of the above<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_175\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_175'>Owner&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_175' id='input_65_175' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_177\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_177'>Personal or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_177' id='input_65_177' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_179\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_179'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_179' id='input_65_179' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_181\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_181'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_181' id='input_65_181' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_65_183\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle Information (Other Vehicle #2)<\/h3><\/div><div id=\"field_65_185\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_185'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_185' id='input_65_185' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_185\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_185'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_187\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_187'>Type<\/label><div class='ginput_container ginput_container_select'><select name='input_187' id='input_65_187' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Passenger Car' >Passenger Car<\/option><option value='Van' >Van<\/option><option value='Light Truck' >Light Truck<\/option><option value='Truck' >Truck<\/option><option value='Minibus' >Minibus<\/option><option value='Motorhome' >Motorhome<\/option><option value='Motorcycle' >Motorcycle<\/option><option value='Snowmobile' >Snowmobile<\/option><option value='Moped Car' >Moped Car<\/option><\/select><\/div><\/div><div id=\"field_65_189\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_189'>Make and model<\/label><div class='ginput_container ginput_container_text'><input name='input_189' id='input_65_189' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_189\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_189'>e.g., Volvo V40 <\/div><\/div><div id=\"field_65_431\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_431'>First Year of Use<\/label><div class='ginput_container ginput_container_select'><select name='input_431' id='input_65_431' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_193\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_193'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_193' id='input_65_193' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_195\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_195'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_195' id='input_65_195' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><fieldset id=\"field_65_197\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_left_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Leased Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_197'>\n\t\t\t<div class='gchoice gchoice_65_197_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_197' type='radio' value='Yes'  id='choice_65_197_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_197_0' id='label_65_197_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_197_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_197' type='radio' value='No'  id='choice_65_197_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_197_1' id='label_65_197_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_199\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Company Car<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_199'>\n\t\t\t<div class='gchoice gchoice_65_199_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_199' type='radio' value='Yes'  id='choice_65_199_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_199_0' id='label_65_199_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_199_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_199' type='radio' value='No'  id='choice_65_199_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_199_1' id='label_65_199_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_201\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_right_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle VAT deductible<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_201'>\n\t\t\t<div class='gchoice gchoice_65_201_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_201' type='radio' value='Yes'  id='choice_65_201_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_201_0' id='label_65_201_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_201_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_201' type='radio' value='No'  id='choice_65_201_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_201_1' id='label_65_201_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_203\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Trailer Information (Other Vehicle #2)<\/h3><\/div><fieldset id=\"field_65_205\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a trailer used?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_205'>\n\t\t\t<div class='gchoice gchoice_65_205_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_205' type='radio' value='Yes'  id='choice_65_205_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_205_0' id='label_65_205_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_205_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_205' type='radio' value='No' checked='checked' id='choice_65_205_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_205_1' id='label_65_205_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_207\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_207'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_207' id='input_65_207' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_207\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_207'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_210\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_210'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_210' id='input_65_210' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_209\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_209'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_209' id='input_65_209' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_136' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_136' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_6' class='gform_page' data-js='page-field-id-136' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_391\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Please fill in at least the driver&#8217;s name and vehicle registration number for other participants. Other fields are not mandatory, but we recommend filling in all available information at the time of completing the damage report. <\/p><\/div><div id=\"field_65_137\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Driver (Other Vehicle #3)<\/h3><\/div><fieldset id=\"field_65_140\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Driver\u2019s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_140'>\n                            \n                            <span id='input_65_140_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_140.3' id='input_65_140_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_140_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_140_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_140.6' id='input_65_140_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_140_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_142\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_142'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_65_142' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_142\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_142'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_144\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_144'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_144' id='input_65_144' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_146\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_146'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_146' id='input_65_146' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_148\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_148' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_148_1_container' >\n                                        <input type='text' name='input_148.1' id='input_65_148_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_148_1' id='input_65_148_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_148_3_container' >\n                                    <input type='text' name='input_148.3' id='input_65_148_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_148_3' id='input_65_148_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_148.4' id='input_65_148_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_148_5_container' >\n                                    <input type='text' name='input_148.5' id='input_65_148_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_148_5' id='input_65_148_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_148.6' id='input_65_148_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_65_150\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Driver&#039;s License<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_150'>\n\t\t\t<div class='gchoice gchoice_65_150_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_150' type='radio' value='Yes'  id='choice_65_150_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_150_0' id='label_65_150_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_150_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_150' type='radio' value='No'  id='choice_65_150_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_150_1' id='label_65_150_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_428\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_428'>Year of Issue<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_428' id='input_65_428' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_154\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_154'>Class<\/label><div class='ginput_container ginput_container_select'><select name='input_154' id='input_65_154' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='A1' >A1<\/option><option value='A' >A<\/option><option value='B' >B<\/option><option value='C1' >C1<\/option><option value='C' >C<\/option><option value='D1' >D1<\/option><option value='D' >D<\/option><option value='BE' >BE<\/option><option value='C1E' >C1E<\/option><option value='CE' >CE<\/option><option value='D1E' >D1E<\/option><option value='DE' >DE<\/option><option value='M' >M<\/option><option value='T' >T<\/option><\/select><\/div><\/div><div id=\"field_65_156\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Holder (Other Vehicle #3)<\/h3><\/div><fieldset id=\"field_65_158\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is the driver the vehicle&#039;s holder?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_158'>\n\t\t\t<div class='gchoice gchoice_65_158_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='Yes'  id='choice_65_158_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_158_0' id='label_65_158_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_158_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='No'  id='choice_65_158_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_158_1' id='label_65_158_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_405\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The holder is the vehicle&#039;s<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_405'>\n\t\t\t<div class='gchoice gchoice_65_405_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_405' type='radio' value='1st holder'  id='choice_65_405_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_405_0' id='label_65_405_0' class='gform-field-label gform-field-label--type-inline'>1st holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_405_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_405' type='radio' value='2nd holder'  id='choice_65_405_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_405_1' id='label_65_405_1' class='gform-field-label gform-field-label--type-inline'>2nd holder<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_161\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_161'>Holder&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_161' id='input_65_161' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_162\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_162'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_162' id='input_65_162' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_164\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_164'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_164' id='input_65_164' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_166\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_166'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_166' id='input_65_166' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_168\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_168' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_168_1_container' >\n                                        <input type='text' name='input_168.1' id='input_65_168_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_168_1' id='input_65_168_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_168_3_container' >\n                                    <input type='text' name='input_168.3' id='input_65_168_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_168_3' id='input_65_168_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_168.4' id='input_65_168_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_168_5_container' >\n                                    <input type='text' name='input_168.5' id='input_65_168_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_168_5' id='input_65_168_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_168.6' id='input_65_168_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_170\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Owner (Other Vehicle #3)<\/h3><\/div><fieldset id=\"field_65_172\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle Owner<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_172'>\n\t\t\t<div class='gchoice gchoice_65_172_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_172' type='radio' value='is the same as the driver'  id='choice_65_172_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_172_0' id='label_65_172_0' class='gform-field-label gform-field-label--type-inline'>is the same as the driver<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_172_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_172' type='radio' value='is the same as the holder'  id='choice_65_172_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_172_1' id='label_65_172_1' class='gform-field-label gform-field-label--type-inline'>is the same as the holder<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_172_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_172' type='radio' value='is neither of the above'  id='choice_65_172_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_172_2' id='label_65_172_2' class='gform-field-label gform-field-label--type-inline'>is neither of the above<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_174\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_174'>Owner&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_174' id='input_65_174' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_176\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_176'>Date of Birth or Business ID<\/label><div class='ginput_container ginput_container_text'><input name='input_176' id='input_65_176' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_178\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_178'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_178' id='input_65_178' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_180\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_180'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_180' id='input_65_180' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_65_182\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle Information (Other Vehicle #3)<\/h3><\/div><div id=\"field_65_184\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_184'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_184' id='input_65_184' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_184\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_184'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_186\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_186'>Type<\/label><div class='ginput_container ginput_container_select'><select name='input_186' id='input_65_186' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Passenger Car' >Passenger Car<\/option><option value='Van' >Van<\/option><option value='Light Truck' >Light Truck<\/option><option value='Truck' >Truck<\/option><option value='Minibus' >Minibus<\/option><option value='Motorhome' >Motorhome<\/option><option value='Motorcycle' >Motorcycle<\/option><option value='Snowmobile' >Snowmobile<\/option><option value='Moped Car' >Moped Car<\/option><\/select><\/div><\/div><div id=\"field_65_188\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_188'>Make and model<\/label><div class='ginput_container ginput_container_text'><input name='input_188' id='input_65_188' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_188\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_188'>e.g., Volvo V40 <\/div><\/div><div id=\"field_65_432\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_432'>First Year of Use<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_432' id='input_65_432' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><div id=\"field_65_192\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_192'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_192' id='input_65_192' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_194\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_194'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_194' id='input_65_194' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><fieldset id=\"field_65_196\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_left_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Leased Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_196'>\n\t\t\t<div class='gchoice gchoice_65_196_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_196' type='radio' value='Yes'  id='choice_65_196_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_196_0' id='label_65_196_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_196_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_196' type='radio' value='No'  id='choice_65_196_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_196_1' id='label_65_196_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_198\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Company Car<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_198'>\n\t\t\t<div class='gchoice gchoice_65_198_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_198' type='radio' value='Yes'  id='choice_65_198_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_198_0' id='label_65_198_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_198_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_198' type='radio' value='No'  id='choice_65_198_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_198_1' id='label_65_198_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_200\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_right_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vehicle VAT deductible<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_200'>\n\t\t\t<div class='gchoice gchoice_65_200_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_200' type='radio' value='Yes'  id='choice_65_200_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_200_0' id='label_65_200_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_200_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_200' type='radio' value='No'  id='choice_65_200_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_200_1' id='label_65_200_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_202\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Trailer Information (Other Vehicle #3)<\/h3><\/div><fieldset id=\"field_65_204\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a trailer used?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_204'>\n\t\t\t<div class='gchoice gchoice_65_204_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_204' type='radio' value='Yes'  id='choice_65_204_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_204_0' id='label_65_204_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_204_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_204' type='radio' value='No' checked='checked' id='choice_65_204_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_204_1' id='label_65_204_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_206\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_206'>License plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_206' id='input_65_206' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_206\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_206'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_211\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_211'>Motor Liability Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_211' id='input_65_211' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_208\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_208'>Car Insurance Company<\/label><div class='ginput_container ginput_container_select'><select name='input_208' id='input_65_208' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_7' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_91\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal Injuries<\/h3><\/div><div id=\"field_65_443\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gf_alert_blue text-small gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If the accident involves personal injuries, please report them on this page to the best of your knowledge. Start by selecting &#8216;Yes&#8217; below. <\/div><fieldset id=\"field_65_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Report personal injuries<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_93'>\n\t\t\t<div class='gchoice gchoice_65_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Yes'  id='choice_65_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_93_0' id='label_65_93_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='No' checked='checked' id='choice_65_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_93_1' id='label_65_93_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_337\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_337'>Injured Persons<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_337' id='input_65_337' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/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><\/select><\/div><\/div><fieldset id=\"field_65_379\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_379'>\n\t\t\t<div class='gchoice gchoice_65_379_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_379' type='radio' value='Own'  id='choice_65_379_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_379_0' id='label_65_379_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_379_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_379' type='radio' value='Other #1'  id='choice_65_379_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_379_1' id='label_65_379_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_379_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_379' type='radio' value='Other #2'  id='choice_65_379_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_379_2' id='label_65_379_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_379_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_379' type='radio' value='Other #3'  id='choice_65_379_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_379_3' id='label_65_379_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_309\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_309'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_309' id='input_65_309' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_310\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_310'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_310' id='input_65_310' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_310\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_310'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_311\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_311'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_311' id='input_65_311' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_312\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_312'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_312' id='input_65_312' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_313\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_313'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_313' id='input_65_313' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_314\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_314'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_314' id='input_65_314' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_380\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_380'>\n\t\t\t<div class='gchoice gchoice_65_380_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Own'  id='choice_65_380_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_380_0' id='label_65_380_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_380_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Other #1'  id='choice_65_380_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_380_1' id='label_65_380_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_380_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Other #2'  id='choice_65_380_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_380_2' id='label_65_380_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_380_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Other #3'  id='choice_65_380_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_380_3' id='label_65_380_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_319\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_319'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_319' id='input_65_319' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_320\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_320'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_320' id='input_65_320' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_320\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_320'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_321\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_321'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_321' id='input_65_321' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_342\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_342'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_342' id='input_65_342' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_338\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_338'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_338' id='input_65_338' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_324\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_324'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_324' id='input_65_324' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_381\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_381'>\n\t\t\t<div class='gchoice gchoice_65_381_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Own'  id='choice_65_381_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_381_0' id='label_65_381_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_381_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Other #1'  id='choice_65_381_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_381_1' id='label_65_381_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_381_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Other #2'  id='choice_65_381_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_381_2' id='label_65_381_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_381_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_381' type='radio' value='Other #3'  id='choice_65_381_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_381_3' id='label_65_381_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_331\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_331'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_331' id='input_65_331' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_333\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_333'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_333' id='input_65_333' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_333\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_333'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_335\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_335'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_335' id='input_65_335' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_322\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_322'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_322' id='input_65_322' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_323\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_323'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_323' id='input_65_323' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_340\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_340'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_340' id='input_65_340' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_382\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_382'>\n\t\t\t<div class='gchoice gchoice_65_382_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Own'  id='choice_65_382_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_382_0' id='label_65_382_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_382_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Other #1'  id='choice_65_382_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_382_1' id='label_65_382_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_382_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Other #2'  id='choice_65_382_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_382_2' id='label_65_382_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_382_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Other #3'  id='choice_65_382_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_382_3' id='label_65_382_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_330\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_330'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_330' id='input_65_330' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_332\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_332'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_332' id='input_65_332' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_332\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_332'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_360\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_360'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_360' id='input_65_360' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_336\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_336'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_336' id='input_65_336' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_339\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_339'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_339' id='input_65_339' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_341\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_341'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_341' id='input_65_341' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_383\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_383'>\n\t\t\t<div class='gchoice gchoice_65_383_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_383' type='radio' value='Own'  id='choice_65_383_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_383_0' id='label_65_383_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_383_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_383' type='radio' value='Other #1'  id='choice_65_383_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_383_1' id='label_65_383_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_383_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_383' type='radio' value='Other #2'  id='choice_65_383_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_383_2' id='label_65_383_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_383_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_383' type='radio' value='Other #3'  id='choice_65_383_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_383_3' id='label_65_383_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_348\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_348'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_348' id='input_65_348' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_354\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_354'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_354' id='input_65_354' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_354\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_354'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_359\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_359'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_359' id='input_65_359' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_366\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_366'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_366' id='input_65_366' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_370\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_370'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_370' id='input_65_370' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_378\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_378'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_378' id='input_65_378' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_384\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_384'>\n\t\t\t<div class='gchoice gchoice_65_384_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Own'  id='choice_65_384_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_384_0' id='label_65_384_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_384_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Other #1'  id='choice_65_384_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_384_1' id='label_65_384_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_384_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Other #2'  id='choice_65_384_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_384_2' id='label_65_384_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_384_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Other #3'  id='choice_65_384_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_384_3' id='label_65_384_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_347\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_347'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_347' id='input_65_347' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_353\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_353'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_353' id='input_65_353' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_353\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_353'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_334\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_334'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_334' id='input_65_334' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_365\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_365'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_365' id='input_65_365' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_372\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_372'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_372' id='input_65_372' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_377\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_377'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_377' id='input_65_377' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_385\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_385'>\n\t\t\t<div class='gchoice gchoice_65_385_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_385' type='radio' value='Own'  id='choice_65_385_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_385_0' id='label_65_385_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_385_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_385' type='radio' value='Other #1'  id='choice_65_385_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_385_1' id='label_65_385_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_385_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_385' type='radio' value='Other #2'  id='choice_65_385_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_385_2' id='label_65_385_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_385_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_385' type='radio' value='Other #3'  id='choice_65_385_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_385_3' id='label_65_385_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_346\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_346'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_346' id='input_65_346' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_351\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_351'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_351' id='input_65_351' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_351\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_351'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_358\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_358'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_358' id='input_65_358' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_364\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_364'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_364' id='input_65_364' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_371\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_371'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_371' id='input_65_371' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_376\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_376'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_376' id='input_65_376' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_386\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_386'>\n\t\t\t<div class='gchoice gchoice_65_386_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Own'  id='choice_65_386_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_386_0' id='label_65_386_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_386_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Other #1'  id='choice_65_386_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_386_1' id='label_65_386_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_386_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Other #2'  id='choice_65_386_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_386_2' id='label_65_386_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_386_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Other #3'  id='choice_65_386_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_386_3' id='label_65_386_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_345\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_345'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_345' id='input_65_345' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_352\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_352'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_352' id='input_65_352' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_352\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_352'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_357\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_357'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_357' id='input_65_357' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_363\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_363'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_363' id='input_65_363' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_369\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_369'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_369' id='input_65_369' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_375\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_375'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_375' id='input_65_375' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_387\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_387'>\n\t\t\t<div class='gchoice gchoice_65_387_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_387' type='radio' value='Own'  id='choice_65_387_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_387_0' id='label_65_387_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_387_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_387' type='radio' value='Other #1'  id='choice_65_387_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_387_1' id='label_65_387_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_387_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_387' type='radio' value='Other #2'  id='choice_65_387_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_387_2' id='label_65_387_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_387_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_387' type='radio' value='Other #3'  id='choice_65_387_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_387_3' id='label_65_387_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_344\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_344'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_344' id='input_65_344' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_350\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_350'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_350' id='input_65_350' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_350\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_350'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_356\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_356'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_356' id='input_65_356' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_362\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_362'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_362' id='input_65_362' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_368\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_368'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_368' id='input_65_368' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_374\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_374'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_374' id='input_65_374' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><fieldset id=\"field_65_388\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Injured Party&#039;s Vehicle<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_388'>\n\t\t\t<div class='gchoice gchoice_65_388_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_388' type='radio' value='Own'  id='choice_65_388_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_388_0' id='label_65_388_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_388_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_388' type='radio' value='Other #1'  id='choice_65_388_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_388_1' id='label_65_388_1' class='gform-field-label gform-field-label--type-inline'>Other #1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_388_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_388' type='radio' value='Other #2'  id='choice_65_388_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_388_2' id='label_65_388_2' class='gform-field-label gform-field-label--type-inline'>Other #2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_388_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_388' type='radio' value='Other #3'  id='choice_65_388_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_388_3' id='label_65_388_3' class='gform-field-label gform-field-label--type-inline'>Other #3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_343\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_343'>Name of Injured Party<\/label><div class='ginput_container ginput_container_text'><input name='input_343' id='input_65_343' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_349\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_349'>Date of Birth<\/label><div class='ginput_container ginput_container_text'><input name='input_349' id='input_65_349' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_349\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_349'>Enter date of birth in DD.MM.YYYY format.<\/div><\/div><div id=\"field_65_355\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_355'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_355' id='input_65_355' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_361\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_361'>Position in Vehicle<\/label><div class='ginput_container ginput_container_select'><select name='input_361' id='input_65_361' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Driver' >Driver<\/option><option value='Passenger in front seat' >Passenger in front seat<\/option><option value='Passenger elsewhere' >Passenger elsewhere<\/option><option value='Not in vehicle' >Not in vehicle<\/option><\/select><\/div><\/div><div id=\"field_65_367\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_367'>Circumstance<\/label><div class='ginput_container ginput_container_select'><select name='input_367' id='input_65_367' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Work' >Work<\/option><option value='Commute' >Commute<\/option><option value='School commute' >School commute<\/option><option value='Leisure time' >Leisure time<\/option><\/select><\/div><\/div><div id=\"field_65_373\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_373'>Severity of Injury<\/label><div class='ginput_container ginput_container_select'><select name='input_373' id='input_65_373' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Minor' >Minor<\/option><option value='Severe' >Severe<\/option><option value='Deceased' >Deceased<\/option><\/select><\/div><\/div><div id=\"field_65_316\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Total Personal Injuries<\/h3><\/div><div id=\"field_65_96\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_96'>Total Injured<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_65_96' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='0' >0<\/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><\/select><\/div><\/div><div id=\"field_65_97\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_97'>Total Deceased<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_65_97' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='0' >0<\/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><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_306' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_306' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_8' class='gform_page' data-js='page-field-id-306' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_84\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle Damages<\/h3><\/div><div id=\"field_65_85\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"\/media\/incar-damage-map-5.jpg\"><\/div><fieldset id=\"field_65_87\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Damages (Own Vehicle)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_87'><div class='gchoice gchoice_65_87_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.1' type='checkbox'  value='A \u2013\u00a0Left rear'  id='choice_65_87_1'   aria-describedby=\"gfield_description_65_87\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_1' id='label_65_87_1' class='gform-field-label gform-field-label--type-inline'>A \u2013\u00a0Left rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.2' type='checkbox'  value='B \u2013 Left Side'  id='choice_65_87_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_2' id='label_65_87_2' class='gform-field-label gform-field-label--type-inline'>B \u2013 Left Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.3' type='checkbox'  value='C \u2013 Left Front'  id='choice_65_87_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_3' id='label_65_87_3' class='gform-field-label gform-field-label--type-inline'>C \u2013 Left Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.4' type='checkbox'  value='D \u2013 Tailgate'  id='choice_65_87_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_4' id='label_65_87_4' class='gform-field-label gform-field-label--type-inline'>D \u2013 Tailgate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.5' type='checkbox'  value='E \u2013 Roof'  id='choice_65_87_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_5' id='label_65_87_5' class='gform-field-label gform-field-label--type-inline'>E \u2013 Roof<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.6' type='checkbox'  value='F \u2013 Windshield'  id='choice_65_87_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_6' id='label_65_87_6' class='gform-field-label gform-field-label--type-inline'>F \u2013 Windshield<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.7' type='checkbox'  value='G \u2013 Hood'  id='choice_65_87_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_7' id='label_65_87_7' class='gform-field-label gform-field-label--type-inline'>G \u2013 Hood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.8' type='checkbox'  value='H \u2013 Right Rear'  id='choice_65_87_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_8' id='label_65_87_8' class='gform-field-label gform-field-label--type-inline'>H \u2013 Right Rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.9' type='checkbox'  value='I \u2013 Right Side'  id='choice_65_87_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_9' id='label_65_87_9' class='gform-field-label gform-field-label--type-inline'>I \u2013 Right Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.11' type='checkbox'  value='J \u2013 Right Front'  id='choice_65_87_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_11' id='label_65_87_11' class='gform-field-label gform-field-label--type-inline'>J \u2013 Right Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_87_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.12' type='checkbox'  value='Other damage (describe in report)'  id='choice_65_87_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_87_12' id='label_65_87_12' class='gform-field-label gform-field-label--type-inline'>Other damage (describe in report)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_87'>You can select multiple items.<\/div><\/fieldset><fieldset id=\"field_65_88\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Damages (Other Vehicle #1)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_88'><div class='gchoice gchoice_65_88_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.1' type='checkbox'  value='A \u2013\u00a0Left rear'  id='choice_65_88_1'   aria-describedby=\"gfield_description_65_88\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_1' id='label_65_88_1' class='gform-field-label gform-field-label--type-inline'>A \u2013\u00a0Left rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.2' type='checkbox'  value='B \u2013 Left Side'  id='choice_65_88_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_2' id='label_65_88_2' class='gform-field-label gform-field-label--type-inline'>B \u2013 Left Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.3' type='checkbox'  value='C \u2013 Left Front'  id='choice_65_88_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_3' id='label_65_88_3' class='gform-field-label gform-field-label--type-inline'>C \u2013 Left Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.4' type='checkbox'  value='D \u2013 Tailgate'  id='choice_65_88_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_4' id='label_65_88_4' class='gform-field-label gform-field-label--type-inline'>D \u2013 Tailgate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.5' type='checkbox'  value='E \u2013 Roof'  id='choice_65_88_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_5' id='label_65_88_5' class='gform-field-label gform-field-label--type-inline'>E \u2013 Roof<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.6' type='checkbox'  value='F \u2013 Windshield'  id='choice_65_88_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_6' id='label_65_88_6' class='gform-field-label gform-field-label--type-inline'>F \u2013 Windshield<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.7' type='checkbox'  value='G \u2013 Hood'  id='choice_65_88_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_7' id='label_65_88_7' class='gform-field-label gform-field-label--type-inline'>G \u2013 Hood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.8' type='checkbox'  value='H \u2013 Right Rear'  id='choice_65_88_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_8' id='label_65_88_8' class='gform-field-label gform-field-label--type-inline'>H \u2013 Right Rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.9' type='checkbox'  value='I \u2013 Right Side'  id='choice_65_88_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_9' id='label_65_88_9' class='gform-field-label gform-field-label--type-inline'>I \u2013 Right Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.11' type='checkbox'  value='J \u2013 Right Front'  id='choice_65_88_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_11' id='label_65_88_11' class='gform-field-label gform-field-label--type-inline'>J \u2013 Right Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_88_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_88.12' type='checkbox'  value='Other damage (describe in report)'  id='choice_65_88_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_88_12' id='label_65_88_12' class='gform-field-label gform-field-label--type-inline'>Other damage (describe in report)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_88'>You can select multiple items.<\/div><\/fieldset><div id=\"field_65_92\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_92'>Description of Damages (Own Vehicle)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_92' id='input_65_92' class='textarea small'  aria-describedby=\"gfield_description_65_92\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_92'>Describe the damages to the car, such as a scratch on the left door, a dent in the rear bumper, etc.<\/div><\/div><div id=\"field_65_90\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_90'>Description of Damages (Other Vehicle #1)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_90' id='input_65_90' class='textarea small'  aria-describedby=\"gfield_description_65_90\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_90'>Describe the damages to the car, such as a scratch on the left door, a dent in the rear bumper, etc.<\/div><\/div><fieldset id=\"field_65_213\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Damages (Other Vehicle #2)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_213'><div class='gchoice gchoice_65_213_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.1' type='checkbox'  value='A \u2013\u00a0Left rear'  id='choice_65_213_1'   aria-describedby=\"gfield_description_65_213\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_1' id='label_65_213_1' class='gform-field-label gform-field-label--type-inline'>A \u2013\u00a0Left rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.2' type='checkbox'  value='B \u2013 Left Side'  id='choice_65_213_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_2' id='label_65_213_2' class='gform-field-label gform-field-label--type-inline'>B \u2013 Left Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.3' type='checkbox'  value='C \u2013 Left Front'  id='choice_65_213_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_3' id='label_65_213_3' class='gform-field-label gform-field-label--type-inline'>C \u2013 Left Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.4' type='checkbox'  value='D \u2013 Tailgate'  id='choice_65_213_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_4' id='label_65_213_4' class='gform-field-label gform-field-label--type-inline'>D \u2013 Tailgate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.5' type='checkbox'  value='E \u2013 Roof'  id='choice_65_213_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_5' id='label_65_213_5' class='gform-field-label gform-field-label--type-inline'>E \u2013 Roof<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.6' type='checkbox'  value='F \u2013 Windshield'  id='choice_65_213_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_6' id='label_65_213_6' class='gform-field-label gform-field-label--type-inline'>F \u2013 Windshield<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.7' type='checkbox'  value='G \u2013 Hood'  id='choice_65_213_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_7' id='label_65_213_7' class='gform-field-label gform-field-label--type-inline'>G \u2013 Hood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.8' type='checkbox'  value='H \u2013 Right Rear'  id='choice_65_213_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_8' id='label_65_213_8' class='gform-field-label gform-field-label--type-inline'>H \u2013 Right Rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.9' type='checkbox'  value='I \u2013 Right Side'  id='choice_65_213_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_9' id='label_65_213_9' class='gform-field-label gform-field-label--type-inline'>I \u2013 Right Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.11' type='checkbox'  value='J \u2013 Right Front'  id='choice_65_213_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_11' id='label_65_213_11' class='gform-field-label gform-field-label--type-inline'>J \u2013 Right Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_213_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.12' type='checkbox'  value='Other damage (describe in report)'  id='choice_65_213_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_213_12' id='label_65_213_12' class='gform-field-label gform-field-label--type-inline'>Other damage (describe in report)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_213'>You can select multiple items.<\/div><\/fieldset><fieldset id=\"field_65_214\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Damages (Other Vehicle #3)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_214'><div class='gchoice gchoice_65_214_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.1' type='checkbox'  value='A \u2013\u00a0Left rear'  id='choice_65_214_1'   aria-describedby=\"gfield_description_65_214\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_1' id='label_65_214_1' class='gform-field-label gform-field-label--type-inline'>A \u2013\u00a0Left rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.2' type='checkbox'  value='B \u2013 Left Side'  id='choice_65_214_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_2' id='label_65_214_2' class='gform-field-label gform-field-label--type-inline'>B \u2013 Left Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.3' type='checkbox'  value='C \u2013 Left Front'  id='choice_65_214_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_3' id='label_65_214_3' class='gform-field-label gform-field-label--type-inline'>C \u2013 Left Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.4' type='checkbox'  value='D \u2013 Tailgate'  id='choice_65_214_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_4' id='label_65_214_4' class='gform-field-label gform-field-label--type-inline'>D \u2013 Tailgate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.5' type='checkbox'  value='E \u2013 Roof'  id='choice_65_214_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_5' id='label_65_214_5' class='gform-field-label gform-field-label--type-inline'>E \u2013 Roof<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.6' type='checkbox'  value='F \u2013 Windshield'  id='choice_65_214_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_6' id='label_65_214_6' class='gform-field-label gform-field-label--type-inline'>F \u2013 Windshield<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.7' type='checkbox'  value='G \u2013 Hood'  id='choice_65_214_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_7' id='label_65_214_7' class='gform-field-label gform-field-label--type-inline'>G \u2013 Hood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.8' type='checkbox'  value='H \u2013 Right Rear'  id='choice_65_214_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_8' id='label_65_214_8' class='gform-field-label gform-field-label--type-inline'>H \u2013 Right Rear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.9' type='checkbox'  value='I \u2013 Right Side'  id='choice_65_214_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_9' id='label_65_214_9' class='gform-field-label gform-field-label--type-inline'>I \u2013 Right Side<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.11' type='checkbox'  value='J \u2013 Right Front'  id='choice_65_214_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_11' id='label_65_214_11' class='gform-field-label gform-field-label--type-inline'>J \u2013 Right Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_214_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_214.12' type='checkbox'  value='Other damage (describe in report)'  id='choice_65_214_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_214_12' id='label_65_214_12' class='gform-field-label gform-field-label--type-inline'>Other damage (describe in report)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_214'>You can select multiple items.<\/div><\/fieldset><div id=\"field_65_215\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_215'>Description of Damages (Other Vehicle #2)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_215' id='input_65_215' class='textarea small'  aria-describedby=\"gfield_description_65_215\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_215'>Describe the damages to the car, such as a scratch on the left door, a dent in the rear bumper, etc.<\/div><\/div><div id=\"field_65_216\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_216'>Description of Damages (Other Vehicle #3)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_216' id='input_65_216' class='textarea small'  aria-describedby=\"gfield_description_65_216\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_216'>Describe the damages to the car, such as a scratch on the left door, a dent in the rear bumper, etc.<\/div><\/div><div id=\"field_65_99\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_99'>Description of how the accident occurred<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_99' id='input_65_99' class='textarea small'   maxlength='3000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_65_245\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Roadworthiness after accident<\/h3><\/div><fieldset id=\"field_65_246\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is your own vehicle roadworthy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_246'>\n\t\t\t<div class='gchoice gchoice_65_246_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_246' type='radio' value='Yes'  id='choice_65_246_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_246_0' id='label_65_246_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_246_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_246' type='radio' value='No'  id='choice_65_246_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_246_1' id='label_65_246_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_250\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_250'>Vehicle Location (address)<\/label><div class='ginput_container ginput_container_text'><input name='input_250' id='input_65_250' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_422\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"clear:both;\"><\/div><\/div><fieldset id=\"field_65_247\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is other vehicle #1 roadworthy?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_247'>\n\t\t\t<div class='gchoice gchoice_65_247_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_247' type='radio' value='Yes'  id='choice_65_247_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_247_0' id='label_65_247_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_247_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_247' type='radio' value='No'  id='choice_65_247_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_247_1' id='label_65_247_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_251\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_251'>Vehicle Location (address)<\/label><div class='ginput_container ginput_container_text'><input name='input_251' id='input_65_251' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_423\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"clear:both;\"><\/div><\/div><fieldset id=\"field_65_249\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is other vehicle #2 roadworthy?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_249'>\n\t\t\t<div class='gchoice gchoice_65_249_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_249' type='radio' value='Yes'  id='choice_65_249_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_249_0' id='label_65_249_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_249_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_249' type='radio' value='No'  id='choice_65_249_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_249_1' id='label_65_249_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_252\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_252'>Vehicle Location (address)<\/label><div class='ginput_container ginput_container_text'><input name='input_252' id='input_65_252' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_424\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"clear:both;\"><\/div><\/div><fieldset id=\"field_65_248\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is other vehicle #3 roadworthy?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_248'>\n\t\t\t<div class='gchoice gchoice_65_248_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_248' type='radio' value='Yes'  id='choice_65_248_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_248_0' id='label_65_248_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_248_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_248' type='radio' value='No'  id='choice_65_248_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_248_1' id='label_65_248_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_253\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_253'>Vehicle Location (address)<\/label><div class='ginput_container ginput_container_text'><input name='input_253' id='input_65_253' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_446\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Glass damage<\/h3><\/div><fieldset id=\"field_65_447\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Damages (Glass damage)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_447'><div class='gchoice gchoice_65_447_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_447.1' type='checkbox'  value='Windshield'  id='choice_65_447_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_447_1' id='label_65_447_1' class='gform-field-label gform-field-label--type-inline'>Windshield<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_447_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_447.2' type='checkbox'  value='Rear window'  id='choice_65_447_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_447_2' id='label_65_447_2' class='gform-field-label gform-field-label--type-inline'>Rear window<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_447_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_447.3' type='checkbox'  value='Other glass (specify in description)'  id='choice_65_447_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_447_3' id='label_65_447_3' class='gform-field-label gform-field-label--type-inline'>Other glass (specify in description)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_448\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_448'>Description of damage (Windshield)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_448' id='input_65_448' class='textarea small'  aria-describedby=\"gfield_description_65_448\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_448'>Describe the damage to the car, such as a stone chip or crack in the glass, etc.<\/div><\/div><div id=\"field_65_451\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_451'>Description of how the damage occurred (Windshield)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_451' id='input_65_451' class='textarea small'   maxlength='3000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_65_449\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_449'>Description of damage (Rear window)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_449' id='input_65_449' class='textarea small'  aria-describedby=\"gfield_description_65_449\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_449'>Describe the damage to the car, such as a stone chip or crack in the glass, etc.<\/div><\/div><div id=\"field_65_452\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_452'>Description of how the damage occurred (Rear window)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_452' id='input_65_452' class='textarea small'   maxlength='3000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_65_450\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_450'>Description of damage (Other glass)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_450' id='input_65_450' class='textarea small'  aria-describedby=\"gfield_description_65_450\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_65_450'>Describe the damage to the car, such as a stone chip or crack in the glass, etc.<\/div><\/div><div id=\"field_65_453\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_453'>Description of how the damage occurred (Other glass)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_453' id='input_65_453' class='textarea small'   maxlength='3000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_65_98\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Time, place, and conditions<\/h3><\/div><div id=\"field_65_101\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_101'>Date of incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_101' id='input_65_101' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_with_icon gdatepicker_with_icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_65_101_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_65_101_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_65_101' class='gform_hidden' value='https:\/\/www.incar.fi\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_65_103\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_103'>Time of incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_65_103' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_103\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_103'>Time, e.g. 15.45<\/div><\/div><div id=\"field_65_118\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_118'>Exact location of damage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_65_118' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_118\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_118'>For example, give an intersection, street address, place name, etc. <\/div><\/div><div id=\"field_65_219\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_219'>Place of incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_219' id='input_65_219' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Level crossing' >Level crossing<\/option><option value='Connection to a private road or area' >Connection to a private road or area<\/option><option value='Priority intersection' >Priority intersection<\/option><option value='Uncontrolled intersection' >Uncontrolled intersection<\/option><option value='Bridge' >Bridge<\/option><option value='Bend' >Bend<\/option><option value='Straight road' >Straight road<\/option><option value='Parking area, square, yard, service station, or similar' >Parking area, square, yard, service station, or similar<\/option><option value='Other area' >Other area<\/option><\/select><\/div><\/div><div id=\"field_65_220\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_220'>Traffic lights<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_220' id='input_65_220' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='No lights' >No lights<\/option><option value='Lights controlled traffic' >Lights controlled traffic<\/option><option value='Lights did not control traffic' >Lights did not control traffic<\/option><\/select><\/div><\/div><div id=\"field_65_221\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_221'>Within speed limit area (Own vehicle) <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_221' id='input_65_221' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_225\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_225'>Speed before the incident (Own vehicle)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_225' id='input_65_225' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_229\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_229'>Road number (Own vehicle)<\/label><div class='ginput_container ginput_container_text'><input name='input_229' id='input_65_229' type='text' value='' class='large' maxlength='5'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_233\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_233'>Type of road (Own vehicle)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_233' id='input_65_233' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Street or similar' >Street or similar<\/option><option value='Motorway' >Motorway<\/option><option value='Main road' >Main road<\/option><option value='Other public road' >Other public road<\/option><option value='Private road' >Private road<\/option><option value='Other road or area' >Other road or area<\/option><\/select><\/div><\/div><div id=\"field_65_222\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_222'>Within speed limit area (Other vehicle #1) <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_222' id='input_65_222' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_226\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_226'>Speed before the incident (Other vehicle 1)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_226' id='input_65_226' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_230\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_230'>Road number (Other vehicle #1)<\/label><div class='ginput_container ginput_container_text'><input name='input_230' id='input_65_230' type='text' value='' class='large' maxlength='5'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_234\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_234'>Type of road (Other vehicle #1)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_234' id='input_65_234' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Street or similar' >Street or similar<\/option><option value='Motorway' >Motorway<\/option><option value='Main road' >Main road<\/option><option value='Other public road' >Other public road<\/option><option value='Private road' >Private road<\/option><option value='Other road or area' >Other road or area<\/option><\/select><\/div><\/div><div id=\"field_65_223\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_223'>Within speed limit area (Other vehicle #2) <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_223' id='input_65_223' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_227\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_227'>Speed before the incident (Other vehicle 2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_227' id='input_65_227' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_231\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_231'>Road number (Other vehicle #2)<\/label><div class='ginput_container ginput_container_text'><input name='input_231' id='input_65_231' type='text' value='' class='large' maxlength='5'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_237\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_237'>Type of road (Other vehicle #2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_237' id='input_65_237' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Street or similar' >Street or similar<\/option><option value='Motorway' >Motorway<\/option><option value='Main road' >Main road<\/option><option value='Other public road' >Other public road<\/option><option value='Private road' >Private road<\/option><option value='Other road or area' >Other road or area<\/option><\/select><\/div><\/div><div id=\"field_65_224\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_224'>Within speed limit area (Other vehicle #3) <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_224' id='input_65_224' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_232\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_232'>Speed before the incident (Other vehicle 3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_232' id='input_65_232' type='text' value='' class='large' maxlength='3'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_228\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_228'>Road number (Other vehicle #3)<\/label><div class='ginput_container ginput_container_text'><input name='input_228' id='input_65_228' type='text' value='' class='large' maxlength='5'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_236\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_236'>Type of road (Other vehicle #3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_236' id='input_65_236' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Street or similar' >Street or similar<\/option><option value='Motorway' >Motorway<\/option><option value='Main road' >Main road<\/option><option value='Other public road' >Other public road<\/option><option value='Private road' >Private road<\/option><option value='Other road or area' >Other road or area<\/option><\/select><\/div><\/div><fieldset id=\"field_65_238\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Built-up area<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_238'>\n\t\t\t<div class='gchoice gchoice_65_238_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_238' type='radio' value='Yes'  id='choice_65_238_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_238_0' id='label_65_238_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_238_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_238' type='radio' value='No'  id='choice_65_238_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_238_1' id='label_65_238_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_239\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Road surface<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_239'>\n\t\t\t<div class='gchoice gchoice_65_239_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_239' type='radio' value='Bare, dry'  id='choice_65_239_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_239_0' id='label_65_239_0' class='gform-field-label gform-field-label--type-inline'>Bare, dry<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_239_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_239' type='radio' value='Bare, wet'  id='choice_65_239_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_239_1' id='label_65_239_1' class='gform-field-label gform-field-label--type-inline'>Bare, wet<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_239_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_239' type='radio' value='Snowy or icy'  id='choice_65_239_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_239_2' id='label_65_239_2' class='gform-field-label gform-field-label--type-inline'>Snowy or icy<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_240\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Lighting<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_240'>\n\t\t\t<div class='gchoice gchoice_65_240_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_240' type='radio' value='Daylight'  id='choice_65_240_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_240_0' id='label_65_240_0' class='gform-field-label gform-field-label--type-inline'>Daylight<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_240_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_240' type='radio' value='Dusk'  id='choice_65_240_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_240_1' id='label_65_240_1' class='gform-field-label gform-field-label--type-inline'>Dusk<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_240_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_240' type='radio' value='Dark, lit road'  id='choice_65_240_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_240_2' id='label_65_240_2' class='gform-field-label gform-field-label--type-inline'>Dark, lit road<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_240_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_240' type='radio' value='Dark, unlit road'  id='choice_65_240_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_240_3' id='label_65_240_3' class='gform-field-label gform-field-label--type-inline'>Dark, unlit road<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_116\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional information<\/h3><\/div><div id=\"field_65_105\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_105'>Who do you think is at fault for the damage?<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_65_105' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_65_107\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Does he\/she admit fault?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_107'>\n\t\t\t<div class='gchoice gchoice_65_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='Yes'  id='choice_65_107_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_107_0' id='label_65_107_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='No'  id='choice_65_107_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_107_1' id='label_65_107_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_112\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Was any of the drivers involved under the influence of alcohol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_112'><div class='gchoice gchoice_65_112_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_112.1' type='checkbox'  value='Yes, driver of own vehicle'  id='choice_65_112_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_112_1' id='label_65_112_1' class='gform-field-label gform-field-label--type-inline'>Yes, driver of own vehicle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_112_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_112.2' type='checkbox'  value='Yes, driver of the other\/third-party vehicle'  id='choice_65_112_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_112_2' id='label_65_112_2' class='gform-field-label gform-field-label--type-inline'>Yes, driver of the other\/third-party vehicle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_112_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_112.3' type='checkbox'  value='No'  id='choice_65_112_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_112_3' id='label_65_112_3' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_110\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a blood test taken?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_110'>\n\t\t\t<div class='gchoice gchoice_65_110_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='Yes'  id='choice_65_110_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_110_0' id='label_65_110_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_110_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='No'  id='choice_65_110_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_110_1' id='label_65_110_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_110_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='No information'  id='choice_65_110_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_110_2' id='label_65_110_2' class='gform-field-label gform-field-label--type-inline'>No information<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_113\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did the police come to the scene?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_113'>\n\t\t\t<div class='gchoice gchoice_65_113_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='Yes'  id='choice_65_113_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_113_0' id='label_65_113_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_113_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='No'  id='choice_65_113_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_113_1' id='label_65_113_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_114\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was a police investigation carried out?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_114'>\n\t\t\t<div class='gchoice gchoice_65_114_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='Yes'  id='choice_65_114_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_114_0' id='label_65_114_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_114_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='No'  id='choice_65_114_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_114_1' id='label_65_114_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_393\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I will report witnesses<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_393'>\n\t\t\t<div class='gchoice gchoice_65_393_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='Yes'  id='choice_65_393_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_393_0' id='label_65_393_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_393_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='No' checked='checked' id='choice_65_393_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_393_1' id='label_65_393_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_115\" class=\"gfield gfield--type-list gfield--input-type-list gp-field-maxrows-10 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Witnesses<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Address<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Email<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Phone<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false'  aria-describedby=\"gfield_description_65_115\" aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell2 gform-grid-col' data-label='Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_65_115\" aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell3 gform-grid-col' data-label='Email'><input aria-invalid='false'  aria-describedby=\"gfield_description_65_115\" aria-label='Email, Row 1' data-aria-label-template='Email, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell4 gform-grid-col' data-label='Phone'><input aria-invalid='false'  aria-describedby=\"gfield_description_65_115\" aria-label='Phone, Row 1' data-aria-label-template='Phone, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 10)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 10)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_115'>You can add up to 10 witnesses. You can skip this section if there are no witnesses or the information is not available.  <\/div><\/fieldset><fieldset id=\"field_65_260\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I also want to fill out the vehicle usage needs report<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_260'>\n\t\t\t<div class='gchoice gchoice_65_260_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_260' type='radio' value='Yes'  id='choice_65_260_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_260_0' id='label_65_260_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_260_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_260' type='radio' value='No' checked='checked' id='choice_65_260_1' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_65_260\"   \/>\n\t\t\t\t\t<label for='choice_65_260_1' id='label_65_260_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_260'>If you are not at fault, you may be entitled to compensation for the costs of using a replacement car. To apply for compensation in a traffic accident case, fill in the vehicle usage needs report on the next page. <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_259' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_259' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_9' class='gform_page' data-js='page-field-id-259' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_269\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Usage needs report<\/h2>\n<h3>Basis for Using a Replacement Car<\/h3>\n<p style=\"font-size:13px; color:#666666;\">The Insurance company will cover the costs incurred for use as described below if the use of the car is\nsufficiently justified or if business operations would otherwise suffer unreasonable harm. The usage needs report must be provided\nwith this form or another report containing equivalent information. <\/p>\n<h3>Insurance Covers<\/h3>\n<ul style=\"padding-left:30px; font-size:13px; color:#666666;\">\n\t<li>94% of daily and per-kilometer charges or the weekly price without a mileage limit when it is your own car or\n a finance lease.<\/li>\n\t<li>100% of daily and per-kilometer charges or the weekly price without a mileage limit when it is a maintenance lease.<\/li>\n\t<li>A copy of the maintenance lease agreement will be provided to the Insurance company upon request.<\/li>\n<\/ul>\n<h3>Insurance Does not Cover<\/h3>\n<ul style=\"padding-left:30px; font-size:13px; color:#666666;\">\n\t<li>Costs related to the replacement car, such as fuel, waiver of deductible, etc.<\/li>\n\t<li>A separate compensation for downtime during the rental period.<\/li>\n\t<li>The deductible is 6% of the rental costs, which corresponds on average to savings in vehicle operating costs during downtime (tire, repair, and maintenance costs).<\/li>\n<\/ul>\n<h3>Points to Note when Renting a Car<\/h3>\n<p style=\"font-size:13px; color:#666666;\">The replacement car must be no larger or more expensive than your own vehicle.\nThe renter is responsible for paying the rental costs unless the Insurance company states it will be responsible for them.\nCheck coverage with the Insurance company.<\/p><\/div><fieldset id=\"field_65_304\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox copy-275-to-276 copy-37-to-277 copy-101-to-278 copy-275-to-279 copy-122-to-280 copy-35-to-284 copy-33-to-283 copy-36-to-285 copy-39-to-286 copy-119-to-300 copy-120-to-301 copy-275-to-302 gwcopy field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Prefill fields based on the information I have already provided<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_304'><div class='gchoice gchoice_65_304_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.1' type='checkbox'  value='Yes, prefill the information'  id='choice_65_304_1'   aria-describedby=\"gfield_description_65_304\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_304_1' id='label_65_304_1' class='gform-field-label gform-field-label--type-inline'>Yes, prefill the information<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_304'>If you select Yes, the service will prefill some fields based on the information you have already provided. You can still change the prefilled information if you wish, and in any case please check that all details in the usage needs report are correct! <\/div><\/fieldset><div id=\"field_65_261\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Party causing the damage<\/h3><\/div><fieldset id=\"field_65_271\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Driver\u2019s name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_271'>\n                            \n                            <span id='input_65_271_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_271.3' id='input_65_271_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_271_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_271_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_271.6' id='input_65_271_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_271_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_272\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_272'>License plate number<\/label><div class='ginput_container ginput_container_text'><input name='input_272' id='input_65_272' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_272\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_272'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_274\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_274'>Claim number<\/label><div class='ginput_container ginput_container_text'><input name='input_274' id='input_65_274' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_65_276\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Policyholder\u2019s name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_276'>\n                            \n                            <span id='input_65_276_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_276.3' id='input_65_276_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_276_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_276_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_276.6' id='input_65_276_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_276_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_277\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_277'>Insurance company<\/label><div class='ginput_container ginput_container_select'><select name='input_277' id='input_65_277' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='AXA' >AXA<\/option><option value='Euro Insurances (Ayvens T\u00e4ysvakuutus)' >Euro Insurances (Ayvens T\u00e4ysvakuutus)<\/option><option value='Fennia' >Fennia<\/option><option value='IF' >IF<\/option><option value='L\u00e4hiTapiola' >L\u00e4hiTapiola<\/option><option value='Pohjant\u00e4hti' >Pohjant\u00e4hti<\/option><option value='Pohjola' >Pohjola<\/option><option value='POP' >POP<\/option><option value='Protector' >Protector<\/option><option value='Turva' >Turva<\/option><option value='Valtionkonttori' >Valtionkonttori<\/option><\/select><\/div><\/div><div id=\"field_65_278\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_278'>Date of incident<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_278' id='input_65_278' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_with_icon gdatepicker_with_icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_65_278_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_65_278_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_65_278' class='gform_hidden' value='https:\/\/www.incar.fi\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_65_262\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Renter<\/h3><\/div><fieldset id=\"field_65_279\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Renter\u2019s name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_279'>\n                            \n                            <span id='input_65_279_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_279.3' id='input_65_279_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_279_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_279_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_279.6' id='input_65_279_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_279_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_281\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_281'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_281' id='input_65_281' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_280\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_280'>Daytime phone (8 am\u20134 pm)<\/label><div class='ginput_container ginput_container_phone'><input name='input_280' id='input_65_280' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_65_282\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_282' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_282_1_container' >\n                                        <input type='text' name='input_282.1' id='input_65_282_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_282_1' id='input_65_282_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_282_3_container' >\n                                    <input type='text' name='input_282.3' id='input_65_282_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_282_3' id='input_65_282_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_282.4' id='input_65_282_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_282_5_container' >\n                                    <input type='text' name='input_282.5' id='input_65_282_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_282_5' id='input_65_282_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_282.6' id='input_65_282_6' value='Suomi' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_263\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Damaged vehicle<\/h3><\/div><div id=\"field_65_283\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_283'>License plate number<\/label><div class='ginput_container ginput_container_text'><input name='input_283' id='input_65_283' type='text' value='' class='large'  aria-describedby=\"gfield_description_65_283\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_65_283'>Enter the license plate in the format: ABC-123.<\/div><\/div><div id=\"field_65_284\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_284'>Make and model<\/label><div class='ginput_container ginput_container_text'><input name='input_284' id='input_65_284' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_285\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_285'>Model year<\/label><div class='ginput_container ginput_container_text'><input name='input_285' id='input_65_285' type='text' value='' class='large' maxlength='4'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_264\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Leasing<\/h3><\/div><fieldset id=\"field_65_286\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is this a leased car?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_65_286'>\n\t\t\t<div class='gchoice gchoice_65_286_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_286' type='radio' value='Yes'  id='choice_65_286_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_286_0' id='label_65_286_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_65_286_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_286' type='radio' value='No'  id='choice_65_286_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_65_286_1' id='label_65_286_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_65_287\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If the car is a leased vehicle, is it:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_287'><div class='gchoice gchoice_65_287_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_287.1' type='checkbox'  value='Finance lease'  id='choice_65_287_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_287_1' id='label_65_287_1' class='gform-field-label gform-field-label--type-inline'>Finance lease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_287_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_287.2' type='checkbox'  value='Maintenance lease'  id='choice_65_287_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_287_2' id='label_65_287_2' class='gform-field-label gform-field-label--type-inline'>Maintenance lease<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_288\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_288'>Name of the maintenance leasing company<\/label><div class='ginput_container ginput_container_text'><input name='input_288' id='input_65_288' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_265\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Usage need<\/h3><\/div><fieldset id=\"field_65_289\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Usage need<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_289'><div class='gchoice gchoice_65_289_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_289.1' type='checkbox'  value='Business driving'  id='choice_65_289_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_289_1' id='label_65_289_1' class='gform-field-label gform-field-label--type-inline'>Business driving<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_289_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_289.2' type='checkbox'  value='Commute between home and workplace'  id='choice_65_289_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_289_2' id='label_65_289_2' class='gform-field-label gform-field-label--type-inline'>Commute between home and workplace<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_65_289_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_289.3' type='checkbox'  value='Other specific reason'  id='choice_65_289_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_289_3' id='label_65_289_3' class='gform-field-label gform-field-label--type-inline'>Other specific reason<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_290\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_290'>Business driving per week (km)<\/label><div class='ginput_container ginput_container_text'><input name='input_290' id='input_65_290' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_291\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_291'>Business driving per month (km)<\/label><div class='ginput_container ginput_container_text'><input name='input_291' id='input_65_291' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_292\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_292'>Explanation of public transport options for the commute<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_292' id='input_65_292' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_65_293\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_293'>Justification for the other specific reason<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_293' id='input_65_293' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_65_305\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >The rental company is already known<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_305'><div class='gchoice gchoice_65_305_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_305.1' type='checkbox'  value='Yes, I will provide the rental company\u2019s details'  id='choice_65_305_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_305_1' id='label_65_305_1' class='gform-field-label gform-field-label--type-inline'>Yes, I will provide the rental company\u2019s details<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_65_266\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Rental company<\/h3><\/div><div id=\"field_65_294\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_294'>Rental company name<\/label><div class='ginput_container ginput_container_text'><input name='input_294' id='input_65_294' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_295\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_295'>Rental company phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_295' id='input_65_295' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_65_296\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Rental company address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_296' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_296_1_container' >\n                                        <input type='text' name='input_296.1' id='input_65_296_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_296_1' id='input_65_296_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_296_3_container' >\n                                    <input type='text' name='input_296.3' id='input_65_296_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_296_3' id='input_65_296_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_296.4' id='input_65_296_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_296_5_container' >\n                                    <input type='text' name='input_296.5' id='input_65_296_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_296_5' id='input_65_296_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_296.6' id='input_65_296_6' value='Suomi' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_267\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Employer\/company<\/h3><\/div><div id=\"field_65_297\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_297'>Employer\u2019s name<\/label><div class='ginput_container ginput_container_text'><input name='input_297' id='input_65_297' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_298\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_298'>Employer\u2019s phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_298' id='input_65_298' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_65_299\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Employer\u2019s address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_65_299' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_65_299_1_container' >\n                                        <input type='text' name='input_299.1' id='input_65_299_1' value=''    aria-required='false'    \/>\n                                        <label for='input_65_299_1' id='input_65_299_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_65_299_3_container' >\n                                    <input type='text' name='input_299.3' id='input_65_299_3' value=''    aria-required='false'    \/>\n                                    <label for='input_65_299_3' id='input_65_299_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_299.4' id='input_65_299_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_65_299_5_container' >\n                                    <input type='text' name='input_299.5' id='input_65_299_5' value=''    aria-required='false'    \/>\n                                    <label for='input_65_299_5' id='input_65_299_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_299.6' id='input_65_299_6' value='Suomi' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_65_268\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Signature for the usage needs report<\/h3><\/div><div id=\"field_65_300\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_300'>Place<\/label><div class='ginput_container ginput_container_text'><input name='input_300' id='input_65_300' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_301\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_301'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_301' id='input_65_301' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_with_icon gdatepicker_with_icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_65_301_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_65_301_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_65_301' class='gform_hidden' value='https:\/\/www.incar.fi\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_65_302\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name of the person submitting the report<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_302'>\n                            \n                            <span id='input_65_302_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_302.3' id='input_65_302_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_302_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_302_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_302.6' id='input_65_302_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_65_302_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_65_130' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_65_130' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_65_10' class='gform_page' data-js='page-field-id-130' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_65_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_65_420\" class=\"gfield gfield--type-html gfield--input-type-html gf_alert_blue gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><strong>Thank you!<\/strong>  Click Save and send to finish, then you will complete the claim submission in your Insurance company\u2019s own service.<\/p><\/div><div id=\"field_65_131\" class=\"gfield gfield--type-html gfield--input-type-html gf_alert_blue gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>On this page, you can check that the information you provided is correct. If you find any errors, you can go back to edit the information by using the form\u2019s Previous button to navigate to the desired section. <\/p>\n<p><strong>Note! Do not use your browser\u2019s Back or Forward buttons to navigate.\n<\/strong><\/p>\n<p>Finally, accept the terms of use at the bottom of this page and send the information by clicking <strong>\u201cSave and send\u201d<\/strong> at the bottom of this page.<\/p><\/div><div id=\"field_65_129\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >{all_fields}<\/div><div id=\"field_65_117\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">I confirm that the information I provided is correct<\/h3><\/div><div id=\"field_65_119\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_119'>Place<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_65_119' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_120\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_120'>Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input readonly='readonly' name='input_120' id='input_65_120' type='text' value='' class='gpro-disabled-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_65_120_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_65_120_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\n                        <input type=\"hidden\" id=\"gwro_hidden_capture_65_120\" name=\"gwro_hidden_capture_65_120\" value=\"\" class=\"gf-default-disabled\" \/><\/div>\n                        <input readonly='readonly' type='hidden' id='gforms_calendar_icon_input_65_120' class='gform_hidden' value='https:\/\/www.incar.fi\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_65_275\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name of the person submitting the report<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_65_275'>\n                            \n                            <span id='input_65_275_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_275.3' id='input_65_275_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_275_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_65_275_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_275.6' id='input_65_275_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_65_275_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_65_122\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_122'>Phone number of the person submitting the report<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_122' id='input_65_122' type='tel' value='' class='large'  placeholder='e.g. 0401234567' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_65_123\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_65_123'>Email of the person submitting the report<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_123' id='input_65_123' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_65_257\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I want a copy of the form in my email<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_65_257'><div class='gchoice gchoice_65_257_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_257.1' type='checkbox'  value='Yes, send the information'  id='choice_65_257_1'   aria-describedby=\"gfield_description_65_257\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_65_257_1' id='label_65_257_1' class='gform-field-label gform-field-label--type-inline'>Yes, send the information<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_65_257'>I want all the information I provided to be emailed to me.<\/div><\/fieldset><fieldset id=\"field_65_392\" class=\"gfield gfield--type-tos gfield--type-choice gfield--input-type-checkbox text-small gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Service terms of use and privacy policy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container'><textarea  readonly='readonly'  id='gw_terms_392' class='text-small medium textarea' rows='10' cols='50'>1. General\n\nUser\nThe User must be at least 18 years old. Minors under 18 may use the Service only with the consent of a guardian. \n\nThe electronic claim form is an online service (hereinafter the \u201cService\u201d) provided by InCar Oy (hereinafter \u201cInCar\u201d), Business ID 0829741-9. Through the incar.fi website, the Service allows the User (hereinafter the \u201cUser\u201d) to send information related to their traffic accident to InCar. \n\nThese terms of use apply between InCar and the User with respect to the Service. The User confirms that they have carefully read these terms before using the Service and agrees to comply with them. \n\n2. Use of the Service\n\nThe Service is available twenty-four (24) hours a day, except during times when it is unavailable due to maintenance,\ninstallation, modifications, public order and safety, system overload, or other similar reasons.\n\nInCar has the right to add, modify, and remove parts of the Service and to discontinue maintaining the Service in part or in full. InCar is not responsible for any typographical and\/or printing errors on the incar.fi website and reserves the right to change the material and information on the website. \n\nThe User receives and uses the Service at their own risk and is responsible for acquiring, maintaining, and properly protecting the devices, connections, and software necessary to use the Service, as well as for information security.\n\nThe Service and its content are protected under copyright law and international agreements.\nAll rights to the Service, including copyrights, are held by InCar.\nThe User is granted a limited right of use to the Service under this agreement.\nThe User is not entitled to store, publicly display, transmit, retransmit, or otherwise use the Service or any content received through it except as permitted under these terms of use and copyright law.\nThe User may not use the Service in a way that infringes the copyrights or other rights of InCar or third parties.\n\nSending information to InCar via the Service does not obligate the User or any other party to purchase repair services and\/or other services from InCar related to the reported damage.\n\n3. Limitation of liability\n\nInCar is not a party to the contract between the User and the Insurance company.\nNor is InCar in any way responsible for any compensation based on the contract between the User and the Insurance company specified by the User in the Service in the event of damage, or for any measures related to seeking compensation.\n\n\nNor is InCar responsible for any damage caused to the Consumer or third parties by the use of the Service or by malfunctions, technical defects, malicious software,\nlinks, or interruptions occurring in it.\n\n4. Intellectual property rights\nInCar reserves all intellectual property rights to the information offered on the incar.fi website and to published content, information, images, videos, and databases.\n\n\n5. Personal Data Act (523\/99) section 10, date of drafting the privacy policy 22 December 2014\n\nData controller:\nInCar Oy\nTakomotie 1\u20133\n00380 Helsinki\ntel. 0300 247 247\nEmail: vahinkoilmoitus@incar.fi\nBusiness ID: 0829741-9 \n\nRegister matters:\nData Protection Officer, tietosuoja@suviagroup.com\n\nName of the register: Customer register for InCar Oy\u2019s electronic services\n\nPurpose of the register: Customer relationship management\n\nData content of the register: User\u2019s Name, Personal Identity Code, Address, Email Address, Phone Number, Driver\u2019s License details. In addition, vehicle details, the vehicle owner\u2019s and holder\u2019s details, and information related to the traffic accident, such as damage details of the vehicle(s) and details of other parties, the time, location, and conditions of the damage. The register also stores information on personal injuries, police investigations, and witnesses related to the damage, as well as historical data on all of the above according to the User\u2019s use of the Service.  \n\nRegular sources of data: The customer enters the data into the system themselves.\n\nRegular disclosures and transfers of data:\nInCar discloses the information provided by the User only to the Insurance companies specified by the User in the Service.\n\nPrinciples of register protection:\nOnly those persons whose work duties include it use the information in the register. The register is located on a protected server, the data of which can only be accessed with a username and password. \n\nVerification of information:\nThe user has the right to check their information in the register in accordance with the Personal Data Act.\nThe user is entitled to check their register information free of charge no more than once a year.\nIf the user wants to check their information more often, InCar is entitled to charge a fee for providing the information.\n\n6. Cookies and other similar technologies\n\nInCar may collect information about the User&#8217;s terminal device using cookies and other technologies. Cookies do not harm the User&#8217;s terminal device or files.\nThe purpose of using cookies and other technologies is to analyze and further develop services to better serve the consumer. The information obtained through cookies and other technologies is anonymous in nature.  \n\nThe user has the option to prevent the use of cookies by changing their browser settings. Preventing the use of cookies may affect the functionality of the Service or parts of it. \n\n\n7. Information security\n\nInCar uses technical and organizational information security measures to protect personal data against unauthorized access, disclosure,\ndestruction or other unauthorized processing.\n\nThe user is aware that the use of an open information network involves an information security risk.\nInCar is not responsible for the User&#8217;s information security when using the Service. The user is responsible for the protection and information security of computers, information systems, local networks or other similar devices or systems. The user is responsible for the consequences of insufficient protection and  \n\ndamages caused to InCar, other Users of the Service or other third parties by viruses and other similar harms that have entered or spread through the network due to the User.\n\n8. Applicable law and dispute resolution\n\nThese terms are governed by Finnish law. Any disputes will be attempted to be resolved through negotiations.\nIf an agreement cannot be reached, disputes will be resolved in the Helsinki District Court. \n\n9. Validity of terms\n\nThese terms come into effect on January 12, 2015 and are valid until further notice.\nInCar has the right to change the terms of use of the Service.<\/textarea><\/div><div class=\"ginput_container gptos_input_container\"><div class=\"gfield_checkbox\" id=\"input_65_392\"><div class='gchoice gchoice_65_392_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_392.1' type='checkbox'  value='I accept the terms of use'  id='choice_65_392_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_65_392_1' id='label_65_392_1' class='gform-field-label gform-field-label--type-inline'>I accept the terms of use<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_65' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' 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