{"id":1006,"date":"2023-08-02T15:01:43","date_gmt":"2023-08-02T20:01:43","guid":{"rendered":"https:\/\/danica-insurance.com\/?p=1006"},"modified":"2023-11-29T12:16:40","modified_gmt":"2023-11-29T17:16:40","slug":"nuestro-formulario","status":"publish","type":"post","link":"https:\/\/danica-insurance.com\/en\/formulario\/nuestro-formulario\/","title":{"rendered":"Nuestro Formulario"},"content":{"rendered":"<div class=\"wp-block-columns slider-interna is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/div><\/div><div style=\"height:19px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div><h3 class=\"wp-block-heading has-text-align-center has-text-color\" style=\"color:#0582f1\"><strong>Solicitud Vincunlaci\u00f3n Danica Group Insurance<\/strong><\/h3><div class=\"wp-block-columns formulario-qr is-layout-flex wp-container-core-columns-is-layout-2 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1502-o1\" lang=\"es-CO\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/posts\/1006\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/posts\/1006#wpcf7-f1502-o1\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1502\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_CO\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1502-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div class=\"three-columns\">\n\t<div class=\"column\">\n\t\t<p><label>First and last name:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Fecha de Nacimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"born-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"born-date\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Email:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"three-columns\">\n\t<div class=\"column\">\n\t\t<p><label>Direcci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-address\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Zip Code:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-estate\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-estate\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Estado:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"four-columns\">\n\t<div class=\"column\">\n\t\t<p><label>Nombre del Banco:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-bank\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-bank\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Nro de Cuenta:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-account-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-account-number\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Nro de Ruta:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-rute-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-rute-number\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone-number\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"four-columns\">\n\t<div class=\"column\">\n\t\t<p><label>Identificaci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-id\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-id\"><option value=\"Seguro Social\">Seguro Social<\/option><option value=\"N\u00famero ITin\">N\u00famero ITin<\/option><option value=\"Pasaporte\">Pasaporte<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Nro de Identificaci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-id-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-id-number\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Valor a Pagar:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-paid-value\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-paid-value\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Fecha de Pago:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fecha-pago\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"fecha-pago\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p class=\"info-bene\"><b>Informaci\u00f3n Beneficiarios:<\/b>\n<\/p>\n<p><label> Nombre y apellido del Beneficiario:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name-lastname1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name-lastname1\" \/><\/span> <\/label>\n<\/p>\n<p><label> Parentezco:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parent1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parent1\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nombre y apellido del Beneficiario:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name-lastname2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name-lastname2\" \/><\/span> <\/label>\n<\/p>\n<p><label> Parentezco:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parent2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parent2\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nombre y apellido del Beneficiario:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name-lastname3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name-lastname3\" \/><\/span> <\/label>\n<\/p>\n<p><label> Parentezco:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parent3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parent3\" \/><\/span> <\/label>\n<\/p>\n<p><label><\/label>\n<\/p>\n<p class=\"info-bene\"><b>Producto:<\/b>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-producto\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-producto\"><option value=\"Incapacidad por Accidente\">Incapacidad por Accidente<\/option><option value=\"Incapacitaci\u00f3n por Accidentes o Enfermedad\">Incapacitaci\u00f3n por Accidentes o Enfermedad<\/option><option value=\"Seguro de Cancer\">Seguro de Cancer<\/option><option value=\"Seguro Funerario\">Seguro Funerario<\/option><option value=\"Seguro de Vida\">Life Insurance<\/option><option value=\"Dental y Visi\u00f3n\">Dental y Visi\u00f3n<\/option><option value=\"Impuestos (Taxes)\">Impuestos (Taxes)<\/option><\/select><\/span>\n<\/p>\n<div class=\"four-columns\">\n\t<div class=\"column\">\n\t\t<p><label>Peso:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-weight\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-weight\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Talla:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-size\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-size\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Ingreso Mensual:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-salary\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-salary\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label>Medicamentos:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-medicines\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-medicines\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label> Observaciones:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-6\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-6\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"politicadatos\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"politicadatos\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I accept the policy of <b>data privacy.<\/b><\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SEND\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"158\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Solicitud Vincunlaci\u00f3n Danica Group Insurance<\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"categories":[13],"tags":[],"class_list":["post-1006","post","type-post","status-publish","format-standard","hentry","category-formulario"],"_links":{"self":[{"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/posts\/1006"}],"collection":[{"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/comments?post=1006"}],"version-history":[{"count":26,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/posts\/1006\/revisions"}],"predecessor-version":[{"id":1504,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/posts\/1006\/revisions\/1504"}],"wp:attachment":[{"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/media?parent=1006"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/categories?post=1006"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danica-insurance.com\/en\/wp-json\/wp\/v2\/tags?post=1006"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}