{"id":5739,"date":"2023-02-28T14:02:13","date_gmt":"2023-02-28T14:02:13","guid":{"rendered":"https:\/\/victoire.com.lb\/%d8%a7%d9%84%d8%ae%d8%b7%d8%a9-%d8%a7%d9%84%d8%b7%d8%a8%d9%8a%d8%a9-%d8%a7%d8%ad%d8%b5%d9%84-%d8%b9%d9%84%d9%89-%d8%b9%d8%b1%d8%b6-%d8%a3%d8%b3%d8%b9%d8%a7%d8%b1\/"},"modified":"2024-05-10T15:26:42","modified_gmt":"2024-05-10T15:26:42","slug":"%d8%a7%d9%84%d8%ae%d8%b7%d8%a9-%d8%a7%d9%84%d8%b7%d8%a8%d9%8a%d8%a9-%d8%a7%d8%ad%d8%b5%d9%84-%d8%b9%d9%84%d9%89-%d8%b9%d8%b1%d8%b6-%d8%a3%d8%b3%d8%b9%d8%a7%d8%b1","status":"publish","type":"page","link":"https:\/\/victoire.com.lb\/ar\/%d8%a7%d9%84%d8%ae%d8%b7%d8%a9-%d8%a7%d9%84%d8%b7%d8%a8%d9%8a%d8%a9-%d8%a7%d8%ad%d8%b5%d9%84-%d8%b9%d9%84%d9%89-%d8%b9%d8%b1%d8%b6-%d8%a3%d8%b3%d8%b9%d8%a7%d8%b1\/","title":{"rendered":"<a href=\"https:\/\/victoire.com.lb\/wp-admin\/admin.php?page=wpforms-builder&amp;view=fields&amp;form_id=2952\"><strong>\u0627\u0644\u062e\u0637\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 \u0627\u062d\u0635\u0644 \u0639\u0644\u0649 \u0639\u0631\u0636 \u0623\u0633\u0639\u0627\u0631<\/strong><\/a>"},"content":{"rendered":"\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-2952\"><form id=\"wpforms-form-2952\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2952\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ar\/wp-json\/wp\/v2\/pages\/5739\" data-token=\"74a4e682cb7cfb17d374f7dae94b6705\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2952-field_125-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"125\"><div id=\"wpforms-2952-field_125\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][125]\"><h4>Travel YA HALA CARE Insurance: GET A QUOTE<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_48-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"48\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_48\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_129-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"129\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_129\">Select a Program <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_129\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][129]\" required=\"required\"><option value=\"Perpetual (Full Network)\" >Perpetual (Full Network)<\/option><option value=\"Perpetual (Limited Network)\" >Perpetual (Limited Network)<\/option><\/select><\/div><div id=\"wpforms-2952-field_131-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"131\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_131\">National Social Security Fund (CNSS) <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_131\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][131]\" required=\"required\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_130-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"130\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_130\">Select a Class <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_130\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][130]\" required=\"required\"><option value=\"Lux (Depending on Program)\" >Lux (Depending on Program)<\/option><option value=\"Class A | Gold Plan ( Includes AUB &amp; CMC)\" >Class A | Gold Plan ( Includes AUB &amp; CMC)<\/option><option value=\"Class B | Silver Plan (Excludes AUB &amp; CMC)\" >Class B | Silver Plan (Excludes AUB &amp; CMC)<\/option><option value=\"SPL ( 50,000$)\" >SPL ( 50,000$)<\/option><option value=\"SP\" >SP<\/option><\/select><\/div><div id=\"wpforms-2952-field_133-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger\" data-field-id=\"133\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_133\"> \u2116 of Persons <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_133\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][133]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_135-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"135\"><div id=\"wpforms-2952-field_135\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][135]\"><p><span style=\"color: #ff0000\">When a family exceeds 6 members, Victoire grants a free Medical Insurance for the 7th <\/span><span style=\"color: #ff0000\">person and so on <\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_13-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"13\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_13\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_27-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"27\"><div id=\"wpforms-2952-field_27\"><p style=\"font-size:19px; padding-top:3%;\">First Member<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_110-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_110\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_110\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][110]\" placeholder=\"dd\/mm\/yyyy\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_49-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"49\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_49\">Layout (copy)<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_53-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"53\"><div id=\"wpforms-2952-field_53\"><p style=\"font-size:19px; padding-top:3%;\">Total Premium<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_52-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"52\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_52\">Single Line Text<\/label><input type=\"text\" id=\"wpforms-2952-field_52\" class=\"wpforms-field-medium\" name=\"wpforms[fields][52]\" placeholder=\"$35\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_59-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"59\" style=\"display:none;\"><div id=\"wpforms-2952-field_59\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][59]\"><h4>BENEFITS AND COVERS<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_56-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"56\" style=\"display:none;\"><div id=\"wpforms-2952-field_56\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][56]\"><ul>\n<li>Victoire Perpetual Plan is the leading Healthcare Insurance Plan available for all classes: Lux, A, B and Semi Private.<\/li>\n<li>The GR feature guarantees you to renew your policy year after year throughout your lifetime,&nbsp; disregarding your age or your health conditions<\/li>\n<li>Emergency treatment is covered 100% in Lebanon and is unlimited.<\/li>\n<li>Maternity complications and\/or Delivery (either normal or C-Section), are fully covered after 1 year of adherence, as well as the Epidural for pain control during delivery. Unlimited cover of days in Incubator for babies, and the first Pediatrician consultation free of charge.<\/li>\n<li>The Newly born baby is covered free of charge until the renewal of the mother\u2018s policy.<\/li>\n<li>This Plan provides a Guarantee of Renewability (GR) from day ONE for newly born babies disregarding their health status.<\/li>\n<li>Covering all congenital cases with unlimited financial cover for continuously renewed policy, as well as all kind of surgeries needed to correct any congenital condition or other malformation at birth.<\/li>\n<li>A free of charge extra bed is granted for parents accompanying a child below 18.<\/li>\n<li>This cover is Worldwide and grants you 100% Financial Medical support up to $65,000, in case of any sudden misfortune resulting in a Medical Emergency occurring during your travels with all its requirements such as Medical Transportation, Repatriation or Hospital or Clinic admission.<\/li>\n<li>Unknown Congenital Cases or undiagnosed or non-treated cases prior to adherence will be covered after 4 months of enrollment.<\/li>\n<li>Covering all work-related accidents, to the same class as your policy cover. 100% is covered in case of an accident. In medical cases it is covered up to $30,000 per prosthesis.<\/li>\n<li>This feature covers stent in medical cases up to $30,000 per stent with unlimited number.<\/li>\n<li>All cosmetic surgeries related to a covered accident are totally covered.<\/li>\n<li>The adherent is covered in case of war or terrorism injury in case he\/she was not actively involved in the related act.<\/li>\n<li>Up to $2,000 are paid to legal heirs of adherent in case of death during hospitalization.<\/li>\n<li>This cover grants the Policyholder $5,000 as Personal Accident Insurance in case of Death or Partial or Total Permanent Disability (TPD).<\/li>\n<li>Covering infertility treatment for in-patient and undiagnosed pre-existing conditions.<\/li>\n<li>Covering Severe Psychotic disorders requiring hospital confinement.<\/li>\n<li>Covering surgery and costs of all kinds of organ transfer and, tissue transplant.<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_45-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"45\"><h3 id=\"wpforms-2952-field_45\" name=\"wpforms[fields][45]\">To get an OFFER kindly fill out the information below<\/h3><\/div><div id=\"wpforms-2952-field_33-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_33\">Full Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" placeholder=\"ex. Marwan Saad\" required><\/div><div id=\"wpforms-2952-field_34-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"34\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_34\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2952-field_38-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"38\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_38\">Get a Quote <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2952-field_38\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2952-field_38_1\" name=\"wpforms[fields][38]\" value=\"Get a Quote\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2952-field_38_1\">Get a Quote<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2952-field_38_2\" name=\"wpforms[fields][38]\" value=\"Get a Quote with Conditions\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2952-field_38_2\">Get a Quote with Conditions<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_40-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns wpforms-conditional-trigger\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_40\">How would you like to receive the Quote: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2952-field_40\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2952-field_40_1\" name=\"wpforms[fields][40]\" value=\"Email\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2952-field_40_1\">Email<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2952-field_40_2\" name=\"wpforms[fields][40]\" value=\"Telephone\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2952-field_40_2\">Telephone<\/label><\/li><\/ul><\/div><div id=\"wpforms-2952-field_118-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_118\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2952-field_118\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][118]\" placeholder=\"Enter email\" spellcheck=\"false\" required><\/div><div id=\"wpforms-2952-field_124-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_124\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-2952-field_124\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][124]\" required><\/div><div id=\"wpforms-2952-field_63-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"63\"><h3 id=\"wpforms-2952-field_63\" name=\"wpforms[fields][63]\"> To buy the POLICY kindly fill out the remaining information below<\/h3><\/div><div id=\"wpforms-2952-field_64-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"64\"><div id=\"wpforms-2952-field_64\"><p style=\"font-size:18px;\"><strong>Personal Details<\/strong><\/p><\/div><\/div><div id=\"wpforms-2952-field_65-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"65\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_65\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_136-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"136\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_136\">Ms. \/ Mr. <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_136\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][136]\" required=\"required\"><option value=\"Ms.\" >Ms.<\/option><option value=\"Mr.\" >Mr.<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_70\">First Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_70\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][70]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_68-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_68\">Father Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_66\">Last Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_66\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][66]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_69-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"69\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_69\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2952-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_67\">Lebanese ID <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_67\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][67]\" required><div class=\"wpforms-field-description\">Please enter your Lebanese Identity Number or Passport Number<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2952-field_137-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"137\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_137\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_137\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][137]\" required=\"required\"><option value=\"Male\" >Male<\/option><option value=\"Female\" >Female<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2952-field_139-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"139\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_139\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2952-field_139\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][139][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_140-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"140\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_140\">Layout (copy)<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2952-field_144-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"144\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_144\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2952-field_144\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][144]\" placeholder=\"Text@abcdef.coom\" spellcheck=\"false\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2952-field_145-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"145\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_145\">Tel\/Mobile <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-2952-field_145\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][145]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><div id=\"wpforms-2952-field_147-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"147\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_147\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_147\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][147]\" required><\/div><div id=\"wpforms-2952-field_72-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"72\"><div id=\"wpforms-2952-field_72\"><p style=\"font-size:18px;\"><strong>Additional Cover Details<\/strong><\/p><\/div><\/div><div id=\"wpforms-2952-field_73-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"73\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2952-field_73\">Layout (copy)<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_148-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"148\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_148\">Member <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_148\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][148]\" required=\"required\"><option value=\"Principal\" >Principal<\/option><option value=\"Spouse\" >Spouse<\/option><option value=\"Child\" >Child<\/option><\/select><\/div><div id=\"wpforms-2952-field_152-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"152\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_152\">Nationality <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_152\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][152]\" required=\"required\"><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"Albania\" >Albania<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_149-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"149\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_149\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_149\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][149]\" required><\/div><div id=\"wpforms-2952-field_151-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"151\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_151\">Height (cm) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_151\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][151]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_80-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_80\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2952-field_80\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][80][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2952-field_150-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"150\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_150\">Weight (kg) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2952-field_150\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][150]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-2952-field_128-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_128\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_128\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][128]\" required=\"required\"><option value=\"Male\" >Male<\/option><option value=\"Female\" >Female<\/option><\/select><\/div><div id=\"wpforms-2952-field_153-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"153\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_153\">Smoker <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2952-field_153\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][153]\" required=\"required\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-2952-field_154-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"154\"><label class=\"wpforms-field-label\" for=\"wpforms-2952-field_154\">Has this member been previously injured or treated, select a reason:<\/label><select id=\"wpforms-2952-field_154\" class=\"wpforms-field-medium\" name=\"wpforms[fields][154]\"><option value=\"Cardiovascular disease (high blood pressure, heart attack\u2026)\" >Cardiovascular disease (high blood pressure, heart attack\u2026)<\/option><option value=\"Respiratory disease (asthma, tuberculosis\u2026)\" >Respiratory disease (asthma, tuberculosis\u2026)<\/option><option value=\"Digestive Disease (ulcers, liver\u2026)\" >Digestive Disease (ulcers, liver\u2026)<\/option><option value=\"Kidney Disease and urinary tract\" >Kidney Disease and urinary tract<\/option><option value=\"Diseases of the bone, muscle or transplanted organs\" >Diseases of the bone, muscle or transplanted organs<\/option><option value=\"Diseases of the nervous system (nervous breakdown, Epilepsy, stroke\u2026)\" >Diseases of the nervous system (nervous breakdown, Epilepsy, stroke\u2026)<\/option><option value=\"Endocrine diseases and diabetes (blood lipid, thyroid\u2026)\" >Endocrine diseases and diabetes (blood lipid, thyroid\u2026)<\/option><option value=\"Diseases of the ear, nose, throat or eye\" >Diseases of the ear, nose, throat or eye<\/option><option value=\"Hematological disease (anemia\u2026)\" >Hematological disease (anemia\u2026)<\/option><option value=\"Malignant tumors in the body or malignant hemopathies(cancer)\" >Malignant tumors in the body or malignant hemopathies(cancer)<\/option><option value=\"Sexually transmitted diseases and AIDs virus\" >Sexually transmitted diseases and AIDs virus<\/option><option value=\"Congenital Malformation or impotence\" >Congenital Malformation or impotence<\/option><option value=\"Other diseases, accidents or previous or future pre-planned operations\" >Other diseases, accidents or previous or future pre-planned operations<\/option><option value=\"Do any of you take any medication or are following a treatment?\" >Do any of you take any medication or are following a treatment?<\/option><option value=\"Do any of you suffer from allergies to food or other medication?\" >Do any of you suffer from allergies to food or other medication?<\/option><option value=\"For women: Are you currently pregnant? When is expected date of \" >For women: Are you currently pregnant? When is expected date of <\/option><\/select><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"2952\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"2\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2952\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/victoire.com.lb\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"Please enable JavaScript in your browser to complete this form.Travel YA HALA CARE Insurance: GET A QUOTE LayoutSelect a Program *Perpetual (Full Network)Perpetual (Limited Network)National Social Security Fund (CNSS) *YesNoSelect...","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-5739","page","type-page","status-publish"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/pages\/5739","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/comments?post=5739"}],"version-history":[{"count":0,"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/pages\/5739\/revisions"}],"wp:attachment":[{"href":"https:\/\/victoire.com.lb\/ar\/wp-json\/wp\/v2\/media?parent=5739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}