{"id":879,"date":"2022-12-02T15:52:54","date_gmt":"2022-12-02T15:52:54","guid":{"rendered":"https:\/\/interexpatriate.com\/?page_id=879"},"modified":"2022-12-02T20:35:47","modified_gmt":"2022-12-02T20:35:47","slug":"leads","status":"publish","type":"page","link":"https:\/\/myinterbrokers.com\/","title":{"rendered":"leads"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"879\" class=\"elementor elementor-879\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-67c56a1 elementor-section-full_width elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"67c56a1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-3b9188c\" data-id=\"3b9188c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-137c817\" data-id=\"137c817\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3d178f0 elementor-widget elementor-widget-image\" data-id=\"3d178f0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.8.1 - 13-11-2022 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"300\" height=\"121\" src=\"https:\/\/myinterbrokers.com\/wp-content\/uploads\/2022\/12\/InterBrokers_Group_Logo_1@2x-8-300x121.png\" class=\"attachment-medium size-medium\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/myinterbrokers.com\/wp-content\/uploads\/2022\/12\/InterBrokers_Group_Logo_1@2x-8-300x121.png 300w, https:\/\/myinterbrokers.com\/wp-content\/uploads\/2022\/12\/InterBrokers_Group_Logo_1@2x-8-1024x413.png 1024w, https:\/\/myinterbrokers.com\/wp-content\/uploads\/2022\/12\/InterBrokers_Group_Logo_1@2x-8-768x310.png 768w, https:\/\/myinterbrokers.com\/wp-content\/uploads\/2022\/12\/InterBrokers_Group_Logo_1@2x-8.png 1244w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-ae926aa\" data-id=\"ae926aa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c9cc7db elementor-widget elementor-widget-heading\" data-id=\"c9cc7db\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.8.1 - 13-11-2022 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">\u00bfQUE TIPO DE POLIZA <BR>DESEA COTIZAR?<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-eb6eb4d elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"eb6eb4d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-901ef56\" data-id=\"901ef56\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3c046e7 elementor-widget elementor-widget-heading\" data-id=\"3c046e7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-905 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-905\" data-uid=\"6a0c5e33e5acc\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-905\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-905 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"905\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a0c5e33e5acc\"\n\t\t\t><div class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><select id=\"forminator-form-905__field--select-1_6a0c5e33e5acc\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"QUE TIPO DE POLIZA DESEA COTIZAR?\" data-search=\"false\"><option value=\"\">QUE TIPO DE POLIZA DESEA COTIZAR?<\/option><option value=\"one\"  data-calculation=\"0\">Expatriados<\/option><option value=\"two\"  data-calculation=\"0\">Salud Internacional<\/option><option value=\"Viaje-Anual\"  data-calculation=\"0\">Viaje Anual<\/option><option value=\"Viaje-Simple\"  data-calculation=\"0\">Viaje Simple<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-1_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-1_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-1-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a0c5e33e5acc\" class=\"forminator-label\">Nacionalidad<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a0c5e33e5acc\" class=\"forminator-label\">Residencia<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">El cliente esta en EEUU actualmente?<\/h4><label for=\"forminator-field-checkbox-1-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-1-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a0c5e33e5acc\" class=\"forminator-label\">Estado:<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-2-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-2-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 1<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-2_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-2_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-2-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-2-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a0c5e33e5acc\" class=\"forminator-label\">Nacionalidad<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a0c5e33e5acc\" class=\"forminator-label\">Residencia<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">El cliente esta en EEUU actualmente?<\/h4><label for=\"forminator-field-checkbox-3-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-3-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a0c5e33e5acc\" class=\"forminator-label\">Estado:<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-5-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-5-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 2<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-3_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-3_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-col forminator-col-12 \"><label for=\"forminator-field-date-3\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-3-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-month_6a0c5e33e5acc\" class=\"forminator-label\">Mes<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-3-month\" value=\"\" placeholder=\"Ejemplo: 01\" id=\"forminator-field-date-3-month_6a0c5e33e5acc\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-3\" \/><\/div><\/div><div id=\"date-3-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-day_6a0c5e33e5acc\" class=\"forminator-label\">D\u00eda<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-3-day\" value=\"\" placeholder=\"Ejemplo: 01\" id=\"forminator-field-date-3-day_6a0c5e33e5acc\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-3\" \/><\/div><\/div><div id=\"date-3-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-year_6a0c5e33e5acc\" class=\"forminator-label\">A\u00f1o<\/label><input type=\"number\" min=\"1\" name=\"date-3-year\" placeholder=\"Ejemplo: 2000\" id=\"forminator-field-date-3-year_6a0c5e33e5acc\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-3\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6a0c5e33e5acc\" class=\"forminator-label\">Nacionalidad<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a0c5e33e5acc\" class=\"forminator-label\">Residencia<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">El cliente esta en EEUU actualmente?<\/h4><label for=\"forminator-field-checkbox-4-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-4-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a0c5e33e5acc\" class=\"forminator-label\">Estado:<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-6-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-6-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 3<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-4_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-4_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-4\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-4_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-4-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-4-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6a0c5e33e5acc\" class=\"forminator-label\">Nacionalidad<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6a0c5e33e5acc\" class=\"forminator-label\">Residencia<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">El cliente esta en EEUU actualmente?<\/h4><label for=\"forminator-field-checkbox-8-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-8-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6a0c5e33e5acc\" class=\"forminator-label\">Estado:<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-5_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-5\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-5_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-5_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-5\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-5_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-5-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-5-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de inicio<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6a0c5e33e5acc\" class=\"forminator-label\">Tiene seguro de salud en su pa\u00eds de residencia?<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6a0c5e33e5acc\" class=\"forminator-label\">Cual es su destino?<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6a0c5e33e5acc\" class=\"forminator-label\">El viaje incluir\u00e1 EEUU?<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6a0c5e33e5acc\" class=\"forminator-label\">30 dias o 45 dias maximo?<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-24\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_6a0c5e33e5acc\" class=\"forminator-label\">Pais de residencia<\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-9-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-9-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 1<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-26\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-26_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-26\" value=\"\" placeholder=\"\" id=\"forminator-field-text-26_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-6_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-6\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-6_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-6_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-6\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-6_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-6-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-6-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-27\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-27_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de inicio<\/label><input type=\"text\" name=\"text-27\" value=\"\" placeholder=\"\" id=\"forminator-field-text-27_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-28\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-28_6a0c5e33e5acc\" class=\"forminator-label\">Tiene seguro de salud en su pa\u00eds de residencia?<\/label><input type=\"text\" name=\"text-28\" value=\"\" placeholder=\"\" id=\"forminator-field-text-28_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-29\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-29_6a0c5e33e5acc\" class=\"forminator-label\">Cual es su destino?<\/label><input type=\"text\" name=\"text-29\" value=\"\" placeholder=\"\" id=\"forminator-field-text-29_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-30\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-30_6a0c5e33e5acc\" class=\"forminator-label\">El viaje incluir\u00e1 EEUU?<\/label><input type=\"text\" name=\"text-30\" value=\"\" placeholder=\"\" id=\"forminator-field-text-30_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-31\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-31_6a0c5e33e5acc\" class=\"forminator-label\">30 dias o 45 dias maximo?<\/label><input type=\"text\" name=\"text-31\" value=\"\" placeholder=\"\" id=\"forminator-field-text-31_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-32\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-32_6a0c5e33e5acc\" class=\"forminator-label\">Pais de residencia<\/label><input type=\"text\" name=\"text-32\" value=\"\" placeholder=\"\" id=\"forminator-field-text-32_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-25\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-25_6a0c5e33e5acc\" class=\"forminator-label\">Pais de ciudadania<\/label><input type=\"text\" name=\"text-25\" value=\"\" placeholder=\"\" id=\"forminator-field-text-25_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-10-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-10-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-12-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-12-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"two\" id=\"forminator-field-checkbox-12-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 2<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-40\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-40_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-40\" value=\"\" placeholder=\"\" id=\"forminator-field-text-40_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-7_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-7\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-7_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-7_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-7\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-7_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-7-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-7-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-39\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-39_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de inicio<\/label><input type=\"text\" name=\"text-39\" value=\"\" placeholder=\"\" id=\"forminator-field-text-39_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-38\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-38_6a0c5e33e5acc\" class=\"forminator-label\">Tiene seguro de salud en su pa\u00eds de residencia?<\/label><input type=\"text\" name=\"text-38\" value=\"\" placeholder=\"\" id=\"forminator-field-text-38_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-37\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-37_6a0c5e33e5acc\" class=\"forminator-label\">Cual es su destino?<\/label><input type=\"text\" name=\"text-37\" value=\"\" placeholder=\"\" id=\"forminator-field-text-37_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-36\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-36_6a0c5e33e5acc\" class=\"forminator-label\">El viaje incluir\u00e1 EEUU?<\/label><input type=\"text\" name=\"text-36\" value=\"\" placeholder=\"\" id=\"forminator-field-text-36_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-35\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-35_6a0c5e33e5acc\" class=\"forminator-label\">30 dias o 45 dias maximo?<\/label><input type=\"text\" name=\"text-35\" value=\"\" placeholder=\"\" id=\"forminator-field-text-35_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-34\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-34_6a0c5e33e5acc\" class=\"forminator-label\">Pais de residencia<\/label><input type=\"text\" name=\"text-34\" value=\"\" placeholder=\"\" id=\"forminator-field-text-34_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-33\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-33_6a0c5e33e5acc\" class=\"forminator-label\">Pais de ciudadania<\/label><input type=\"text\" name=\"text-33\" value=\"\" placeholder=\"\" id=\"forminator-field-text-33_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-14-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-14-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-13-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-13-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-6\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Familiar 3<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-48\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-48_6a0c5e33e5acc\" class=\"forminator-label\">Nombre y apellido<\/label><input type=\"text\" name=\"text-48\" value=\"\" placeholder=\"\" id=\"forminator-field-text-48_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-8_6a0c5e33e5acc\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-8\" value=\"\" placeholder=\"Ejemplo: +1 300 400 5000\" id=\"forminator-field-phone-8_6a0c5e33e5acc\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-8_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico<\/label><input type=\"email\" name=\"email-8\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-8_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de nacimiento<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-8-picker_6a0c5e33e5acc\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-8-picker_6a0c5e33e5acc\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-47\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-47_6a0c5e33e5acc\" class=\"forminator-label\">Fecha de inicio<\/label><input type=\"text\" name=\"text-47\" value=\"\" placeholder=\"\" id=\"forminator-field-text-47_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-46\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-46_6a0c5e33e5acc\" class=\"forminator-label\">Tiene seguro de salud en su pa\u00eds de residencia?<\/label><input type=\"text\" name=\"text-46\" value=\"\" placeholder=\"\" id=\"forminator-field-text-46_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-45\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-45_6a0c5e33e5acc\" class=\"forminator-label\">Cual es su destino?<\/label><input type=\"text\" name=\"text-45\" value=\"\" placeholder=\"\" id=\"forminator-field-text-45_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-44\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-44_6a0c5e33e5acc\" class=\"forminator-label\">El viaje incluir\u00e1 EEUU?<\/label><input type=\"text\" name=\"text-44\" value=\"\" placeholder=\"\" id=\"forminator-field-text-44_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-43\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-43_6a0c5e33e5acc\" class=\"forminator-label\">30 dias o 45 dias maximo?<\/label><input type=\"text\" name=\"text-43\" value=\"\" placeholder=\"\" id=\"forminator-field-text-43_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-42\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-42_6a0c5e33e5acc\" class=\"forminator-label\">Pais de residencia<\/label><input type=\"text\" name=\"text-42\" value=\"\" placeholder=\"\" id=\"forminator-field-text-42_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-41\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-41_6a0c5e33e5acc\" class=\"forminator-label\">Pais de ciudadania<\/label><input type=\"text\" name=\"text-41\" value=\"\" placeholder=\"\" id=\"forminator-field-text-41_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-16\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-16-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"one\" id=\"forminator-field-checkbox-16-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-16-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"two\" id=\"forminator-field-checkbox-16-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a0c5e33e5acc-label\"><h4 id=\"forminator-checkbox-group-6a0c5e33e5acc-label\" class=\"forminator-label\">Agregar miembro familiar?<\/h4><label for=\"forminator-field-checkbox-15-1-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"SI\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">SI<\/span><\/label><label for=\"forminator-field-checkbox-15-2-6a0c5e33e5acc\" class=\"forminator-checkbox\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a0c5e33e5acc\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0c5e33e5acc\" class=\"forminator-label\">Observaciones<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a0c5e33e5acc\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0c5e33e5acc\" class=\"forminator-label\">Agente <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Ejemplo: Juan P\u00e9rez\" id=\"forminator-field-name-1_6a0c5e33e5acc\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-9\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-9_6a0c5e33e5acc\" class=\"forminator-label\">Correo electr\u00f3nico del agente <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-9\" value=\"\" placeholder=\"Ej . : john@doe.com\" id=\"forminator-field-email-9_6a0c5e33e5acc\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Registro<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"a38e0feccf\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F879\" \/><input type=\"hidden\" name=\"form_id\" value=\"905\"><input type=\"hidden\" name=\"page_id\" value=\"879\"><input type=\"hidden\" name=\"form_type\" value=\"registration\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/myinterbrokers.com\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u00bfQUE TIPO DE POLIZA DESEA COTIZAR?<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/pages\/879"}],"collection":[{"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=879"}],"version-history":[{"count":16,"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/pages\/879\/revisions"}],"predecessor-version":[{"id":922,"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=\/wp\/v2\/pages\/879\/revisions\/922"}],"wp:attachment":[{"href":"https:\/\/myinterbrokers.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=879"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}