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| 1 | + |
| 2 | + |
| 3 | +<div class="question YesNo" style="background-image: none; background-color: rgba(0, 0, 0, 0);"> |
| 4 | + <div class="text">tbd</div> |
| 5 | + <label class="check-container">Yes |
| 6 | + <input id="question_y_" type="radio" value="Yes" name="question_"> |
| 7 | + <span class="checkmark"></span> |
| 8 | + </label> |
| 9 | + <label class="check-container">No |
| 10 | + <input id="question_n_" type="radio" value="No" name="question_" > |
| 11 | + <span class="checkmark"></span> |
| 12 | + </label> |
| 13 | +</div> |
| 14 | + |
| 15 | +<!-- checkbox --> |
| 16 | +<div class="question YesNo" style="background-image: none; background-color: rgba(0, 0, 0, 0);"> |
| 17 | + <div class="text">tbd</div> |
| 18 | + <label class="check-container">Option 1 |
| 19 | + <input id="question_y_" type="checkbox" checked="checked"> |
| 20 | + <span class="checkmark"></span> |
| 21 | + </label> |
| 22 | + <label class="check-container">Option 2 |
| 23 | + <input id="question_n_" type="checkbox"> |
| 24 | + <span class="checkmark"></span> |
| 25 | + </label> |
| 26 | +</div> |
| 27 | + |
| 28 | +<!-- money question--> |
| 29 | +<div id="question_wageroll" class="question Money RISKGROUP_ID_5593"> |
| 30 | + <div class="text">Wageroll</div> |
| 31 | + <span class="char_label prefix">£</span><input tabindex="1" type="text" |
| 32 | + id="question_wageroll_input" name="LossofRent" value="0" |
| 33 | + class="number_input cover Money"><span class="char_label suffix"></span> |
| 34 | +</div> |
| 35 | + |
| 36 | + |
| 37 | + |
| 38 | +<!-- Money question with help --> |
| 39 | +<input type="hidden" id="trigger_2313BuildSIM" name="trigger_2313BuildSIM" value=""> |
| 40 | +<div id="question_2313BuildSIM" class="question Money RISKGROUP_ID_5593"><input type="hidden" |
| 41 | + id="questionName_2313BuildSIM" class="questionName" value="2313BuildSIM"> |
| 42 | + <div class="text">Buildings<a href="" class="help_link" |
| 43 | + onclick="this.blur(); return false;"><img alt="" src="https://picsum.photos/10/10" |
| 44 | + class="bozo"> |
| 45 | + <div class="help_text ttRight">Day One Reinstatement Value</div> |
| 46 | + </a> |
| 47 | + <div class="info_text">Including Subsidence and Landlords Fixtures and Fittings</div> |
| 48 | + </div> |
| 49 | + <span class="char_label prefix">£</span><input tabindex="1" type="text" id="2313BuildSIM" |
| 50 | + name="2313BuildSIM" value="0" class="number_input cover Money"><span |
| 51 | + class="char_label suffix"></span> |
| 52 | + <input type="hidden" id="2313BuildSIM_rate" name="2313BuildSIM_rate" class="rate" |
| 53 | + value="0.0000"> |
| 54 | + <input type="hidden" id="2313BuildSIM_result" name="2313BuildSIM_result" class="result" |
| 55 | + value="0"> |
| 56 | +</div> |
| 57 | + |
| 58 | +<!-- Subsection --> |
| 59 | +<div class="question SmallTitle"> |
| 60 | + <h5><u><b>Financial</b></u></h5> |
| 61 | + <div class="info_text"></div> |
| 62 | +</div> |
| 63 | + |
| 64 | + |
| 65 | +<!-- Bold --> |
| 66 | +<div id="question_Declaration5" class="question SmallTitle RISKGROUP_ID_0"><input type="hidden" |
| 67 | + id="questionName_Declaration5" class="questionName" value="Declaration5"> |
| 68 | + <h5><b>Neither the Proposer, nor any directors or partners in the business or in the name of |
| 69 | + any other business which any of us had an interest have:-</b></h5> |
| 70 | + <div class="info_text"></div> |
| 71 | +</div> |
| 72 | + |
| 73 | +<!-- Yes no question qif --> |
| 74 | +<div id="question_" class="question YesNo"> |
| 75 | + <div class="text">been declared bankrupt or insolvent either as private individuals or in |
| 76 | + connection with any business within the last ten years.</div> |
| 77 | + <label class="radio" for="question_y_TBD"> |
| 78 | + <input tabindex="1" type="radio" |
| 79 | + onclick="this.blur(); document.getElementById('TBD').style=null" |
| 80 | + name="2313disclosheader4" id="question_y_TBD" value="Yes" class="radio"><span |
| 81 | + class="radioMark"> |
| 82 | + </span>Yes |
| 83 | + </label> |
| 84 | + <label class="radio" for="question_n_TBD"><input tabindex="1" type="radio" |
| 85 | + onclick="this.blur(); document.getElementById('TBD').style='display: none;'" |
| 86 | + name="2313disclosheader4" id="question_n_TBD" value="No" checked="checked" |
| 87 | + class="radio"><span class="radioMark"></span>No |
| 88 | + </label> |
| 89 | + <input type="hidden" name="ignore-2313disclosheader4" value="" class="radio-default"> |
| 90 | +</div> |
| 91 | +<input type="hidden" id="trigger_2313CCJdetails" name="trigger_2313CCJdetails" value="HIDDEN"> |
| 92 | +<div id="TBD" class="question TextArea trigger_question RISKGROUP_ID_0" style="display: none;"> |
| 93 | + <div class="text">Please provide full details:</div> |
| 94 | + <textarea tabindex="1" id="TBD" name="2313CCJdetails" rows="5" |
| 95 | + class="text_input"></textarea> |
| 96 | +</div> |
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