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const str = `<style>a.card-link{display:block;width:450px}</style><header class="container"><nav class="row"><ul class="nav nav-tabs"><li class="nav-item active"><a href="#HOME" class="nav-link" data-toggle="tab">Home</a></li><li class="nav-item"><a href="#tab-inventory" class="nav-link" data-toggle="tab">Inventory</a></li><li class="nav-item"><a href="#tab-general-information" class="nav-link" data-toggle="tab">General Information</a></li><li class="nav-item"><a href="#tab-house" class="nav-link" data-toggle="tab">House</a></li><li class="nav-item"><a href="#tab-car" class="nav-link" data-toggle="tab">Car</a></li><li class="nav-item"><a href="#tab-car-old" class="nav-link" data-toggle="tab">Car - Classic</a></li><li class="nav-item"><a href="#tab-van" class="nav-link" data-toggle="tab">Van</a></li><li class="nav-item"><a href="#tab-caravan" class="nav-link" data-toggle="tab">Caravan</a></li><li class="nav-item"><a href="#tab-camper" class="nav-link" data-toggle="tab">Camper</a></li><li class="nav-item"><a href="#tab-motorcycle" class="nav-link" data-toggle="tab">Motorcycle</a></li><li class="nav-item"><a href="#tab-motorcycle-old" class="nav-link" data-toggle="tab">Motorcycle - Classic</a></li><li class="nav-item"><a href="#tab-responsibility" class="nav-link" data-toggle="tab">Responsibility</a></li><li class="nav-item"><a href="#tab-legal-aid" class="nav-link" data-toggle="tab">Legal-Aid</a></li><li class="nav-item"><a href="#tab-accident-insurance" class="nav-link" data-toggle="tab">Accident Insurance</a></li><li class="nav-item"><a href="#tab-travel-cancellation" class="nav-link" data-toggle="tab">Travel/Cancellation</a></li><li class="nav-item"><a href="#tab-overview" class="nav-link" data-toggle="tab">Overview</a></li><li class="nav-item"><a href="#tab-provision-discounts" class="nav-link" data-toggle="tab">Provision Discounts</a></li></ul></nav></header><main class="tab-content"><article id="HOME" class="tab-pane container active"><section class="row"><div id="home-accordion" class="col-6-md col-12-sm"><div class="card"><div class="card-header"><a class="card-link" data-toggle="collapse" href="#home-col00">Home Col00</a></div><div id="home-col00" class="collapse show" data-parent="#home-accordion"><div class="card-body">This collapsible is open initially because it has class .show</div></div></div><div class="card"><div class="card-header"><a class="collapsed card-link" data-toggle="collapse" href="#home-col01">Home Col01</a></div><div id="home-col01" class="collapse" data-parent="#home-accordion"><div class="card-body">Home Col01 content</div></div></div><div class="card"><div class="card-header"><a class="collapsed card-link" data-toggle="collapse" href="#home-col02">Home Col02</a></div><div id="home-col02" class="collapse" data-parent="#home-accordion"><div class="card-body">Home Col02 content</div></div></div></div></section></article><hr><div role="tabpanel" class="tab-pane container" id="tab-inventory"><div class="row tp-wrapper"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><h1>Kies verzekering(en)</h1><div class="row verzekeringen-mogelijk-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><h4>woonpakket</h4><hr><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="house" data-productid="1"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-home fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Woonhuis</label><span class="amount-value badge">1</span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="responsibility" data-productid="2"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-file-text fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Aansprakelijkheid</label><span class="amount-value badge">1</span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="house" data-productid="3"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-television fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Inboedel</label><span class="amount-value badge">1</span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6 hidden" data-tab="house" data-productid="4"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-home fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Buitenshuisdekking</label><span class="amount-value badge">1</span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="legal-aid" data-productid="5"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-balance-scale fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Rechtsbijstand</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="accident-insurance" data-productid="6"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-medkit fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>(Gezins)ongevallen</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="travel-and-cancellation" data-productid="7"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-suitcase fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Reis & annulering</label><span class="amount-value badge">1</span></div></div></div></div></div></div><div class="row verzekeringen-mogelijk-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><h4>voertuigen</h4><hr><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="car" data-productid="9"><div class="well active active-well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-car fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Auto</label><span class="amount-value badge">1</span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="car-oldtimer" data-productid="10"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-car fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Oldtimer auto</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="motorcycle" data-productid="11"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-motorcycle fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Motor</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="motorcycle-oldtimer" data-productid="12"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-motorcycle fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Oldtimer motor</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="van" data-productid="13"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-truck fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Bestelauto</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="caravan" data-productid="14"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-car fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Caravan</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="camper" data-productid="18"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-car fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Kampeerauto</label><span class="amount-value badge"></span></div></div></div></div></div></div><div class="row verzekeringen-mogelijk-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><h4>overig</h4><hr><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="" data-productid="15"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-medkit fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Kortlopende reis</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="responsibility" data-productid="16"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-camera fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Kostbaarheden</label><span class="amount-value badge"></span></div></div></div></div><div class="verzekering-mogelijk col-lg-2 col-md-3 col-sm-4 col-xs-6" data-tab="house" data-productid="17"><div class="well"><div class="row"><div class="col-lg-8 col-md-8 col-sm-8 col-xs-8"><i class="fa fa-mobile fa-3x"></i></div><div class="col-lg-4 col-md-4 col-sm-4 col-xs-4"><button type="button" class="plus-button plus-minus-button btn btn-default"><i class="fa fa-plus fa-lg"></i></button> <button type="button" class="minus-button plus-minus-button btn btn-default"><i class="fa fa-minus fa-lg"></i></button></div></div><div class="row label-row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><label>Mobiele apparatuur</label><span class="amount-value badge"></span></div></div></div></div></div></div></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-general-information"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/generalinfo/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Verzekeringnemer</div><div class="panel-body"><p>De gegevens van de verzekeringnemer worden hier ingevuld</p><br/><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="initials" class="control-label">Relatienummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="initials" id="initials"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="lastname" class="control-label">Vergelijkingsnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="lastname" id="lastname"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="birthdate" class="control-label required">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control required" placeholder="dd-mm-jjjj" required="required" name="birthdate" value="09-05-1988" id="birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="gender" class="control-label required">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="gender_male" checked="checked" name="gender" type="radio" value="male"><label for="gender_male" class="control-label">Man</label><input id="gender_female" name="gender" type="radio" value="female"><label for="gender_female" class="control-label">Vrouw</label></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="family_situation" class="control-label required">Gezinssituatie</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control required" required="required" id="family_situation" name="family_situation"><option value="single_without_children" selected="selected">Alleenstaande zonder kinderen</option><option value="single_with_children">Alleenstaande met kinderen</option><option value="family_without_children">Gezin zonder kinderen</option><option value="family_with_children">Gezin met kinderen</option></select></div></div><div id="general_info_partner_birthdate" class="form-group"><input type="hidden" name="partner_initials"/> <input type="hidden" name="partner_lastname"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="partner_birthdate" class="control-label">Geboortedatum partner</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="partner_birthdate" id="partner_birthdate"></div></div></div></div><hr/><div id="general_info_amount_children" class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="amount_children" class="control-label">Aantal kinderen</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" min="1" max="8" name="amount_children" type="number" value="0" id="amount_children"></div></div><div id="general-info-children-repeater" class="repeater" data-children="[]"><div data-repeater-list="general-info-children-list"><div class="form-group" data-repeater-item style="display:none"><div class="repeater-label-col col-lg-4 col-md-4 col-xs-5"><label>Geboortedatum{index}</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input name="geboortedatum" class="form-control" placeholder="dd-mm-jjjj"/></div></div><input class="remove-repeater-item hidden" data-repeater-delete type="button" value="Delete"/></div><input class="add-repeater-item hidden" data-repeater-create type="button" value="Add"/></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="postcode" class="control-label required">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" required="required" name="postcode" value="7908NV" id="postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="housenumber" class="control-label required">Huisnummer en toevoeging</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" required="required" name="housenumber" value="37" id="housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="street" value="De Drift" id="street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="city" value="Hoogeveen" id="city"></div></div><hr/><div class="form-group"><div class="col-xs-12"><p class="text-right">Selecteer API voor de automatischeaanvulling woonhuisgegevens:</p><div class="btn-group pull-right" data-toggle="buttons"><label class="btn btn-default active"><input type="radio" name="options" id="option1" checked="checked"> Infofolio</label><label class="btn btn-default"><input type="radio" name="options" id="option2"> Kadaster</label></div></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="calculation_date" class="control-label required">Berekendatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control required" placeholder="dd-mm-jjjj" required="required" name="calculation_date" value="28-03-2018" id="calculation_date"></div></div></div><hr/><div class="form-group"><div class="col-xs-12"><p>Weging van de premie</p><div style="padding:0 15px"><input id="premium-points-slider" class="no-user-select full-size" data-setval=""/></div></div></div></div></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row" id="streetview-row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-house"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/house/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Te verzekeren objecten; en/of waar de inboedel zich bevindt</div></div><div class="panel-body"><p>De gegevens van het woonhuis zijn altijd nodig voor een woonhuis- en/of inboedelverzekering</p><br/><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_type" class="control-label">Type woning</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control api-fillable" id="house_type" name="house_type"><option value="vrijstaande-woning">Vrijstaande woning</option><option value="rijtjeswoning">Rijtjeswoning</option><option value="twee-onder-een-kap" selected="selected">Twee-onder-één-kap</option><option value="hoekwoning">Hoekwoning</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="buildyear" class="control-label">Bouwjaar</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="buildyear" value="1991" id="buildyear"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="surface_area" class="control-label">Vloeroppervlak</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">m²</div><input class="form-control api-fillable" name="surface_area" value="155" id="surface_area"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="contents" class="control-label">Inhoud</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">m³</div><input class="form-control api-fillable" name="contents" value="458" id="contents"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="roof_construction_type" class="control-label">Bouwaard dak</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="roof_construction_type" name="roof_construction_type"><option value="dakpannen" selected="selected">Dakpannen</option><option value="bitumen">Bitumen</option><option value="mastiek">Mastiek</option><option value="riet">Riet</option><option value="leisteen">Leisteen</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="roof_kind" class="control-label">Soort dak</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="roof_kind" name="roof_kind"><option value="schuin" selected="selected">Schuin</option><option value="plat">Plat</option></select></div></div><input type="hidden" name="has_chimney" value="geen-rookkanaal-voor-open-haard-of-kachel"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="walls_construction_type" class="control-label">Bouwaard muren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="walls_construction_type" name="walls_construction_type"><option value="steen-hard" selected="selected">Steen/hard</option><option value="hout">Hout</option></select></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="amount_rooms" class="control-label">Aantal kamers</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="amount_rooms" value="4" id="amount_rooms"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_improvements" class="control-label">Verbeteringen woning</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_improvements" name="house_improvements"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div><div class="house-improvements"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="bathroom_type" class="control-label">Badkamer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="bathroom_type" name="bathroom_type"><option value="eenvoudig">Eenvoudig</option><option value="normaal" selected="selected">Normaal</option><option value="luxe">Luxe</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="kitchen_type" class="control-label">Keuken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="kitchen_type" name="kitchen_type"><option value="eenvoudig">Eenvoudig</option><option value="normaal" selected="selected">Normaal</option><option value="luxe">Luxe</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_other_completions" class="control-label">Overige afbouw</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_other_completions" name="house_other_completions"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="rental_house" class="control-label">Huurwoning</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="rental_house" name="rental_house"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_development_plan" class="control-label">Bestemming woning</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_development_plan" name="house_development_plan"><option value="particulier-gebruik" selected="selected">Particulier gebruik</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_expansion" class="control-label">Bijgebouwd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_expansion" name="house_expansion"><option value="nee" selected="selected">Nee</option><option value="ja-kleiner-dan-25m2">Ja, kleiner dan 25m²</option><option value="ja-groter-dan-25m2">Ja, groter dan 25m²</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_expansion_surface_area" class="control-label">Opp. bijgebouw</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">m²</div><input class="form-control" name="house_expansion_surface_area" value="0" id="house_expansion_surface_area"></div></div></div></div></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-xs-12"><div class="panel panel-default"><div class="panel-heading">Aanvullende gegevens woonhuis en inboedel</div><div class="panel-body inputinlabel"><div class="row"><div class="col-md-4 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="netto_month_income_main_breadwinner" class="control-label">Netto maandinkomen hoofdkostwinner</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control required" id="netto_month_income_main_breadwinner" name="netto_month_income_main_breadwinner"><option value="">Selecteer maandinkomen</option><option value="<1000">< € 1.000</option><option value="1000-2000" selected="selected">€ 2.000</option><option value="2000-3000">€ 3.000</option><option value="3000-4850">€ 4.850</option><option value=">4850">> € 4.850</option></select></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="insure_glass" class="control-label">Glas meeverzekeren</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control" id="insure_glass" name="insure_glass"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="additional_risks_rent" class="control-label">Verhuur</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control" id="additional_risks_rent" name="additional_risks_rent"><option value="geen-verhuur" selected="selected">Geen verhuur</option><option value="gedeeltelijke-verhuur">Gedeeltelijke verhuur</option><option value="volledige-verhuur">Volledige verhuur</option></select></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="additional_risks_solar_panels" class="control-label">Zonnepanelen</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control" id="additional_risks_solar_panels" name="additional_risks_solar_panels"><option value="geen-zonnepanelen" selected="selected">Geen zonnepanelen</option><option value="zonnepanelen-meeverzekeren">Zonnepanelen meeverzekeren</option></select></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="additional_risks_ownership_renter_stake_option" class="control-label">Eigenaars- /Huurdersbelang</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control" id="additional_risks_ownership_renter_stake_option" name="additional_risks_ownership_renter_stake_option"><option value="niet-van-toepassing" selected="selected">Niet van toepassing</option><option value="ja-standaard">Ja, standaard</option><option value="aangepaste-verzekerde-bedragen">Aangepaste verzekerde bedragen</option></select></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="additional_risks_ownership_renter_stake_value" class="control-label">Eigenaars- /Huurdersbelang</label></div><div class="col-lg-7 col-md-7 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_ownership_renter_stake_value" id="additional_risks_ownership_renter_stake_value"></div></div></div></div><div class="col-md-8 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_mobile_electronics_cover_option" class="control-label">Mobiele elektronicadekking (a.s.r.)</label></div><div class="col-lg-4 col-md-4 col-xs-6"><select class="form-control" id="additional_risks_mobile_electronics_cover_option" name="additional_risks_mobile_electronics_cover_option"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_smartphone_tablet_cover_option" class="control-label">Smartphone en tablet (Unigarant)</label></div><div class="col-lg-4 col-md-4 col-xs-6"><select class="form-control" id="additional_risks_smartphone_tablet_cover_option" name="additional_risks_smartphone_tablet_cover_option"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_outside_cover" class="control-label">Buitenshuisdekking</label></div><div class="col-lg-4 col-md-4 col-xs-12"><select class="form-control" id="additional_risks_outside_cover" name="additional_risks_outside_cover"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_outside_nn_cover_option" class="control-label">Buitenshuisdekking (Nat. Ned.)</label></div><div class="col-lg-4 col-md-4 col-xs-12"><select class="form-control" id="additional_risks_outside_nn_cover_option" name="additional_risks_outside_nn_cover_option"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_valuables_asr_cover_option" class="control-label">Kostbaarheden (a.s.r.)</label></div><div class="col-lg-4 col-md-4 col-xs-12"><select class="form-control" id="additional_risks_valuables_asr_cover_option" name="additional_risks_valuables_asr_cover_option"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div><div class="col-lg-3 col-md-3 col-xs-6"><select class="form-control" name="additional_risks_valuables_cover_value"><option value="-7500" selected="selected">€ 7.500</option><option value="-15500">€ 15.500</option><option value="-25500">€ 25.500</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="additional_risks_valuables_option" class="control-label">Kostbaarheden</label></div><div class="col-lg-4 col-md-4 col-xs-12"><select class="form-control" id="additional_risks_valuables_option" name="additional_risks_valuables_option"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div><div id="additional_risks_valuables_cover_subvalues"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_computer_value" class="control-label">Computerapparatuur</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_computer_value" value="0" id="additional_risks_valuables_computer_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_horloge_value" class="control-label">(Pols)horloges</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_horloge_value" value="0" id="additional_risks_valuables_horloge_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_music_value" class="control-label">Elektrisch versterkte muziekinstrumenten</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_music_value" value="0" id="additional_risks_valuables_music_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_jewellery_value" class="control-label">Lijfsieraden (excl. (pols)horloges)</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_jewellery_value" value="0" id="additional_risks_valuables_jewellery_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_film_value" class="control-label">Foto-, Film- en videoapparatuur</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_film_value" value="0" id="additional_risks_valuables_film_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_optical_value" class="control-label">Optische instrumenten</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_optical_value" value="0" id="additional_risks_valuables_optical_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"></div><div class="col-lg-4 col-md-7 col-xs-12"><label for="additional_risks_valuables_art_value" class="control-label">Kunst</label></div><div class="col-lg-3 col-md-3 col-xs-6"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="additional_risks_valuables_art_value" value="0" id="additional_risks_valuables_art_value"></div></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="furniture_insurance_security[]" class="control-label">Vrijwillige beveiliging</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="furniture_insurance_security_veilig-wonen" name="furniture_insurance_security[]" type="checkbox" value="veilig-wonen"><label for="furniture_insurance_security_veilig-wonen" class="control-label">Veilig Wonen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="furniture_insurance_security_elektronisch-beveiligd-borg" name="furniture_insurance_security[]" type="checkbox" value="elektronisch-beveiligd-borg"><label for="furniture_insurance_security_elektronisch-beveiligd-borg" class="control-label">Elektronisch beveiligd (BORG)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="furniture_insurance_security_blusdeken-en-brandblusser" name="furniture_insurance_security[]" type="checkbox" value="blusdeken-en-brandblusser"><label for="furniture_insurance_security_blusdeken-en-brandblusser" class="control-label">Blusdeken en brandblusser</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="furniture_insurance_security_rookmelder-per-verdieping" name="furniture_insurance_security[]" type="checkbox" value="rookmelder-per-verdieping"><label for="furniture_insurance_security_rookmelder-per-verdieping" class="control-label">Rookmelder per verdieping</label></div></div></div></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden woonhuis</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#house-own-risk-modal"><i class="fa fa-info-circle"></i></button><label for="house_insurance_own_risk" class="control-label">Eigen risico's</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_insurance_own_risk" name="house_insurance_own_risk"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="house_insurance_own_risk_storm" class="control-label">Eigen risico storm</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="house_insurance_own_risk_storm" name="house_insurance_own_risk_storm"><option value="0" selected="selected">Afkopen</option><option value="1">Niet afkopen</option></select></div></div></div></div><div class="row product-coverages" data-product="1"><hr><div class="panel-group float full-width mb5" id="accordion0" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading00"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion0" href="#collapse_coverages_1" aria-expanded="false" aria-controls="collapse_coverages_1">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_1" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading00"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td><td>Herbouwwaarde</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="1" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="2" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">All-in</option><option value="4" data-selected-initially="0" data-default-score="3" data-realname="Allrisk (maatwerk)">All-in (maatwerk)</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="3" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="6" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="7" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">AVBKOD</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="8" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Royaal</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" readonly="readonly" data-company="17" autocomplete="off"><option value="3" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option><option value="103" data-selected-initially="0" data-default-score="3" data-realname="Allrisk (Premium)">Allrisk (Premium)</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="1" data-product-name="Woonhuis"></div></div></div><div class="panel panel-default"><div class="panel-heading">Inboedel: Verzekerd bedrag per rubriek</div><div class="panel-body"><div class="row modal-risk"><div class="col-xs-12"><div class="checkbox"><label><input id="hogere-verzekerde-bedragen-rubrieken-checkbox" class="modal-risk-input" type="checkbox"> <span class="cr"><i class="cr-icon fa fa-check"></i></span> <strong>Hogere verzekerde bedragen per rubriek opgeven</strong></label></div><hr/></div></div><div id="hogere-verzekerde-bedragen-rubrieken" class="row"><div class="col-xs-12"><h4>Klaverblad</h4><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Is de totale waarde van de sieraden en horloges, elektronische apparatuur, hobbygereedschap en andere bijzondere bezittingen, zoals antiek, kunst en verzamelingen hoger dan € 30.000?</div></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_klaverblad_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_klaverblad_value" type="number"></div></div></div></div><div class="col-xs-12"><small>Let op: Een hoger verzekerd bedrag moet telefonisch besproken worden met Klaverblad, en kan dus niet door CompanyName berekend worden.</small></div></div><h4>ASR</h4><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Is de totale waarde van bijzondere bezittingen hoger dan € 15.000?</div><small>Bijzondere bezittingen: uw kunst, verzamelingen, antiek, foto-, film-, beeld-, audio- en videoapparatuur en beeld- en geluidsdragers, computers, muziekinstrumenten, duiksport-, paardensport-, paracture-, gold- en hengelsportuitrustingen en medische apparatuur (gehoorapparaten vallen hier niet onder). Uw mobiele elektronica valt niet onder bijzondere bezittingen.</small><br/><br/></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_asr_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_asr_value" type="number"></div></div></div></div><div class="col-xs-12"><small>Let op: Een totale waarde van € 50.000 moet telefonisch besproken worden met a.s.r., en kan dus niet door CompanyName berekend worden.</small></div></div><h4>Eventuele bijtellingen <small>voorzover niet apart verzekerd</small></h4><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Heeft u meer dan € 12.000 aan audiovisuele- en computerapparatuur?</div><br/><div>Zo ja, welk bedrag boven € 12.000?</div></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_audiovisual_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_audiovisual_value" type="number"></div></div></div></div></div><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Heeft u meer dan € 6.000 aan lijfsieraden?</div><br/><div>Zo ja, welk bedrag boven € 6.000?</div></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_jewelry_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_jewelry_value" type="number"></div></div></div></div></div><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Heeft u meer dan € 15.000 aan bijzondere bezittingen?</div><br/><div>Zo ja, welk bedrag boven € 15.000?</div></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_special_possessions_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_special_possessions_value" type="number"></div></div></div></div></div><div class="form-group"><div class="col-lg-8 col-md-8 col-xs-7"><div>Heeft u meer dan € 6.000 aan huurdersbelang?</div><br/><div>Zo ja, welk bedrag boven € 6.000?</div></div><div class="col-lg-4 col-md-4 col-xs-5"><div class="form-group"><div class="col-xs-12"><select class="form-control" name="insured_amount_renter_stake_option"><option value="0" selected="selected">Nee</option><option value="1">Ja</option></select></div></div><div class="form-group"><div class="col-xs-12"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="insured_amount_renter_stake_value" type="number"></div></div></div></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden inboedel</div><div class="panel-body inputinlabel"><div class="row"><div class="col-xs-12"><input type="hidden" name="furniture_insurance_start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#inventory-own-risk-modal"><i class="fa fa-info-circle"></i></button><label for="furniture_insurance_own_risk" class="control-label">Eigen risico's</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="furniture_insurance_own_risk" name="furniture_insurance_own_risk"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div></div></div><div class="row product-coverages" data-product="3"><hr><div class="panel-group float full-width mb5" id="accordion1" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading01"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion1" href="#collapse_coverages_3" aria-expanded="false" aria-controls="collapse_coverages_3">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_3" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading01"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td><td>Inboedelwaarde</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="9" data-selected-initially="0" data-default-score="4" data-realname="Allrisk">Allrisk</option><option value="60" data-selected-initially="1" data-default-score="2" data-realname="Allrisk + Smartphone & Tablet" selected="selected">Allrisk + Smartphone & Tablet</option><option value="61" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option><option value="62" data-selected-initially="0" data-default-score="1" data-realname="Allrisk + Smartphone & Tablet + Buitenshuis">Allrisk + Smartphone & Tablet + Buitenshuis</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="9" data-selected-initially="0" data-default-score="4" data-realname="Allrisk">All-in</option><option value="14" data-selected-initially="0" data-default-score="3" data-realname="Allrisk (maatwerk)">All-in (maatwerk)</option><option value="61" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option><option value="88" data-selected-initially="1" data-default-score="0" data-realname="Allrisk + Buitenshuis (Maatwerk)" selected="selected">Allrisk + Buitenshuis (Maatwerk)</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="9" data-selected-initially="0" data-default-score="4" data-realname="Allrisk">Allrisk</option><option value="72" data-selected-initially="1" data-default-score="2" data-realname="Allrisk + Mobiele elektronica" selected="selected">Allrisk + Mobiele elektronica</option><option value="73" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Kostbaarheden">Allrisk + Kostbaarheden</option><option value="74" data-selected-initially="0" data-default-score="1" data-realname="Allrisk + Mobiele elektronica + Kostbaarheden">Allrisk + Mobiele elektronica + Kostbaarheden</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="9" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option><option value="61" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="9" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">AVBKOD</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="9" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Royaal</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"><option value="9" data-selected-initially="1" data-default-score="4" data-realname="Allrisk" selected="selected">Allrisk</option><option value="104" data-selected-initially="0" data-default-score="4" data-realname="Allrisk (Premium)">Allrisk (Premium)</option></select></td><td><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" readonly="readonly"/></div></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="3" data-product-name="Inboedel"></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden buitenshuis</div><div class="panel-body"><div class="row hidden-"><div class="col-xs-12"><input type="hidden" name="outside_coverage_start_date" value="28-03-2018"/><div class="row product-coverages" data-product="4"><hr><div class="panel-group float full-width mb5" id="accordion2" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading02"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion2" href="#collapse_coverages_4" aria-expanded="false" aria-controls="collapse_coverages_4">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_4" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading02"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="0" data-default-score="3" data-realname="Allrisk">Allrisk</option><option value="93" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option><option value="97" data-selected-initially="1" data-default-score="2" data-realname="Allrisk + Smartphone & Tablet" selected="selected">Allrisk + Smartphone & Tablet</option><option value="98" data-selected-initially="0" data-default-score="1" data-realname="Allrisk + Smartphone & Tablet + Buitenshuis">Allrisk + Smartphone & Tablet + Buitenshuis</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="0" data-default-score="3" data-realname="Allrisk">All-in</option><option value="91" data-selected-initially="0" data-default-score="3" data-realname="Allrisk (maatwerk)">All-in (maatwerk)</option><option value="92" data-selected-initially="0" data-default-score="4" data-realname="Allrisk (standaard)">All-in (standaard)</option><option value="93" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option><option value="99" data-selected-initially="0" data-default-score="0" data-realname="Allrisk + Buitenshuis (Maatwerk)">Allrisk + Buitenshuis (Maatwerk)</option><option value="100" data-selected-initially="1" data-default-score="2" data-realname="Allrisk + Buitenshuis (Standaard)" selected="selected">Allrisk + Buitenshuis (Standaard)</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="0" data-default-score="3" data-realname="Allrisk">Allrisk</option><option value="94" data-selected-initially="1" data-default-score="2" data-realname="Allrisk + Mobiele elektronica" selected="selected">Allrisk + Mobiele elektronica</option><option value="95" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Kostbaarheden">Allrisk + Kostbaarheden</option><option value="96" data-selected-initially="0" data-default-score="1" data-realname="Allrisk + Mobiele elektronica + Kostbaarheden">Allrisk + Mobiele elektronica + Kostbaarheden</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="1" data-default-score="3" data-realname="Allrisk" selected="selected">Allrisk</option><option value="93" data-selected-initially="0" data-default-score="2" data-realname="Allrisk + Buitenshuis">Allrisk + Buitenshuis</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="1" data-default-score="3" data-realname="Allrisk" selected="selected">AVBKOD</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="48" data-selected-initially="0" data-default-score="1" data-realname="Buitenshuisdekking">Buitenshuisdekking</option><option value="90" data-selected-initially="1" data-default-score="3" data-realname="Allrisk" selected="selected">Royaal</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="4" data-product-name="Buitenshuisdekking"></div></div></div></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-car"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/car/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-7 col-md-7 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Autogegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-5 col-md-5 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="license_plate" value="34grt2" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" value="6660" id="model_code"></div></div><input type="hidden" name="cilinder_contents" value="0"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-12"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label></div><div class="col-lg-5 col-md-5 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="manufacture_year" value="2008" id="manufacture_year"></div><div class="col-lg-3 col-md-3 col-xs-5"><input class="form-control" placeholder="mm" name="manufacture_month" value="0"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value" class="control-label">Nieuwwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" name="new_value" value="16553" id="new_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="day_value" class="control-label">Dagwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="day_value" id="day_value"></div></div></div></div><div class="col-lg-7 col-md-7 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-9 col-md-9 col-xs-7"><input class="form-control api-fillable" name="brand" value="HONDA" id="brand"></div></div><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-9 col-md-9 col-xs-7"><input class="form-control api-fillable" name="model" value="Jazz" id="model"></div></div><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-9 col-md-9 col-xs-7"><input class="form-control api-fillable" name="type" value="1.4 I" id="type"></div></div><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="body" class="control-label">Carrosserie</label></div><div class="col-lg-9 col-md-9 col-xs-7"><input class="form-control api-fillable" name="body" value="Hatchback" id="body"></div></div><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="weight" class="control-label">Gewicht</label></div><div class="col-lg-9 col-md-9 col-xs-7"><div class="input-group"><div class="input-group-addon">KG</div><input class="form-control api-fillable" name="weight" value="971" id="weight"></div></div></div><div class="form-group"><div class="col-lg-3 col-md-3 col-xs-5"><label for="fuel_code" class="control-label">Brandstof</label></div><div class="col-lg-9 col-md-9 col-xs-7"><select class="form-control api-fillable" id="fuel_code" name="fuel_code"><option value="A">Alcohol</option><option value="B" selected="selected">Benzine</option><option value="C">Cryogeen</option><option value="D">Diesel</option><option value="E">Electrisch</option><option value="BE">Hybride benzine</option><option value="DE">Hybride diesel</option><option value="G">Gas (LPG / Propaan)</option><option value="H">Hogedruk gas</option><option value="W">Waterstof</option></select></div></div></div></div><div class="row klaverblad-options-row hidden"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><hr/><div class="alert alert-warning" role="alert">U moet handmatig de volgende gegevens aanvullen om auto Klaverblad te berekenen.</div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="klaverblad_model" class="control-label">Model voor Klaverblad</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control api-fillable" id="klaverblad_model" name="klaverblad_model"></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="klaverblad_body" class="control-label">Carrosserie voor Klaverblad</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control api-fillable" id="klaverblad_body" name="klaverblad_body"></select></div></div></div></div><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="incl_vat" class="control-label">Incl. BTW</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="incl_vat" name="incl_vat"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="private_usage" class="control-label">Particulier gebruik</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="private_usage" name="private_usage"><option value="ja" selected="selected">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="financed" class="control-label">Is het voertuig gefinancierd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="financed" name="financed"><option value="nee" selected="selected">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="imported" class="control-label">Voertuig geïmporteerd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="imported" name="imported"><option value="nee" selected="selected">Nee</option><option value="ja">Ja</option></select></div></div></div></div></div></div></div><div class="col-lg-5 col-md-5 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-7 col-md-7 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_volledig-casco" checked="checked" name="coverage" type="radio" value="volledig-casco"><label for="coverage_volledig-casco" class="control-label">Volledig casco</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mileage" class="control-label">Kilometrage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">km</div><input class="form-control" name="mileage" type="number" value="12000" id="mileage"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="accessories_insured" class="control-label">Accessoires meeverzekeren?</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="accessories_insured" type="number" value="0" id="accessories_insured"></div></div></div><div id="vehicle-own-risk-fields"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_non_ahb" class="control-label">Vrijwillig eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_non_ahb" name="own_risk_non_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div></div><hr/><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><h4>Aanvullende dekkingen</h4></div></div><div class="row"><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="avd_accidents_passengers" class="control-label">Ongevallen inzittenden</label></div><div class="float full-size"><select class="form-control" id="avd_accidents_passengers" name="avd_accidents_passengers"><option value="geen-dekking">Geen dekking</option><option value="standaard-verzekerde-bedragen">Standaard verzekerde bedragen</option><option value="lage-verzekerde-bedragen">Lage verzekerde bedragen</option><option value="hoge-verzekerde-bedragen">Hoge verzekerde bedragen</option></select></div></div><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="avd_damage_insured_passengers" class="control-label">Schadeverzekering voor inzittenden</label></div><div class="float full-size"><select class="form-control" id="avd_damage_insured_passengers" name="avd_damage_insured_passengers"><option value="geen-dekking">Geen dekking</option><option value="basis">Basis</option><option value="uitgebreide-dekking-vsv">Uitgebreide dekking (VSV)</option></select></div></div><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="avd_claim_or_legal_aid" class="control-label">Verhaalshulp of rechtsbijstand</label></div><div class="float full-size"><select class="form-control" id="avd_claim_or_legal_aid" name="avd_claim_or_legal_aid"><option value="geen-dekking">Geen dekking</option><option value="verhaalshulp">Verhaalshulp</option><option value="rechtsbijstand">Rechtsbijstand</option><option value="rechtsbijstand-uitgebreid">Rechtsbijstand uitgebreid</option></select></div></div><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="avd_breakdown_service_cover_area" class="control-label">Pechhulp NL of EU</label></div><div class="float full-size"><select class="form-control" id="avd_breakdown_service_cover_area" name="avd_breakdown_service_cover_area"><option value="geen-dekking">Geen dekking</option><option value="nederland">Nederland</option><option value="europe">Europe</option></select></div></div><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="purchase_value_insured_period" class="control-label">Aanschafwaarderegeling of -garantie</label></div><div class="float full-size"><select class="form-control" id="purchase_value_insured_period" name="purchase_value_insured_period"><option value="nee" selected="selected">Nee</option><option value="aankoopwaarde1jaar">1 jaar</option><option value="aankoopwaarde2jaar">2 jaar</option><option value="aankoopwaarde3jaar">3 jaar</option></select></div></div><div class="col-sm-6 col-xs-12 mb5"><div class="float full-size"><label for="new_value_insured_period" class="control-label">Nieuwwaarderegeling of -garantie</label></div><div class="float full-size"><select class="form-control" id="new_value_insured_period" name="new_value_insured_period"><option value="nee" selected="selected">Nee</option><option value="standaard1jaar">1 jaar</option><option value="nieuwwaarde2jaar">2 jaar</option><option value="nieuwwaarde3jaar">3 jaar</option></select></div></div></div><div class="form-group"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel mb5 id-extended_coverages_no-claimbeschermer"><input id="extended_coverages_no-claimbeschermer" name="extended_coverages[]" type="checkbox" value="no-claimbeschermer"><label for="extended_coverages_no-claimbeschermer" class="control-label">No-claimbeschermer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel mb5 id-extended_coverages_vervangend-vervoer"><input id="extended_coverages_vervangend-vervoer" name="extended_coverages[]" type="checkbox" value="vervangend-vervoer"><label for="extended_coverages_vervangend-vervoer" class="control-label">Vervangend vervoer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel mb5 id-extended_coverages_geen-eigen-risico-bij-niet-aangesloten-herstelbedrijf-vrije-keuze"><input id="extended_coverages_geen-eigen-risico-bij-niet-aangesloten-herstelbedrijf-vrije-keuze" name="extended_coverages[]" type="checkbox" value="geen-eigen-risico-bij-niet-aangesloten-herstelbedrijf-vrije-keuze"><label for="extended_coverages_geen-eigen-risico-bij-niet-aangesloten-herstelbedrijf-vrije-keuze" class="control-label">Geen eigen risico bij niet-aangesloten herstelbedrijf (Vrije keuze)</label></div></div></div></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden auto</div><div class="panel-body"><div class="row product-coverages" data-product="9"><hr><div class="panel-group float full-width mb5" id="accordion3" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading03"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion3" href="#collapse_coverages_9" aria-expanded="false" aria-controls="collapse_coverages_9">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_9" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading03"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option><option value="58" data-selected-initially="0" data-default-score="1" data-realname="Inruilplus (a.s.r.)">Inruilplus (a.s.r.)</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"><option value="55" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option><option value="56" data-selected-initially="0" data-default-score="1" data-realname="Beperkt casco">Beperkt casco</option><option value="57" data-selected-initially="0" data-default-score="1" data-realname="Volledig casco">Volledig casco</option></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="9" data-product-name="Auto"></div></div></div></div><div class="col-lg-5 col-md-5 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelmatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_insurer_is_main_driver" class="control-label">Verzekeringnemer is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_insurer_is_main_driver_ja" name="main_driver_insurer_is_main_driver" type="radio" value="ja"><label for="main_driver_insurer_is_main_driver_ja" class="control-label">ja</label><input id="main_driver_insurer_is_main_driver_nee" name="main_driver_insurer_is_main_driver" type="radio" value="nee"><label for="main_driver_insurer_is_main_driver_nee" class="control-label">nee</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_person" class="control-label">Wie is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_person_partner" name="main_driver_person" type="radio" value="partner"><label for="main_driver_person_partner" class="control-label">Partner</label><input id="main_driver_person_anders" name="main_driver_person" type="radio" value="anders"><label for="main_driver_person_anders" class="control-label">Anders</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" value="09-05-1988" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_gender" class="control-label">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_gender_man" name="main_driver_gender" type="radio" value="man"><label for="main_driver_gender_man" class="control-label">Man</label><input id="main_driver_gender_vrouw" name="main_driver_gender" type="radio" value="vrouw"><label for="main_driver_gender_vrouw" class="control-label">Vrouw</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_postcode" class="control-label">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="main_driver_postcode" value="7908NV" id="main_driver_postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_housenumber" class="control-label">Huisnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_housenumber" value="3" id="main_driver_housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_street" id="main_driver_street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_city" id="main_driver_city"></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-car-oldtimer"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/car-oldtimer/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Oldtimer autogegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="type" id="type"></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="day_value" class="control-label">Dagwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control required" name="day_value" id="day_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="appraisal_value" class="control-label">Taxatiewaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control required" name="appraisal_value" type="number" value="0" id="appraisal_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="member_fehac" class="control-label">Lid FEHAC</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><select class="form-control" id="member_fehac" name="member_fehac"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mileage" class="control-label">Kilometrage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">km</div><input class="form-control" name="mileage" type="number" value="12000" id="mileage"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_volledig-casco" checked="checked" name="coverage" type="radio" value="volledig-casco"><label for="coverage_volledig-casco" class="control-label">Volledig casco</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-laag" name="extended_coverages[]" type="checkbox" value="ovi-laag"><label for="extended_coverages_ovi-laag" class="control-label">OVI Laag</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-gem" name="extended_coverages[]" type="checkbox" value="ovi-gem"><label for="extended_coverages_ovi-gem" class="control-label">OVI Gem.</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-hoog" name="extended_coverages[]" type="checkbox" value="ovi-hoog"><label for="extended_coverages_ovi-hoog" class="control-label">OVI Hoog</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-standaard" name="extended_coverages[]" type="checkbox" value="svi-standaard"><label for="extended_coverages_svi-standaard" class="control-label">SVI (Standaard)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-uitgebreid" name="extended_coverages[]" type="checkbox" value="svi-uitgebreid"><label for="extended_coverages_svi-uitgebreid" class="control-label">SVI (Uitgebreid)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhaalshulp" name="extended_coverages[]" type="checkbox" value="verhaalshulp"><label for="extended_coverages_verhaalshulp" class="control-label">Verhaalshulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand-uitgebreid" name="extended_coverages[]" type="checkbox" value="rechtsbijstand-uitgebreid"><label for="extended_coverages_rechtsbijstand-uitgebreid" class="control-label">Rechtsbijstand uitgebreid</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-nederland" name="extended_coverages[]" type="checkbox" value="pechhulp-nederland"><label for="extended_coverages_pechhulp-nederland" class="control-label">Pechhulp Nederland</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-europa" name="extended_coverages[]" type="checkbox" value="pechhulp-europa"><label for="extended_coverages_pechhulp-europa" class="control-label">Pechhulp Europa</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-aanschafwaarde" name="extended_coverages[]" type="checkbox" value="max-aanschafwaarde"><label for="extended_coverages_max-aanschafwaarde" class="control-label">Max. aanschafwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-nieuwwaarde" name="extended_coverages[]" type="checkbox" value="max-nieuwwaarde"><label for="extended_coverages_max-nieuwwaarde" class="control-label">Max. nieuwwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_no-claimbeschermer" name="extended_coverages[]" type="checkbox" value="no-claimbeschermer"><label for="extended_coverages_no-claimbeschermer" class="control-label">No-claimbeschermer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_winterstop" name="extended_coverages[]" type="checkbox" value="winterstop"><label for="extended_coverages_winterstop" class="control-label">Winterstop</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_track-trace" name="extended_coverages[]" type="checkbox" value="track-trace"><label for="extended_coverages_track-trace" class="control-label">Track Trace</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_vrije-keuze-herstel" name="extended_coverages[]" type="checkbox" value="vrije-keuze-herstel"><label for="extended_coverages_vrije-keuze-herstel" class="control-label">Vrije keuze herstel</label></div></div></div></div></div></div><div class="row product-coverages" data-product="10"><hr><div class="panel-group float full-width mb5" id="accordion4" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading04"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion4" href="#collapse_coverages_10" aria-expanded="false" aria-controls="collapse_coverages_10">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_10" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading04"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="54" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="10" data-product-name="Oldtimer auto"></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelmatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_insurer_is_main_driver" class="control-label">Verzekeringnemer is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_insurer_is_main_driver_ja" name="main_driver_insurer_is_main_driver" type="radio" value="ja"><label for="main_driver_insurer_is_main_driver_ja" class="control-label">ja</label><input id="main_driver_insurer_is_main_driver_nee" name="main_driver_insurer_is_main_driver" type="radio" value="nee"><label for="main_driver_insurer_is_main_driver_nee" class="control-label">nee</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_person" class="control-label">Wie is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_person_partner" name="main_driver_person" type="radio" value="partner"><label for="main_driver_person_partner" class="control-label">Partner</label><input id="main_driver_person_anders" name="main_driver_person" type="radio" value="anders"><label for="main_driver_person_anders" class="control-label">Anders</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_gender" class="control-label">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_gender_man" name="main_driver_gender" type="radio" value="man"><label for="main_driver_gender_man" class="control-label">Man</label><input id="main_driver_gender_vrouw" name="main_driver_gender" type="radio" value="vrouw"><label for="main_driver_gender_vrouw" class="control-label">Vrouw</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_postcode" class="control-label">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="main_driver_postcode" id="main_driver_postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_housenumber" class="control-label">Huisnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_housenumber" id="main_driver_housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_street" id="main_driver_street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_city" id="main_driver_city"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-van"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/van/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Bestelautogegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="type" id="type"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="weight" class="control-label">Gewicht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">KG</div><input class="form-control api-fillable" name="weight" value="0" id="weight"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="fuel_code" class="control-label">Brandstof</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control api-fillable" id="fuel_code" name="fuel_code"><option value="A">Alcohol</option><option value="B" selected="selected">Benzine</option><option value="C">Cryogeen</option><option value="D">Diesel</option><option value="E">Electrisch</option><option value="BE">Hybride benzine</option><option value="DE">Hybride diesel</option><option value="G">Gas (LPG / Propaan)</option><option value="H">Hogedruk gas</option><option value="W">Waterstof</option></select></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="imported" class="control-label">Voertuig geïmporteerd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="imported" name="imported"><option value="nee">Nee</option><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value" class="control-label">Nieuwwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" name="new_value" id="new_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="day_value" class="control-label">Dagwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="day_value" id="day_value"></div></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="private_usage" class="control-label">Particulier gebruik</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="private_usage" name="private_usage"><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="incl_vat" class="control-label">Incl. BTW</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="incl_vat" name="incl_vat"><option value="ja">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="financed" class="control-label">Is het voertuig gefinancierd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="financed" name="financed"><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="accessories_insured" class="control-label">Accessoires meeverzekeren?</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="accessories_insured" type="number" value="0" id="accessories_insured"></div></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mileage" class="control-label">Kilometrage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">km</div><input class="form-control" name="mileage" type="number" value="12000" id="mileage"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_volledig-casco" checked="checked" name="coverage" type="radio" value="volledig-casco"><label for="coverage_volledig-casco" class="control-label">Volledig casco</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_non_ahb" class="control-label">Vrijwillig eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_non_ahb" name="own_risk_non_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-laag" name="extended_coverages[]" type="checkbox" value="ovi-laag"><label for="extended_coverages_ovi-laag" class="control-label">OVI Laag</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-gem" name="extended_coverages[]" type="checkbox" value="ovi-gem"><label for="extended_coverages_ovi-gem" class="control-label">OVI Gem.</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-hoog" name="extended_coverages[]" type="checkbox" value="ovi-hoog"><label for="extended_coverages_ovi-hoog" class="control-label">OVI Hoog</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-standaard" name="extended_coverages[]" type="checkbox" value="svi-standaard"><label for="extended_coverages_svi-standaard" class="control-label">SVI (Standaard)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-uitgebreid" name="extended_coverages[]" type="checkbox" value="svi-uitgebreid"><label for="extended_coverages_svi-uitgebreid" class="control-label">SVI (Uitgebreid)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhaalshulp" name="extended_coverages[]" type="checkbox" value="verhaalshulp"><label for="extended_coverages_verhaalshulp" class="control-label">Verhaalshulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand-uitgebreid" name="extended_coverages[]" type="checkbox" value="rechtsbijstand-uitgebreid"><label for="extended_coverages_rechtsbijstand-uitgebreid" class="control-label">Rechtsbijstand uitgebreid</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-nederland" name="extended_coverages[]" type="checkbox" value="pechhulp-nederland"><label for="extended_coverages_pechhulp-nederland" class="control-label">Pechhulp Nederland</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-europa" name="extended_coverages[]" type="checkbox" value="pechhulp-europa"><label for="extended_coverages_pechhulp-europa" class="control-label">Pechhulp Europa</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-aanschafwaarde" name="extended_coverages[]" type="checkbox" value="max-aanschafwaarde"><label for="extended_coverages_max-aanschafwaarde" class="control-label">Max. aanschafwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-nieuwwaarde" name="extended_coverages[]" type="checkbox" value="max-nieuwwaarde"><label for="extended_coverages_max-nieuwwaarde" class="control-label">Max. nieuwwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_no-claimbeschermer" name="extended_coverages[]" type="checkbox" value="no-claimbeschermer"><label for="extended_coverages_no-claimbeschermer" class="control-label">No-claimbeschermer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_winterstop" name="extended_coverages[]" type="checkbox" value="winterstop"><label for="extended_coverages_winterstop" class="control-label">Winterstop</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_track-trace" name="extended_coverages[]" type="checkbox" value="track-trace"><label for="extended_coverages_track-trace" class="control-label">Track Trace</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_vrije-keuze-herstel" name="extended_coverages[]" type="checkbox" value="vrije-keuze-herstel"><label for="extended_coverages_vrije-keuze-herstel" class="control-label">Vrije keuze herstel</label></div></div></div></div></div></div><div class="row product-coverages" data-product="13"><hr><div class="panel-group float full-width mb5" id="accordion5" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading05"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion5" href="#collapse_coverages_13" aria-expanded="false" aria-controls="collapse_coverages_13">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_13" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading05"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="13" data-product-name="Bestelauto"></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelmatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_insurer_is_main_driver" class="control-label">Verzekeringnemer is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_insurer_is_main_driver_ja" name="main_driver_insurer_is_main_driver" type="radio" value="ja"><label for="main_driver_insurer_is_main_driver_ja" class="control-label">ja</label><input id="main_driver_insurer_is_main_driver_nee" name="main_driver_insurer_is_main_driver" type="radio" value="nee"><label for="main_driver_insurer_is_main_driver_nee" class="control-label">nee</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_person" class="control-label">Wie is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_person_partner" name="main_driver_person" type="radio" value="partner"><label for="main_driver_person_partner" class="control-label">Partner</label><input id="main_driver_person_anders" name="main_driver_person" type="radio" value="anders"><label for="main_driver_person_anders" class="control-label">Anders</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_gender" class="control-label">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_gender_man" name="main_driver_gender" type="radio" value="man"><label for="main_driver_gender_man" class="control-label">Man</label><input id="main_driver_gender_vrouw" name="main_driver_gender" type="radio" value="vrouw"><label for="main_driver_gender_vrouw" class="control-label">Vrouw</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_postcode" class="control-label">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="main_driver_postcode" id="main_driver_postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_housenumber" class="control-label">Huisnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_housenumber" id="main_driver_housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_street" id="main_driver_street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_city" id="main_driver_city"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-caravan"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/caravan/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Caravangegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_or_occasion" class="control-label">Nieuw of occasion</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="new_or_occasion" name="new_or_occasion"><option value="nieuw">Nieuw</option><option value="occasion">Occasion</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="type" name="type"><option value="toercaravan">Toercaravan</option><option value="stacaravan">Stacaravan</option><option value="vouw-en-bagage">Vouw- en bagage</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="overall_length" class="control-label">Totale opbouwlengte</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="overall_length" name="overall_length"><option value="tot-5-meter">Tot 5 meter</option><option value="meer-dan-5-meter">Meer dan 5 meter</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label><label for="manufacture_month" class="control-label">Bouwmaand</label></div><div class="col-lg-4 col-md-4 col-xs-4"><input class="form-control" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div><div class="col-lg-4 col-md-4 col-xs-4"><input class="form-control" placeholder="mm" name="manufacture_month" id="manufacture_month"></div></div><hr/><h3>Verzekerde bedragen</h3><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value" class="control-label">Nieuwwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" name="new_value" id="new_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="inventory_value" class="control-label">Inventaris waarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="inventory_value" id="inventory_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="accessories_insured" class="control-label">Accessoires</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="accessories_insured" type="number" value="0" id="accessories_insured"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="awning_or_canopy_value" class="control-label">Voortent/luifel</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="awning_or_canopy_value" id="awning_or_canopy_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mover_value" class="control-label">Mover</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="mover_value" id="mover_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extension_value" class="control-label">Aanbouw</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="extension_value" id="extension_value"></div></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_casco" name="coverage" type="radio" value="casco"><label for="coverage_casco" class="control-label">Casco</label><input id="coverage_standaard-wa" name="coverage" type="radio" value="standaard-wa"><label for="coverage_standaard-wa" class="control-label">Standaard WA</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="value_coverage_type" class="control-label">Dekkingswaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="value_coverage_type" name="value_coverage_type"><option value="dagwaarde">Dagwaarde</option><option value="nieuwwaarde">Nieuwwaarde</option><option value="5-jaar-nieuwwaarde">5 jaar nieuwwaarde</option><option value="10-jaar-nieuwwaarde">10 jaar nieuwwaarde</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_nieuwwaarde-garantie" name="extended_coverages[]" type="checkbox" value="nieuwwaarde-garantie"><label for="extended_coverages_nieuwwaarde-garantie" class="control-label">Nieuwwaarde garantie</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_hagel-en-stormschade" name="extended_coverages[]" type="checkbox" value="hagel-en-stormschade"><label for="extended_coverages_hagel-en-stormschade" class="control-label">Hagel- en stormschade</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_hagelbestendig-dak" name="extended_coverages[]" type="checkbox" value="hagelbestendig-dak"><label for="extended_coverages_hagelbestendig-dak" class="control-label">Hagelbestendig dak</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhuur" name="extended_coverages[]" type="checkbox" value="verhuur"><label for="extended_coverages_verhuur" class="control-label">Verhuur</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_anwb-lid" name="extended_coverages[]" type="checkbox" value="anwb-lid"><label for="extended_coverages_anwb-lid" class="control-label">ANWB-lid</label></div></div></div></div></div></div><div class="row product-coverages" data-product="14"><hr><div class="panel-group float full-width mb5" id="accordion6" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading06"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion6" href="#collapse_coverages_14" aria-expanded="false" aria-controls="collapse_coverages_14">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_14" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading06"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="14" data-product-name="Caravan"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-camper"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/camper/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Kampeerautogegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_or_occasion" class="control-label">Nieuw of occasion</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="new_or_occasion" name="new_or_occasion"><option value="nieuw">Nieuw</option><option value="occasion">Occasion</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="type" id="type"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="overall_length" class="control-label">Totale opbouwlengte</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="overall_length" name="overall_length"><option value="tot-5-meter">Tot 5 meter</option><option value="meer-dan-5-meter">Meer dan 5 meter</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="weight" class="control-label">Gewicht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">KG</div><input class="form-control" name="weight" value="0" id="weight"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label><label for="manufacture_month" class="control-label">Bouwmaand</label></div><div class="col-lg-4 col-md-4 col-xs-4"><input class="form-control" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div><div class="col-lg-4 col-md-4 col-xs-4"><input class="form-control" placeholder="mm" name="manufacture_month" id="manufacture_month"></div></div><hr/><h3>Verzekerde bedragen</h3><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value" class="control-label">Nieuwwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" name="new_value" id="new_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="inventory_value" class="control-label">Inventaris waarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="inventory_value" id="inventory_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="accessories_insured" class="control-label">Accessoires meeverzekeren?</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="accessories_insured" type="number" value="0" id="accessories_insured"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="awning_or_canopy_value" class="control-label">Voortent/luifel</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="awning_or_canopy_value" id="awning_or_canopy_value"></div></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_casco" name="coverage" type="radio" value="casco"><label for="coverage_casco" class="control-label">Casco</label><input id="coverage_standaard-wa" name="coverage" type="radio" value="standaard-wa"><label for="coverage_standaard-wa" class="control-label">Standaard WA</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="value_coverage_type" class="control-label">Dekkingswaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="value_coverage_type" name="value_coverage_type"><option value="dagwaarde">Dagwaarde</option><option value="nieuwwaarde">Nieuwwaarde</option><option value="5-jaar-nieuwwaarde">5 jaar nieuwwaarde</option><option value="10-jaar-nieuwwaarde">10 jaar nieuwwaarde</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-laag" name="extended_coverages[]" type="checkbox" value="ovi-laag"><label for="extended_coverages_ovi-laag" class="control-label">OVI Laag</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-gem" name="extended_coverages[]" type="checkbox" value="ovi-gem"><label for="extended_coverages_ovi-gem" class="control-label">OVI Gem.</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-hoog" name="extended_coverages[]" type="checkbox" value="ovi-hoog"><label for="extended_coverages_ovi-hoog" class="control-label">OVI Hoog</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-standaard" name="extended_coverages[]" type="checkbox" value="svi-standaard"><label for="extended_coverages_svi-standaard" class="control-label">SVI (Standaard)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-uitgebreid" name="extended_coverages[]" type="checkbox" value="svi-uitgebreid"><label for="extended_coverages_svi-uitgebreid" class="control-label">SVI (Uitgebreid)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhaalshulp" name="extended_coverages[]" type="checkbox" value="verhaalshulp"><label for="extended_coverages_verhaalshulp" class="control-label">Verhaalshulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhuur" name="extended_coverages[]" type="checkbox" value="verhuur"><label for="extended_coverages_verhuur" class="control-label">Verhuur</label></div></div></div></div></div></div><div class="row product-coverages" data-product="18"><hr><div class="panel-group float full-width mb5" id="accordion7" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading07"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion7" href="#collapse_coverages_18" aria-expanded="false" aria-controls="collapse_coverages_18">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_18" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading07"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="63" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="18" data-product-name="Kampeerauto"></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelmatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-motorcycle"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/motorcycle/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Motorgegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="type" id="type"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="vehicle_type" class="control-label">Motor / Quad / Trike</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="vehicle_type" name="vehicle_type"><option value="motor" selected="selected">Motor</option><option value="quad">Quad</option><option value="trike">Trike</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="weight" class="control-label">Gewicht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">KG</div><input class="form-control api-fillable" name="weight" value="0" id="weight"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="kw" class="control-label">KW</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="kw" value="0" id="kw"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="motor_contents" class="control-label">Motorinhoud in CC</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="motor_contents" value="0" id="motor_contents"></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="imported" class="control-label">Voertuig geïmporteerd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="imported" name="imported"><option value="nee">Nee</option><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value" class="control-label">Nieuwwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control api-fillable" name="new_value" id="new_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="day_value" class="control-label">Dagwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="day_value" id="day_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="appraisal_value" class="control-label">Taxatiewaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control required" name="appraisal_value" type="number" value="0" id="appraisal_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="appraisal_date" class="control-label">Taxatiedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="appraisal_date" id="appraisal_date"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="self_build" class="control-label">Eigenbouw</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="self_build" name="self_build"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="private_usage" class="control-label">Particulier gebruik</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="private_usage" name="private_usage"><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="incl_vat" class="control-label">Incl. BTW</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="incl_vat" name="incl_vat"><option value="ja">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="financed" class="control-label">Is het voertuig gefinancierd</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="financed" name="financed"><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="accessories_insured" class="control-label">Accessoires meeverzekeren?</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="accessories_insured" type="number" value="0" id="accessories_insured"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="bagage_insured" class="control-label">Helm, kleding en bagage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="bagage_insured" type="number" value="0" id="bagage_insured"></div></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mileage" class="control-label">Kilometrage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">km</div><input class="form-control" name="mileage" type="number" value="12000" id="mileage"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_volledig-casco" checked="checked" name="coverage" type="radio" value="volledig-casco"><label for="coverage_volledig-casco" class="control-label">Volledig casco</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_non_ahb" class="control-label">Vrijwillig eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_non_ahb" name="own_risk_non_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="purchase_value_insured_period" class="control-label">Aanschafwaarderegeling of -garantie</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="purchase_value_insured_period" name="purchase_value_insured_period"><option value="nee">Nee</option><option value="aankoopwaarde1jaar">1 jaar</option><option value="aankoopwaarde2jaar">2 jaar</option><option value="aankoopwaarde3jaar">3 jaar</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="new_value_insured_period" class="control-label">Nieuwwaarderegeling of -garantie</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="new_value_insured_period" name="new_value_insured_period"><option value="nee">Nee</option><option value="standaard1jaar">1 jaar</option><option value="nieuwwaarde2jaar">2 jaar</option><option value="nieuwwaarde3jaar">3 jaar</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-laag" name="extended_coverages[]" type="checkbox" value="ovi-laag"><label for="extended_coverages_ovi-laag" class="control-label">OVI Laag</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-gem" name="extended_coverages[]" type="checkbox" value="ovi-gem"><label for="extended_coverages_ovi-gem" class="control-label">OVI Gem.</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-hoog" name="extended_coverages[]" type="checkbox" value="ovi-hoog"><label for="extended_coverages_ovi-hoog" class="control-label">OVI Hoog</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-standaard" name="extended_coverages[]" type="checkbox" value="svi-standaard"><label for="extended_coverages_svi-standaard" class="control-label">SVI (Standaard)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-uitgebreid" name="extended_coverages[]" type="checkbox" value="svi-uitgebreid"><label for="extended_coverages_svi-uitgebreid" class="control-label">SVI (Uitgebreid)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhaalshulp" name="extended_coverages[]" type="checkbox" value="verhaalshulp"><label for="extended_coverages_verhaalshulp" class="control-label">Verhaalshulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand-uitgebreid" name="extended_coverages[]" type="checkbox" value="rechtsbijstand-uitgebreid"><label for="extended_coverages_rechtsbijstand-uitgebreid" class="control-label">Rechtsbijstand uitgebreid</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-nederland" name="extended_coverages[]" type="checkbox" value="pechhulp-nederland"><label for="extended_coverages_pechhulp-nederland" class="control-label">Pechhulp Nederland</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-europa" name="extended_coverages[]" type="checkbox" value="pechhulp-europa"><label for="extended_coverages_pechhulp-europa" class="control-label">Pechhulp Europa</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-aanschafwaarde" name="extended_coverages[]" type="checkbox" value="max-aanschafwaarde"><label for="extended_coverages_max-aanschafwaarde" class="control-label">Max. aanschafwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-nieuwwaarde" name="extended_coverages[]" type="checkbox" value="max-nieuwwaarde"><label for="extended_coverages_max-nieuwwaarde" class="control-label">Max. nieuwwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_no-claimbeschermer" name="extended_coverages[]" type="checkbox" value="no-claimbeschermer"><label for="extended_coverages_no-claimbeschermer" class="control-label">No-claimbeschermer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_winterstop" name="extended_coverages[]" type="checkbox" value="winterstop"><label for="extended_coverages_winterstop" class="control-label">Winterstop</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_track-trace" name="extended_coverages[]" type="checkbox" value="track-trace"><label for="extended_coverages_track-trace" class="control-label">Track Trace</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_vrije-keuze-herstel" name="extended_coverages[]" type="checkbox" value="vrije-keuze-herstel"><label for="extended_coverages_vrije-keuze-herstel" class="control-label">Vrije keuze herstel</label></div></div></div></div></div></div><div class="row product-coverages" data-product="11"><hr><div class="panel-group float full-width mb5" id="accordion8" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading08"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion8" href="#collapse_coverages_11" aria-expanded="false" aria-controls="collapse_coverages_11">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_11" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading08"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="53" data-selected-initially="1" data-default-score="1" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="11" data-product-name="Motor"></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_insurer_is_main_driver" class="control-label">Verzekeringnemer is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_insurer_is_main_driver_ja" name="main_driver_insurer_is_main_driver" type="radio" value="ja"><label for="main_driver_insurer_is_main_driver_ja" class="control-label">ja</label><input id="main_driver_insurer_is_main_driver_nee" name="main_driver_insurer_is_main_driver" type="radio" value="nee"><label for="main_driver_insurer_is_main_driver_nee" class="control-label">nee</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_person" class="control-label">Wie is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_person_partner" name="main_driver_person" type="radio" value="partner"><label for="main_driver_person_partner" class="control-label">Partner</label><input id="main_driver_person_anders" name="main_driver_person" type="radio" value="anders"><label for="main_driver_person_anders" class="control-label">Anders</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_gender" class="control-label">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_gender_man" name="main_driver_gender" type="radio" value="man"><label for="main_driver_gender_man" class="control-label">Man</label><input id="main_driver_gender_vrouw" name="main_driver_gender" type="radio" value="vrouw"><label for="main_driver_gender_vrouw" class="control-label">Vrouw</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_postcode" class="control-label">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="main_driver_postcode" id="main_driver_postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_housenumber" class="control-label">Huisnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_housenumber" id="main_driver_housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_street" id="main_driver_street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_city" id="main_driver_city"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="driving_certificate" class="control-label">In bezit van rijvaardigheidscertificaat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="driving_certificate" name="driving_certificate"><option value="ja">Ja</option><option value="nee">Nee</option></select></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-motorcycle-oldtimer"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/motorcycle-oldtimer/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Oldtimer motorgegevens</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="license_plate" class="control-label">Kenteken</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="license_plate" id="license_plate"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model_code" class="control-label">Meldcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" name="model_code" id="model_code"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="brand" class="control-label">Merk</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="brand" id="brand"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="model" class="control-label">Model</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="model" id="model"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="type" class="control-label">Type</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="type" id="type"></div></div><hr/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="manufacture_year" class="control-label">Bouwjaar en -maand</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control api-fillable" placeholder="jjjj" name="manufacture_year" id="manufacture_year"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="day_value" class="control-label">Dagwaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control required" name="day_value" id="day_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="appraisal_value" class="control-label">Taxatiewaarde</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control required" name="appraisal_value" type="number" value="0" id="appraisal_value"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="member_fehac" class="control-label">Lid FEHAC</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="member_fehac" name="member_fehac"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Voertuig 1</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="full-size" src="https://i.imgur.com/LcHFQNfm.jpg?1"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Dekking</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="bagage_insured" class="control-label">Helm, kleding en bagage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">€</div><input class="form-control" name="bagage_insured" type="number" value="0" id="bagage_insured"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="mileage" class="control-label">Kilometrage</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon">km</div><input class="form-control" name="mileage" type="number" value="12000" id="mileage"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverage" class="control-label">Dekking</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="coverage_wa" name="coverage" type="radio" value="wa"><label for="coverage_wa" class="control-label">WA</label><input id="coverage_beperkt-casco" name="coverage" type="radio" value="beperkt-casco"><label for="coverage_beperkt-casco" class="control-label">Beperkt casco</label><input id="coverage_volledig-casco" checked="checked" name="coverage" type="radio" value="volledig-casco"><label for="coverage_volledig-casco" class="control-label">Volledig casco</label><input id="coverage_verschillend-per-maatschappij" name="coverage" type="radio" value="verschillend-per-maatschappij"><label for="coverage_verschillend-per-maatschappij" class="control-label">Verschillend per maatschappij</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_ahb" class="control-label">Eigen risico</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_ahb" name="own_risk_ahb"><option value="geen-eigen-risico-of-zo-laag-mogelijk">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="extended_coverages[]" class="control-label">Aanvullende dekkingen:</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-laag" name="extended_coverages[]" type="checkbox" value="ovi-laag"><label for="extended_coverages_ovi-laag" class="control-label">OVI Laag</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-gem" name="extended_coverages[]" type="checkbox" value="ovi-gem"><label for="extended_coverages_ovi-gem" class="control-label">OVI Gem.</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_ovi-hoog" name="extended_coverages[]" type="checkbox" value="ovi-hoog"><label for="extended_coverages_ovi-hoog" class="control-label">OVI Hoog</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-standaard" name="extended_coverages[]" type="checkbox" value="svi-standaard"><label for="extended_coverages_svi-standaard" class="control-label">SVI (Standaard)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_svi-uitgebreid" name="extended_coverages[]" type="checkbox" value="svi-uitgebreid"><label for="extended_coverages_svi-uitgebreid" class="control-label">SVI (Uitgebreid)</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_verhaalshulp" name="extended_coverages[]" type="checkbox" value="verhaalshulp"><label for="extended_coverages_verhaalshulp" class="control-label">Verhaalshulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand" name="extended_coverages[]" type="checkbox" value="rechtsbijstand"><label for="extended_coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_rechtsbijstand-uitgebreid" name="extended_coverages[]" type="checkbox" value="rechtsbijstand-uitgebreid"><label for="extended_coverages_rechtsbijstand-uitgebreid" class="control-label">Rechtsbijstand uitgebreid</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-nederland" name="extended_coverages[]" type="checkbox" value="pechhulp-nederland"><label for="extended_coverages_pechhulp-nederland" class="control-label">Pechhulp Nederland</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_pechhulp-europa" name="extended_coverages[]" type="checkbox" value="pechhulp-europa"><label for="extended_coverages_pechhulp-europa" class="control-label">Pechhulp Europa</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-aanschafwaarde" name="extended_coverages[]" type="checkbox" value="max-aanschafwaarde"><label for="extended_coverages_max-aanschafwaarde" class="control-label">Max. aanschafwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_max-nieuwwaarde" name="extended_coverages[]" type="checkbox" value="max-nieuwwaarde"><label for="extended_coverages_max-nieuwwaarde" class="control-label">Max. nieuwwaarde</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_no-claimbeschermer" name="extended_coverages[]" type="checkbox" value="no-claimbeschermer"><label for="extended_coverages_no-claimbeschermer" class="control-label">No-claimbeschermer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_winterstop" name="extended_coverages[]" type="checkbox" value="winterstop"><label for="extended_coverages_winterstop" class="control-label">Winterstop</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_track-trace" name="extended_coverages[]" type="checkbox" value="track-trace"><label for="extended_coverages_track-trace" class="control-label">Track Trace</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="extended_coverages_vrije-keuze-herstel" name="extended_coverages[]" type="checkbox" value="vrije-keuze-herstel"><label for="extended_coverages_vrije-keuze-herstel" class="control-label">Vrije keuze herstel</label></div></div></div></div></div></div><div class="row product-coverages" data-product="12"><hr><div class="panel-group float full-width mb5" id="accordion9" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading09"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion9" href="#collapse_coverages_12" aria-expanded="false" aria-controls="collapse_coverages_12">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_12" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading09"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="105" data-selected-initially="1" data-default-score="4" data-realname="WA" selected="selected">WA</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="12" data-product-name="Oldtimer motor"></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Regelatige bestuurder</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_insurer_is_main_driver" class="control-label">Verzekeringnemer is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_insurer_is_main_driver_ja" name="main_driver_insurer_is_main_driver" type="radio" value="ja"><label for="main_driver_insurer_is_main_driver_ja" class="control-label">ja</label><input id="main_driver_insurer_is_main_driver_nee" name="main_driver_insurer_is_main_driver" type="radio" value="nee"><label for="main_driver_insurer_is_main_driver_nee" class="control-label">nee</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_person" class="control-label">Wie is regelmatige bestuurder</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_person_partner" name="main_driver_person" type="radio" value="partner"><label for="main_driver_person_partner" class="control-label">Partner</label><input id="main_driver_person_anders" name="main_driver_person" type="radio" value="anders"><label for="main_driver_person_anders" class="control-label">Anders</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_birthdate" class="control-label">Geboortedatum</label></div><div class="col-lg-8 col-md-8 col-xs-7"><div class="input-group"><div class="input-group-addon"><i class="fa fa-calendar"></i></div><input class="form-control" placeholder="dd-mm-jjjj" name="main_driver_birthdate" id="main_driver_birthdate"></div></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_gender" class="control-label">Geslacht</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input id="main_driver_gender_man" name="main_driver_gender" type="radio" value="man"><label for="main_driver_gender_man" class="control-label">Man</label><input id="main_driver_gender_vrouw" name="main_driver_gender" type="radio" value="vrouw"><label for="main_driver_gender_vrouw" class="control-label">Vrouw</label></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_postcode" class="control-label">Postcode</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control required" name="main_driver_postcode" id="main_driver_postcode"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_housenumber" class="control-label">Huisnummer</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_housenumber" id="main_driver_housenumber"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_street" class="control-label">Straat</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_street" id="main_driver_street"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_city" class="control-label">Woonplaats</label></div><div class="col-lg-8 col-md-8 col-xs-7"><input class="form-control" name="main_driver_city" id="main_driver_city"></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="main_driver_claim_free_years" class="control-label">Schadevrije jaren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="main_driver_claim_free_years" name="main_driver_claim_free_years"><option value="-6">-6</option><option value="-5">-5</option><option value="-4">-4</option><option value="-3">-3</option><option value="-2">-2</option><option value="-1">-1</option><option value="0" selected="selected">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><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option><option value="37">37</option><option value="38">38</option><option value="39">39</option><option value="40">40</option></select></div></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-responsibility"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/responsibility/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Aansprakelijkheid</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="insured_amount" class="control-label">Verzekerd bedrag</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="insured_amount" name="insured_amount"><option value="2500000" selected="selected">€2.500.000</option><option value="1000000">€1.000.000</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="hunter_risk_insured" class="control-label">Jagersrisico meeverzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="hunter_risk_insured" name="hunter_risk_insured"><option value="nee" selected="selected">Nee</option><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="claim_service" class="control-label">Verhaalsservice</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="claim_service" name="claim_service"><option value="nee" selected="selected">Nee</option><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="rent_second_house" class="control-label">Verhuur 2e woning</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="rent_second_house" name="rent_second_house"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden aansprakelijkheid</div><div class="panel-body"><div class="row"><div class="col-xs-12"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#responibility-own-risk-modal"><i class="fa fa-info-circle"></i></button><label for="own_risk" class="control-label">Eigen risico’s</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk" name="own_risk"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_children" class="control-label">Eigen risico kinderen</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_children" name="own_risk_children"><option value="nee" selected="selected">Nee</option><option value="ja">Ja</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="own_risk_animals" class="control-label">Eigen risico dieren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk_animals" name="own_risk_animals"><option value="nee" selected="selected">Nee</option><option value="ja">Ja</option></select></div></div><div class="row product-coverages" data-product="2"><hr><div class="panel-group float full-width mb5" id="accordion10" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading10"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion10" href="#collapse_coverages_2" aria-expanded="false" aria-controls="collapse_coverages_2">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_2" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading10"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="17" data-selected-initially="1" data-default-score="1" data-realname="€2.500.000" selected="selected">€2.500.000</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="15" data-selected-initially="1" data-default-score="1" data-realname="€1.000.000" selected="selected">€1.000.000</option><option value="17" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000">€2.500.000</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="16" data-selected-initially="1" data-default-score="1" data-realname="€1.250.000" selected="selected">€1.250.000</option><option value="17" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000">€2.500.000</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="16" data-selected-initially="1" data-default-score="1" data-realname="€1.250.000" selected="selected">€1.250.000</option><option value="17" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000">€2.500.000</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="18" data-selected-initially="1" data-default-score="1" data-realname="€1.250.000 incl. RB + motorijtuigen" selected="selected">€1.250.000 incl. RB + motorijtuigen</option><option value="19" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000 incl. RB + motorijtuigen">€2.500.000 incl. RB + motorijtuigen</option><option value="20" data-selected-initially="0" data-default-score="1" data-realname="€1.250.000 incl. RB - motorijtuigen">€1.250.000 incl. RB - motorijtuigen</option><option value="21" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000 incl. RB - motorijtuigen">€2.500.000 incl. RB - motorijtuigen</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="16" data-selected-initially="1" data-default-score="1" data-realname="€1.250.000" selected="selected">€1.250.000</option><option value="17" data-selected-initially="0" data-default-score="1" data-realname="€2.500.000">€2.500.000</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"><option value="17" data-selected-initially="1" data-default-score="1" data-realname="€2.500.000" selected="selected">€2.500.000</option></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="2" data-product-name="Aansprakelijkheid"></div></div></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-legal-aid"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/legalaid/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Rechtsbijstand</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="cover_area" class="control-label">Dekkingsgebied</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="cover_area" name="cover_area"><option value="nederland" selected="selected">Nederland</option><option value="europa">Europa</option><option value="wereld">Wereld</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="occupier_capacity" class="control-label">Hoedanigheid bewoner</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="occupier_capacity" name="occupier_capacity"><option value="huurder" selected="selected">Huurder</option><option value="huiseigenaar">Huiseigenaar</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverages[]" class="control-label">Dekkingen</label></div><div class="col-lg-8 col-md-8 col-xs-7 inputinlabel"><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_verkeersrechtsbijstand-excl-motorrijtuigen" name="coverages[]" type="checkbox" value="verkeersrechtsbijstand-excl-motorrijtuigen"><label for="coverages_verkeersrechtsbijstand-excl-motorrijtuigen" class="control-label">Verkeersrechtsbijstand excl. motorrijtuigen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_verkeersrechtsbijstand-incl-motorrijtuigen" name="coverages[]" type="checkbox" value="verkeersrechtsbijstand-incl-motorrijtuigen"><label for="coverages_verkeersrechtsbijstand-incl-motorrijtuigen" class="control-label">Verkeersrechtsbijstand incl. motorrijtuigen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_consument" name="coverages[]" type="checkbox" value="consument"><label for="coverages_consument" class="control-label">Consument</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_medisch" name="coverages[]" type="checkbox" value="medisch"><label for="coverages_medisch" class="control-label">Medisch</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_wonen" name="coverages[]" type="checkbox" value="wonen"><label for="coverages_wonen" class="control-label">Wonen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_werk" name="coverages[]" type="checkbox" value="werk"><label for="coverages_werk" class="control-label">Werk</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_inkomen" name="coverages[]" type="checkbox" value="inkomen"><label for="coverages_inkomen" class="control-label">Inkomen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_erfrecht" name="coverages[]" type="checkbox" value="erfrecht"><label for="coverages_erfrecht" class="control-label">Erfrecht</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_fiscaalvermogen" name="coverages[]" type="checkbox" value="fiscaalvermogen"><label for="coverages_fiscaalvermogen" class="control-label">Fiscaal/vermogen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_scheidingsmediation" name="coverages[]" type="checkbox" value="scheidingsmediation"><label for="coverages_scheidingsmediation" class="control-label">Scheidingsmediation</label></div></div></div></div></div></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden rechtsbijstand</div><div class="panel-body"><div class="row product-coverages" data-product="5"><hr><div class="panel-group float full-width mb5" id="accordion11" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading11"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion11" href="#collapse_coverages_5" aria-expanded="false" aria-controls="collapse_coverages_5">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_5" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading11"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="40" data-selected-initially="1" data-default-score="1" data-realname="Default" selected="selected">Default</option><option value="49" data-selected-initially="0" data-default-score="1" data-realname="Consument en Wonen">Consument en Wonen</option><option value="50" data-selected-initially="0" data-default-score="1" data-realname="Wonen">Wonen</option><option value="51" data-selected-initially="0" data-default-score="1" data-realname="Consument">Consument</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="5" data-product-name="Rechtsbijstand"></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-accident-insurance"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/accidentinsurance/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Ongevallenverzekering</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="who_insured" class="control-label">Wie verzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="who_insured" name="who_insured"><option value="single_without_children">Alleenstaande zonder kinderen</option><option value="single_with_children">Alleenstaande met kinderen</option><option value="family_without_children">Gezin zonder kinderen</option><option value="family_with_children">Gezin met kinderen</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="death_insured_amount" class="control-label">Bij overlijden</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="death_insured_amount" name="death_insured_amount"><option value="standaard-verzekerde-bedragen">Standaard verzekerde bedragen</option><option value="lage-verzekerde-bedragen">Lage verzekerde bedragen</option><option value="hoge-verzekerde-bedragen">Hoge verzekerde bedragen</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="disability_insured_amount" class="control-label">Bij blijvende invaliditeit</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="disability_insured_amount" name="disability_insured_amount"><option value="standaard-verzekerde-bedragen">Standaard verzekerde bedragen</option><option value="lage-verzekerde-bedragen">Lage verzekerde bedragen</option><option value="hoge-verzekerde-bedragen">Hoge verzekerde bedragen</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="job_professional_activity_insured" class="control-label">Beroepswerkzaamheden meeverzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="job_professional_activity_insured" name="job_professional_activity_insured"><option value="ja">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="car_passengers_insured" class="control-label">Passagiers auto meeverzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="car_passengers_insured" name="car_passengers_insured"><option value="ja" selected="selected">Ja</option><option value="nee">Nee</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="motorcycle_passengers_insured" class="control-label">Bijrijders motor meeverzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="motorcycle_passengers_insured" name="motorcycle_passengers_insured"><option value="ja">Ja</option><option value="nee" selected="selected">Nee</option></select></div></div></div></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden ongevallen</div><div class="panel-body"><div class="row product-coverages" data-product="6"><hr><div class="panel-group float full-width mb5" id="accordion12" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading12"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion12" href="#collapse_coverages_6" aria-expanded="false" aria-controls="collapse_coverages_6">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_6" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading12"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"><option value="52" data-selected-initially="1" data-default-score="1" data-realname="(Gezins)ongevallen" selected="selected">(Gezins)ongevallen</option></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="6" data-product-name="(Gezins)ongevallen"></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street"></span> <span class="streetview-housenumber"></span><br/><span class="streetview-postalcode"></span> <span class="streetview-city"></span><br/><span class="streetview-family-situation"></span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-travel-and-cancellation"><div class="row tp-wrapper"><div class="col-sm-12"><form method="POST" action="https://app.example.net/app/travelandcancellation/store" accept-charset="UTF-8" class="form-horizontal"><input name="_token" type="hidden" value="LSJ7UMmOiFRd1ufN0UBhb4WuSKg907ZGCfXiwIym"><div class="row"><div class="col-lg-8 col-md-8 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading pull-left col-xs-12"><div class="pull-left">Doorlopende reis- en/of annuleringsverzekering</div></div><div class="panel-body"><p></p><br/><div class="row"><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><input type="hidden" name="start_date" value="28-03-2018"/><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="insured_people" class="control-label">Wie verzekeren</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="insured_people" name="insured_people"><option value="single_without_children" selected="selected">Alleenstaande zonder kinderen</option><option value="single_with_children">Alleenstaande met kinderen</option><option value="family_without_children">Gezin zonder kinderen</option><option value="family_with_children">Gezin met kinderen</option></select></div></div><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><label for="cover_area" class="control-label">Dekkingsgebied</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="cover_area" name="cover_area"><option value="europa" selected="selected">Europa</option><option value="wereld">Wereld</option></select></div></div><div class="form-group"><div class="col-lg-12 col-md-12 col-xs-12" style="padding-left:42px"><div class="row"><div class="col-lg-4 col-md-4 col-xs-5"><label for="coverages[]" class="control-label">Dekkingen</label></div></div><div class="row"><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_persoonlijke-hulp" checked="checked" name="coverages[]" type="checkbox" value="persoonlijke-hulp"><label for="coverages_persoonlijke-hulp" class="control-label">Persoonlijke hulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_autohulp" name="coverages[]" type="checkbox" value="autohulp"><label for="coverages_autohulp" class="control-label">Autohulp</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_calamiteiten--aansprakelijkheid" checked="checked" name="coverages[]" type="checkbox" value="calamiteiten--aansprakelijkheid"><label for="coverages_calamiteiten--aansprakelijkheid" class="control-label">Calamiteiten / aansprakelijkheid</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_vervangend-vervoer" name="coverages[]" type="checkbox" value="vervangend-vervoer"><label for="coverages_vervangend-vervoer" class="control-label">Vervangend vervoer</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_bagage-zonder-geld" checked="checked" name="coverages[]" type="checkbox" value="bagage-zonder-geld"><label for="coverages_bagage-zonder-geld" class="control-label">Bagage zonder geld</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_vervangend-verblijf" name="coverages[]" type="checkbox" value="vervangend-verblijf"><label for="coverages_vervangend-verblijf" class="control-label">Vervangend verblijf</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_bagage-met-geld" name="coverages[]" type="checkbox" value="bagage-met-geld"><label for="coverages_bagage-met-geld" class="control-label">Bagage met geld</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_wintersport" name="coverages[]" type="checkbox" value="wintersport"><label for="coverages_wintersport" class="control-label">Wintersport</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_medische-kosten" checked="checked" name="coverages[]" type="checkbox" value="medische-kosten"><label for="coverages_medische-kosten" class="control-label">Medische kosten</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_gevaarlijke-sporten" name="coverages[]" type="checkbox" value="gevaarlijke-sporten"><label for="coverages_gevaarlijke-sporten" class="control-label">Gevaarlijke sporten</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_ongevallen" name="coverages[]" type="checkbox" value="ongevallen"><label for="coverages_ongevallen" class="control-label">Ongevallen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_rechtsbijstand" name="coverages[]" type="checkbox" value="rechtsbijstand"><label for="coverages_rechtsbijstand" class="control-label">Rechtsbijstand</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_sportuitrusting" name="coverages[]" type="checkbox" value="sportuitrusting"><label for="coverages_sportuitrusting" class="control-label">Sportuitrusting</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_reisduur-verlengen" name="coverages[]" type="checkbox" value="reisduur-verlengen"><label for="coverages_reisduur-verlengen" class="control-label">Reisduur verlengen</label></div><div class="col-lg-6 col-md-6 col-xs-12 inputinlabel"><input id="coverages_zakelijke-reis" name="coverages[]" type="checkbox" value="zakelijke-reis"><label for="coverages_zakelijke-reis" class="control-label">Zakelijke reis</label></div></div></div></div></div><div class="col-lg-6 col-md-6 col-sm-12 col-xs-12"><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="insured_amounts" class="control-label">Dekking annulering</label></div><div class="col-lg-7 col-md-7 col-xs-7"><select class="form-control" id="insured_amounts" name="insured_amounts"><option value="geen-dekking" selected="selected">Geen dekking</option><option value="standaard-verzekerde-bedragen">Standaard verzekerde bedragen</option><option value="lage-verzekerde-bedragen">Lage verzekerde bedragen</option><option value="hoge-verzekerde-bedragen">Hoge verzekerde bedragen</option></select></div></div><div id="cancellation-options"><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="guarantee_cancellation" class="control-label">Garantie annulering</label></div><div class="col-lg-7 col-md-7 col-xs-7"><input id="guarantee_cancellation_nee" checked="checked" name="guarantee_cancellation" type="radio" value="nee"><label for="guarantee_cancellation_nee" class="control-label">Nee</label><input id="guarantee_cancellation_ja" name="guarantee_cancellation" type="radio" value="ja"><label for="guarantee_cancellation_ja" class="control-label">Ja</label></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5"><label for="representative_insured" class="control-label">Zaakwaarnemer</label></div><div class="col-lg-7 col-md-7 col-xs-7"><input id="representative_insured_nee" checked="checked" name="representative_insured" type="radio" value="nee"><label for="representative_insured_nee" class="control-label">Nee</label><input id="representative_insured_ja" name="representative_insured" type="radio" value="ja"><label for="representative_insured_ja" class="control-label">Ja</label></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5 has-info-button"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#travel-animals-modal"><i class="fa fa-info-circle"></i></button><label for="cancellation_animals" class="control-label">Huisdieren</label></div><div class="col-lg-7 col-md-7 col-xs-7"><input id="cancellation_animals_nee" checked="checked" name="cancellation_animals" type="radio" value="nee"><label for="cancellation_animals_nee" class="control-label">Nee</label><input id="cancellation_animals_ja" name="cancellation_animals" type="radio" value="ja"><label for="cancellation_animals_ja" class="control-label">Ja</label></div></div><div class="form-group"><div class="col-lg-5 col-md-5 col-xs-5 has-info-button"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#travel-extra-modal"><i class="fa fa-info-circle"></i></button><label for="cancellation_extra" class="control-label">Extra annuleringsredenen</label></div><div class="col-lg-7 col-md-7 col-xs-7"><input id="cancellation_extra_nee" checked="checked" name="cancellation_extra" type="radio" value="nee"><label for="cancellation_extra_nee" class="control-label">Nee</label><input id="cancellation_extra_ja" name="cancellation_extra" type="radio" value="ja"><label for="cancellation_extra_ja" class="control-label">Ja</label></div></div></div></div></div></div></div><div class="panel panel-default"><div class="panel-heading">Risico's en voorwaarden reis en/of annulering</div><div class="panel-body"><div class="form-group"><div class="col-lg-4 col-md-4 col-xs-5"><button type="button" class="btn btn-default btn-xs pull-right ml5" data-toggle="modal" data-target="#travel-own-risk-modal"><i class="fa fa-info-circle"></i></button><label for="own_risk" class="control-label">Eigen risico's</label></div><div class="col-lg-8 col-md-8 col-xs-7"><select class="form-control" id="own_risk" name="own_risk"><option value="geen-eigen-risico-of-zo-laag-mogelijk" selected="selected">Geen eigen risico of zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-laag-mogelijk">Met eigen risico, maar zo laag mogelijk</option><option value="met-eigen-risico-maar-zo-hoog-mogelijk">Met eigen risico, maar zo hoog mogelijk</option></select></div></div><div class="row product-coverages" data-product="7"><hr><div class="panel-group float full-width mb5" id="accordion13" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading13"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion13" href="#collapse_coverages_7" aria-expanded="false" aria-controls="collapse_coverages_7">Klik hier voor de dekkingen per maatschappij</a></h4></div><div id="collapse_coverages_7" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading13"><div class="panel-body"><table class="table product-coverages-table"><thead><tr><td>Maatschappij</td><td>Dekking</td></tr></thead><tbody><tr data-company="1"><td><label class="control-label text-left">Unigarant</label></td><td><select class="form-control product-insurance-coverage" data-company="1" autocomplete="off"><option value="46" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis basis (Unigarant)" selected="selected">Doorlopende reis basis (Unigarant)</option><option value="47" data-selected-initially="0" data-default-score="1" data-realname="Doorlopende reis Uitgebreid (Unigarant)">Doorlopende reis Uitgebreid (Unigarant)</option></select></td></tr><tr data-company="2"><td><label class="control-label text-left">Nationale Nederlanden</label></td><td><select class="form-control product-insurance-coverage" data-company="2" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr><tr data-company="3"><td><label class="control-label text-left">a.s.r.</label></td><td><select class="form-control product-insurance-coverage" data-company="3" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr><tr data-company="6"><td><label class="control-label text-left">Reaal</label></td><td><select class="form-control product-insurance-coverage" data-company="6" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr><tr data-company="7"><td><label class="control-label text-left">Ansvar Idéa</label></td><td><select class="form-control product-insurance-coverage" data-company="7" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr><tr data-company="8"><td><label class="control-label text-left">Klaverblad</label></td><td><select class="form-control product-insurance-coverage" data-company="8" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr><tr data-company="17"><td><label class="control-label text-left">Turien en co.</label></td><td><select class="form-control product-insurance-coverage" data-company="17" autocomplete="off"><option value="39" data-selected-initially="1" data-default-score="1" data-realname="Doorlopende reis" selected="selected">Doorlopende reis</option></select></td></tr></tbody></table></div></div></div></div></div><div class="row product-risks-wrapper" data-product-id="7" data-product-name="Reis & annulering"></div></div></div></div><div class="col-lg-4 col-md-4 col-sm-12 col-xs-12"><div class="panel panel-default streetview-panel"><div class="panel-heading">Streetview</div><div class="panel-body"><div class="row"><div class="col-xs-12"><img class="housephoto full-size"></div></div><div class="row"><div class="col-xs-12"><br/><span class="streetview-street">De schutstraat</span> <span class="streetview-housenumber">145</span><br/><span class="streetview-postalcode">7907 CD</span> <span class="streetview-city">Hoogeveen</span><br/><span class="streetview-family-situation">Gezin met kinderen</span><hr/></div></div><div class="row form-color-legend"></div></div></div></div></div></form></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-overview"><div id="results-top" class="row tp-wrapper"><div class="col-sm-8"><div class="panel-group" id="accordion14" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="heading14"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion14" href="#collapse14" aria-expanded="false" aria-controls="collapse14">Gegevens</a></h4></div><div id="collapse14" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading14"><div class="panel-body">Hier komen de gegevens in te staan waarmee gerekend wordt in de onderstaande tabel</div></div></div></div></div><div class="col-sm-4"><div class="panel-group pull-right panel-verzekeraars" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="headingE"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#panel-verzekeraars" href="#collapse-filter-1242610" aria-expanded="false" aria-controls="collapse-filter-1242610">Filter verzekeraars</a></h4></div><div id="collapse-filter-1242610" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingE"><div class="panel-body"><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Unigarant" value="1" checked="checked"/> Unigarant</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Nationale Nederlanden" value="2" checked="checked"/> Nationale Nederlanden</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="a.s.r." value="3" checked="checked"/> a.s.r.</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Reaal" value="6" checked="checked"/> Reaal</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Ansvar Idéa" value="7" checked="checked"/> Ansvar Idéa</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Klaverblad" value="8" checked="checked"/> Klaverblad</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Turien en co." value="17" checked="checked"/> Turien en co.</label></div></div></div></div><div class="pull-right"><label for="aantal-verzekeraars">Aantal verzekeraars:</label><select id="aantal-verzekeraars" class="amount-companies-select form-control" autocomplete="off"><option value="3">3</option><option value="4" selected="selected">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option></select></div><div class="pull-right"><a class="generate-pdf" href="#" target="_blank"><i class="fa fa-file-pdf-o" aria-hidden="true"></i></a></div><div class="pull-right" style="padding-right:20px"><label for="d-22">debug</label><input id="d-22" type="checkbox" autocomplete="off"/><br/><label for="p-22">punten</label><input id="p-22" type="checkbox" autocomplete="off"/></div></div></div><div id="results-wrapper" class="tp-wrapper overview"><div id="overview-loader" class="overview-progress progress-loader"><div class="overview-loader-inner progress-loader-inner"><div class="overview-loader-content progress-loader-content"><h2><span class="mif-android"></span> Even geduld</h2><p>Het overzicht wordt samengesteld!</p><div id="overview-progressbar" class="meter progress-loader-bar progress-loader-progressbar"><span></span></div></div></div></div><div id="results-content" class="hidden"></div></div></div><div role="tabpanel" class="tab-pane container" id="tab-provision-discounts"><div class="row tp-wrapper"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><div class="panel panel-default"><div class="panel-heading">Provisies & kortingen</div><div class="panel-body"><div class="panel-group pull-right panel-verzekeraars" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="headingF"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#panel-verzekeraars" href="#collapse-filter-6540761" aria-expanded="false" aria-controls="collapse-filter-6540761">Filter verzekeraars</a></h4></div><div id="collapse-filter-6540761" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading3"><div class="panel-body"><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Unigarant" value="1" checked="checked"/> Unigarant</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Nationale Nederlanden" value="2" checked="checked"/> Nationale Nederlanden</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="a.s.r." value="3" checked="checked"/> a.s.r.</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Reaal" value="6" checked="checked"/> Reaal</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Ansvar Idéa" value="7" checked="checked"/> Ansvar Idéa</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Klaverblad" value="8" checked="checked"/> Klaverblad</label><label><input type="checkbox" class="filter-verzekeraars" data-companyname="Turien en co." value="17" checked="checked"/> Turien en co.</label></div></div></div></div><div class="panel-group pull-right panel-provisions-discounts" role="tablist" aria-multiselectable="true"><div class="panel panel-default"><div class="panel-heading" role="tab" id="headingG"><h4 class="panel-title"><a class="collapsed" role="button" data-toggle="collapse" data-parent="#panel-provisions-discounts" href="#collapse-filter-4615031" aria-expanded="false" aria-controls="collapse-filter-4615031">Filter velden</a></h4></div><div id="collapse-filter-4615031" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading3"><div class="panel-body"><label><input type="checkbox" class="filter-provisions-discounts" data-target="bruto_premium_pre_package" autocomplete="off" value="1"/> Bruto-premie voor pakketkorting</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="bruto_premium_post_package" autocomplete="off" value="1"/> Bruto-premie na pakketkorting</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="commercial_discount" autocomplete="off" value="1"/> Commerciële korting</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="extra_provision_discount" autocomplete="off" value="1"/> Provisie korting</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="provision" autocomplete="off" value="1" checked="checked"/> Provisiepercentage</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="tax" autocomplete="off" value="1" checked="checked"/> Assurantiebelasting</label><label><input type="checkbox" class="filter-provisions-discounts" data-target="netto_premium" autocomplete="off" value="1" checked="checked"/> Totale premies</label></div></div></div></div><div id="provisions-discounts-ajax"></div><div id="provisions-discounts-loader" class="provisions-discounts-progress progress-loader"><div class="provisions-discounts-loader-inner progress-loader-inner"><div class="provisions-discounts-loader-content progress-loader-content"><h2><span class="mif-android"></span> Even geduld</h2><p>De premies, provisies en kortingen worden voor u berekend!</p><div id="provisions-discounts-progressbar" class="meter progress-loader-bar progress-loader-progressbar"><span></span></div></div></div></div></div></div></div></div></div></main>`;
const frag = document.createDocumentFragment();
const node = document.createElement('div');
let build = function(node, str, frag) {
node.insertAdjacentHTML('beforeend', str);
frag.appendChild(node);
document.body.appendChild(frag);
}
build(node, str, frag);
}());
</script>
</body>
</html>
SO49496716
==========
OP experiencing heavy latency when attempting to add a huge amount of markup to DOM by `innerHTML`. Up to 34 seconds to render it completely using Edge while other browsers OP reported at 3 seconds.
Although OP had tried using [**createDocumentFragment()**](https://developer.mozilla.org/en-US/docs/Web/API/Document/createDocumentFragment) already, I believe it is key to a quick load and parse of said HTML. The other key components that the OP probably didn't use are:
[**insertAdjacentHTML()**](https://developer.mozilla.org/en-US/docs/Web/API/Element/insertAdjacentHTML) and [**Immediately Invoked Function Expression**](https://www.kirupa.com/html5/immediately_invoked_function_expressions_iife.htm)
Using method instead of `innerHTML` property. **iAHTML** is a powerful and versitile version of **iHTML**.
**Similarities:**
Both will take a given string and parse as HTML.
Both are quick.
**Differences:**
iAHTML inserts HTML into the DOM, it doesn't overwrite any existing HTML in an element or anywhere in the DOM. **iHTML** overwrites the inside of an element.
iHTML is directed by reference to an element to which it will take a string and overwrite all content of said element with the given string. If iHTML is just directed to an element without a string, then it will return with the HTML content of said element. iHTML ability to *GET* is the only thing iAHTML it *can't do*. In contrast, iAHTML ability to *SET* is powerful as explained: iAHTML is directed not only by reference to an element it is told exactly where to go in relation to the referenced element by its first parameter which is one of the 4 DOMStrings that correlate to a *position*:
*"beforebegin"* places the string right **before** the **begin**ning of the element.
`$elector.before(str)`★
*"afterend"* places the string right **after** the **end** of the elemenmt.
`$elector.after(str)`★
*"afterbegin"* places the string *within* the element right **after** the **brgin**ning. In otherwords the string is inserted before the element's contents.
`$elector.prepend(str)`★
*"beforeend"* places the string *within* the element right **before** the **end**. Basically the string is placed after the element's content. This position is the most optimized for speed since the are no proceeding siblings to slow things down.
`$elector.append(str)`★
**iAHTML** second parameter is the string that will be parsed into HTML. Using Template Literals instead of literal strings allows us to a whole extra level of easy string manipulation.
`element.insertAdjacentHTML("beforeend", <input id="${ID+i}" type="${typeArr[i]}" value="${Math.floor(Math.random() * i}">)`
**Immediately Invoked Function Expression** is a function with a special pattern.
- It is usually two ananonymous functions:
- The outer function is wrapped in parenthesis.
- The inner function usually forms a closure.
- Anonymous/expression functions are created when evaluated and then they are immediately invoked due to the extra parenthesis wrappoed around them.
- They have no name and the variables that the inner function uses can only be accessed by the outer function because they are local scope.
These conditions make an ***IIFE*** a one time thing. The signature of an ***IIFE*** have slight variances in their signature but the gist of one goes like this:
`(function() { var x = function() {...} x})();`
DOM manipulation is processor intensive and the more we avoid it the better. **`DocumentFragment`** was made in order for us to do all of the meanial yet numerous tasks involving the DOM -- *off of the DOM*. We can add as many elements, text, attributes, set event handlers, etc. to the **DocFrag** and its descendants without touching the DOM. Once everything is complete, only one DOM operation needs to be dome:
`document.body.appendChild(frag);`