{"id":64,"date":"2022-06-17T19:16:29","date_gmt":"2022-06-17T17:16:29","guid":{"rendered":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/?page_id=64"},"modified":"2022-06-19T17:07:43","modified_gmt":"2022-06-19T15:07:43","slug":"verkehrsunfall","status":"publish","type":"page","link":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/verkehrsunfall\/","title":{"rendered":"Verkehrsunfall-Anspruchsanmeldung"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Verkehr<\/h2>\n                            <p class='gform_description'>Bitte f\u00fcllen Sie den Bogen so detailliert und gewissenhaft wie m\u00f6glich aus<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u201e<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u201c zeigt erforderliche Felder an<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/pages\/64#gf_1' data-formid='1' novalidate>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Schritt <span class='gf_step_current_page'>1<\/span> von <span class='gf_step_page_count'>13<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_7' style='width:7%;'><span>7%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_129\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_129'>URL<\/label><div class='ginput_container'><input name='input_129' id='input_1_129' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_129'>Dieses Feld dient zur Validierung und sollte nicht ver\u00e4ndert werden.<\/div><\/div><div id=\"field_1_109\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_109'>Wann fand der Unfall statt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_109' id='input_1_109' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='tt.mm.jjjj' aria-describedby=\"input_1_109_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_109_date_format' class='screen-reader-text'>TT Punkt MM Punkt JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_109' class='gform_hidden' value='https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_1_13\" class=\"gfield gfield--type-time gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Um welche Uhrzeit (etwa)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_1_13'>\n                            <input type='number' name='input_13[]' id='input_1_13_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_1_13_1'>Stunden<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_13[]' id='input_1_13_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_1_13_2'>Minuten<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_1_14\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'>Wo fand der Unfall statt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_14\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_14'>Stra\u00dfe, PLZ und Ort<\/div><\/div><div id=\"field_1_18\" class=\"gfield gfield--type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_18'>In welchem Land?<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_1_18' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Deutschland' >Deutschland<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albanien' >Albanien<\/option><option value='Algerien' >Algerien<\/option><option value='Amerikanisch-Samoa' >Amerikanisch-Samoa<\/option><option value='Amerikanische Jungferninseln' >Amerikanische Jungferninseln<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktis' >Antarktis<\/option><option value='Antigua und Barbuda' >Antigua und Barbuda<\/option><option value='Argentinien' >Argentinien<\/option><option value='Armenien' >Armenien<\/option><option value='Aruba' >Aruba<\/option><option value='Aserbaidschan' >Aserbaidschan<\/option><option value='Australien' >Australien<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgien' >Belgien<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosnien und Herzegowina' >Bosnien und Herzegowina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvetinsel' >Bouvetinsel<\/option><option value='Brasilien' >Brasilien<\/option><option value='Britische Jungferninseln' >Britische Jungferninseln<\/option><option value='Britisches Territorium im Indischen Ozean' >Britisches Territorium im Indischen Ozean<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarien' >Bulgarien<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Caymen Inseln' >Caymen Inseln<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Cookinseln' >Cookinseln<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Demokratische Volksrepublik Laos' >Demokratische Volksrepublik Laos<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominikanische Republik' >Dominikanische Republik<\/option><option value='D\u00e4nemark' >D\u00e4nemark<\/option><option value='Ecuador' >Ecuador<\/option><option value='El Salvador' >El Salvador<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Falklandinseln' >Falklandinseln<\/option><option value='Fidschi' >Fidschi<\/option><option value='Finnland' >Finnland<\/option><option value='Frankreich' >Frankreich<\/option><option value='Franz\u00f6sisch-Guayana' >Franz\u00f6sisch-Guayana<\/option><option value='Franz\u00f6sisch-Polynesien' >Franz\u00f6sisch-Polynesien<\/option><option value='Franz\u00f6sische S\u00fcd- und Antarktisgebiete' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='Futuna (Wallis und Futuna)' >Futuna (Wallis und Futuna)<\/option><option value='F\u00e4r\u00f6er-Inseln' >F\u00e4r\u00f6er-Inseln<\/option><option value='Gabun' >Gabun<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griechenland' >Griechenland<\/option><option value='Gro\u00dfbritannien' >Gro\u00dfbritannien<\/option><option value='Gr\u00f6nland' >Gr\u00f6nland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard und McDonaldinseln' >Heard und McDonaldinseln<\/option><option value='Heiliger Stuhl' >Heiliger Stuhl<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indien' >Indien<\/option><option value='Indonesien' >Indonesien<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irland' >Irland<\/option><option value='Island' >Island<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italien' >Italien<\/option><option value='Jamaika' >Jamaika<\/option><option value='Japan' >Japan<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kambodscha' >Kambodscha<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Kap Verde' >Kap Verde<\/option><option value='Karibische Niederlande' >Karibische Niederlande<\/option><option value='Kasachstan' >Kasachstan<\/option><option value='Katar' >Katar<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kokosinseln' >Kokosinseln<\/option><option value='Kolumbien' >Kolumbien<\/option><option value='Komoren' >Komoren<\/option><option value='Kongo, Demokratische Republik des' >Kongo, Demokratische Republik des<\/option><option value='Kongo, Republik des' >Kongo, Republik des<\/option><option value='Kroatien' >Kroatien<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwait' >Kuwait<\/option><option value='K\u00f6nigreich Eswatini (Swasiland)' >K\u00f6nigreich Eswatini (Swasiland)<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettland' >Lettland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litauen' >Litauen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macao' >Macao<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Malediven' >Malediven<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall-Inseln' >Marshall-Inseln<\/option><option value='Martinique' >Martinique<\/option><option value='Mauretanien' >Mauretanien<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mazedonien' >Mazedonien<\/option><option value='Mexiko' >Mexiko<\/option><option value='Mikronesien' >Mikronesien<\/option><option value='Moldawien' >Moldawien<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolei' >Mongolei<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mosambik' >Mosambik<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Neukaledonien' >Neukaledonien<\/option><option value='Neuseeland' >Neuseeland<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niederlande' >Niederlande<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Nordkorea (Volksrepublik)' >Nordkorea (Volksrepublik)<\/option><option value='Norfolkinsel' >Norfolkinsel<\/option><option value='Norwegen' >Norwegen<\/option><option value='N\u00f6rdliche Marianen' >N\u00f6rdliche Marianen<\/option><option value='Oman' >Oman<\/option><option value='Osttimor' >Osttimor<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Pal\u00e4stina, Bundesstaat' >Pal\u00e4stina, Bundesstaat<\/option><option value='Panama' >Panama<\/option><option value='Papua Neu Guinea' >Papua Neu Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippinen' >Philippinen<\/option><option value='Pitcairninseln' >Pitcairninseln<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Ruanda' >Ruanda<\/option><option value='Rum\u00e4nien' >Rum\u00e4nien<\/option><option value='Russland' >Russland<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='S&uuml;dgeorgien' >S&uuml;dgeorgien<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Pierre und Miquelon' >Saint-Pierre und Miquelon<\/option><option value='Salomonen' >Salomonen<\/option><option value='Sambia' >Sambia<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Saudi-Arabien' >Saudi-Arabien<\/option><option value='Schweden' >Schweden<\/option><option value='Schweiz' >Schweiz<\/option><option value='Senegal' >Senegal<\/option><option value='Serbien' >Serbien<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Simbabwe' >Simbabwe<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovenien' >Slovenien<\/option><option value='Slowakei' >Slowakei<\/option><option value='Somalia' >Somalia<\/option><option value='Spanien' >Spanien<\/option><option value='Spitzbergen' >Spitzbergen<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='St. Helena' >St. Helena<\/option><option value='St. Kitts und Nevis' >St. Kitts und Nevis<\/option><option value='St. Lucia' >St. Lucia<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Vincent und die Grenadinen' >St. Vincent und die Grenadinen<\/option><option value='Sudan' >Sudan<\/option><option value='Surinam' >Surinam<\/option><option value='Syrien' >Syrien<\/option><option value='S\u00e3o Tom\u00e9 und Pr\u00edncipe' >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value='S\u00fcdafrika' >S\u00fcdafrika<\/option><option value='S\u00fcdkorea' >S\u00fcdkorea<\/option><option value='S\u00fcdsudan' >S\u00fcdsudan<\/option><option value='Tadschikistan' >Tadschikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad und Tobago' >Trinidad und Tobago<\/option><option value='Tschad' >Tschad<\/option><option value='Tschechische Republik' >Tschechische Republik<\/option><option value='Tunesien' >Tunesien<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- und Caicosinseln' >Turks- und Caicosinseln<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkei' >T\u00fcrkei<\/option><option value='U.S.A.' >U.S.A.<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='Ungarn' >Ungarn<\/option><option value='Uruguay' >Uruguay<\/option><option value='Usbekistan' >Usbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vereinigte Arabische Emirate' >Vereinigte Arabische Emirate<\/option><option value='Vietnam' >Vietnam<\/option><option value='Weihnachtsinsel' >Weihnachtsinsel<\/option><option value='Wei\u00dfrussland' >Wei\u00dfrussland<\/option><option value='Westsahara' >Westsahara<\/option><option value='Zentralafrikanische Republik' >Zentralafrikanische Republik<\/option><option value='Zypern' >Zypern<\/option><option value='\u00c4gypten' >\u00c4gypten<\/option><option value='\u00c4quatorial Guinea' >\u00c4quatorial Guinea<\/option><option value='\u00c4thopien' >\u00c4thopien<\/option><option value='\u00c5landinseln' >\u00c5landinseln<\/option><option value='\u00d6sterreich' >\u00d6sterreich<\/option><\/select><\/div><\/div><fieldset id=\"field_1_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wurde der Unfall polizeilich aufgenommen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_20'><div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Ja'  id='choice_1_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Nein'  id='choice_1_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_2' id='label_1_20_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_17\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'>Welche Polizeidienststelle hat den Unfall aufgenommen?<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>Haben Sie ein Aktenzeichen?<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_1_22' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_4\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Daten des Eigent\u00fcmers des Fahrzeugs<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1_4'>\n                            <span id='input_1_4_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_4.2' id='input_1_4_2'   autocomplete=\"honorific-prefix\" aria-required='false'   >\n                          <option value=''><\/option><option value='Frau' >Frau<\/option><option value='Herr' >Herr<\/option><option value='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option>\n                      <\/select>\n                                                    <label for='input_1_4_2' class='gform-field-label gform-field-label--type-sub '>Anrede<\/label>\n                                                  <\/span>\n                            <span id='input_1_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_4.3' id='input_1_4_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_1_4_3' class='gform-field-label gform-field-label--type-sub '>Vorname<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_4.6' id='input_1_4_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_1_4_6' class='gform-field-label gform-field-label--type-sub '>Nachname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_5\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_1_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_5_1' id='input_1_5_1_label' class='gform-field-label gform-field-label--type-sub '>Anschrift<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_1_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_5_3' id='input_1_5_3_label' class='gform-field-label gform-field-label--type-sub '>Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_5.4' id='input_1_5_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_1_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_5_5' id='input_1_5_5_label' class='gform-field-label gform-field-label--type-sub '>PLZ<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_5_6_container' >\n                                        <select name='input_5.6' id='input_1_5_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albanien' >Albanien<\/option><option value='Algerien' >Algerien<\/option><option value='Amerikanisch-Samoa' >Amerikanisch-Samoa<\/option><option value='Amerikanische Jungferninseln' >Amerikanische Jungferninseln<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktis' >Antarktis<\/option><option value='Antigua und Barbuda' >Antigua und Barbuda<\/option><option value='Argentinien' >Argentinien<\/option><option value='Armenien' >Armenien<\/option><option value='Aruba' >Aruba<\/option><option value='Aserbaidschan' >Aserbaidschan<\/option><option value='Australien' >Australien<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgien' >Belgien<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosnien und Herzegowina' >Bosnien und Herzegowina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvetinsel' >Bouvetinsel<\/option><option value='Brasilien' >Brasilien<\/option><option value='Britische Jungferninseln' >Britische Jungferninseln<\/option><option value='Britisches Territorium im Indischen Ozean' >Britisches Territorium im Indischen Ozean<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarien' >Bulgarien<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Caymen Inseln' >Caymen Inseln<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Cookinseln' >Cookinseln<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Demokratische Volksrepublik Laos' >Demokratische Volksrepublik Laos<\/option><option value='Deutschland' selected='selected'>Deutschland<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominikanische Republik' >Dominikanische Republik<\/option><option value='D\u00e4nemark' >D\u00e4nemark<\/option><option value='Ecuador' >Ecuador<\/option><option value='El Salvador' >El Salvador<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Falklandinseln' >Falklandinseln<\/option><option value='Fidschi' >Fidschi<\/option><option value='Finnland' >Finnland<\/option><option value='Frankreich' >Frankreich<\/option><option value='Franz\u00f6sisch-Guayana' >Franz\u00f6sisch-Guayana<\/option><option value='Franz\u00f6sisch-Polynesien' >Franz\u00f6sisch-Polynesien<\/option><option value='Franz\u00f6sische S\u00fcd- und Antarktisgebiete' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='Futuna (Wallis und Futuna)' >Futuna (Wallis und Futuna)<\/option><option value='F\u00e4r\u00f6er-Inseln' >F\u00e4r\u00f6er-Inseln<\/option><option value='Gabun' >Gabun<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griechenland' >Griechenland<\/option><option value='Gro\u00dfbritannien' >Gro\u00dfbritannien<\/option><option value='Gr\u00f6nland' >Gr\u00f6nland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard und McDonaldinseln' >Heard und McDonaldinseln<\/option><option value='Heiliger Stuhl' >Heiliger Stuhl<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indien' >Indien<\/option><option value='Indonesien' >Indonesien<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irland' >Irland<\/option><option value='Island' >Island<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italien' >Italien<\/option><option value='Jamaika' >Jamaika<\/option><option value='Japan' >Japan<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kambodscha' >Kambodscha<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Kap Verde' >Kap Verde<\/option><option value='Karibische Niederlande' >Karibische Niederlande<\/option><option value='Kasachstan' >Kasachstan<\/option><option value='Katar' >Katar<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kokosinseln' >Kokosinseln<\/option><option value='Kolumbien' >Kolumbien<\/option><option value='Komoren' >Komoren<\/option><option value='Kongo' >Kongo<\/option><option value='Kongo, Demokratische Republik des' >Kongo, Demokratische Republik des<\/option><option value='Korea. Demokratische Volksrepublik' >Korea. Demokratische Volksrepublik<\/option><option value='Kroatien' >Kroatien<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwait' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettland' >Lettland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litauen' >Litauen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Malediven' >Malediven<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall-Inseln' >Marshall-Inseln<\/option><option value='Martinique' >Martinique<\/option><option value='Mauretanien' >Mauretanien<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexiko' >Mexiko<\/option><option value='Mikronesien' >Mikronesien<\/option><option value='Moldawien' >Moldawien<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolei' >Mongolei<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mosambik' >Mosambik<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Neukaledonien' >Neukaledonien<\/option><option value='Neuseeland' >Neuseeland<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niederlande' >Niederlande<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Nordmazedonien' >Nordmazedonien<\/option><option value='Norfolkinsel' >Norfolkinsel<\/option><option value='Norwegen' >Norwegen<\/option><option value='N\u00f6rdliche Marianen' >N\u00f6rdliche Marianen<\/option><option value='Oman' >Oman<\/option><option value='Osttimor' >Osttimor<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Pal\u00e4stina, Bundesstaat' >Pal\u00e4stina, Bundesstaat<\/option><option value='Panama' >Panama<\/option><option value='Papua Neu Guinea' >Papua Neu Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippinen' >Philippinen<\/option><option value='Pitcairninseln' >Pitcairninseln<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Ruanda' >Ruanda<\/option><option value='Rum\u00e4nien' >Rum\u00e4nien<\/option><option value='Russische F\u00f6deration' >Russische F\u00f6deration<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Pierre und Miquelon' >Saint-Pierre und Miquelon<\/option><option value='Salomonen' >Salomonen<\/option><option value='Sambia' >Sambia<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Saudi-Arabien' >Saudi-Arabien<\/option><option value='Schweden' >Schweden<\/option><option value='Schweiz' >Schweiz<\/option><option value='Senegal' >Senegal<\/option><option value='Serbien' >Serbien<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Simbabwe' >Simbabwe<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovenien' >Slovenien<\/option><option value='Slowakei' >Slowakei<\/option><option value='Somalia' >Somalia<\/option><option value='Spanien' >Spanien<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='St. Helena, Ascension und Tristan da Cunha' >St. Helena, Ascension und Tristan da Cunha<\/option><option value='St. Kitts und Nevis' >St. Kitts und Nevis<\/option><option value='St. Lucia' >St. Lucia<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Vincent und die Grenadinen' >St. Vincent und die Grenadinen<\/option><option value='Sudan' >Sudan<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard und Jan Mayen' >Svalbard und Jan Mayen<\/option><option value='Syrien, Arabische Republik' >Syrien, Arabische Republik<\/option><option value='S\u00e3o Tom\u00e9 und Pr\u00edncipe' >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value='S\u00fcdafrika' >S\u00fcdafrika<\/option><option value='S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln' >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value='S\u00fcdkorea' >S\u00fcdkorea<\/option><option value='S\u00fcdsudan' >S\u00fcdsudan<\/option><option value='Tadschikistan' >Tadschikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tansania, Vereinte Republik' >Tansania, Vereinte Republik<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad und Tobago' >Trinidad und Tobago<\/option><option value='Tschad' >Tschad<\/option><option value='Tschechien' >Tschechien<\/option><option value='Tunesien' >Tunesien<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- und Caicosinseln' >Turks- und Caicosinseln<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkei' >T\u00fcrkei<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='Ungarn' >Ungarn<\/option><option value='Uruguay' >Uruguay<\/option><option value='Usbekistan' >Usbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vereinigte Arabische Emirate' >Vereinigte Arabische Emirate<\/option><option value='Vereinigte Staaten von Amerika' >Vereinigte Staaten von Amerika<\/option><option value='Vietnam' >Vietnam<\/option><option value='Weihnachtsinsel' >Weihnachtsinsel<\/option><option value='Wei\u00dfrussland' >Wei\u00dfrussland<\/option><option value='Westsahara' >Westsahara<\/option><option value='Zentralafrikanische Republik' >Zentralafrikanische Republik<\/option><option value='Zypern' >Zypern<\/option><option value='\u00c4gypten' >\u00c4gypten<\/option><option value='\u00c4quatorial Guinea' >\u00c4quatorial Guinea<\/option><option value='\u00c4thopien' >\u00c4thopien<\/option><option value='\u00c5landinseln' >\u00c5landinseln<\/option><option value='\u00d6sterreich' >\u00d6sterreich<\/option><\/select>\n                                        <label for='input_1_5_6' id='input_1_5_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_23\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_1_23' type='tel' value='+49' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_24\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >E-Mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_24_container'>\n                                <span id='input_1_24_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_24' id='input_1_24' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_24\" \/>\n                                    <label for='input_1_24' class='gform-field-label gform-field-label--type-sub '>E-Mail eingeben<\/label>\n                                <\/span>\n                                <span id='input_1_24_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_24_2' id='input_1_24_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_24\" \/>\n                                    <label for='input_1_24_2' class='gform-field-label gform-field-label--type-sub '>E-Mail best\u00e4tigen<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><div class='gfield_description' id='gfield_description_1_24'>Ihre Email ist notwendig, damit wir Ihnen die Mandatsunterlagen und weiteren Infos zukommen lassen k\u00f6nnen.<\/div><\/fieldset><div id=\"field_1_25\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_25'>Kontodaten-IBAN<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='DE' class='large'  aria-describedby=\"gfield_description_1_25\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_25'>Die Kontodaten werden abgefragt, damit die Versicherung den Ihnen zustehenden Geldbetrag direkt an Sie \u00fcberweisen kann. Sollten Sie dies nicht w\u00fcnschen, so w\u00fcrde der Geldbetrag auf das Kanzleikonto abgefordert werden. Durch die Weiterleitung des Fremdgeldes entsteht eine Hebegeb\u00fchr, welche ich Ihnen in Rechnung stelle. <\/div><\/div><div id=\"field_1_28\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_28'>Kreditinstitut\/BIC<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_1_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_30' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_30' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-30' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_31\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_31'>Ihr Fahrzeug (Art, Marke, Modell)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_38\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_38'>Fahrgestellnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_32\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>Amtliches Kennzeichen<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_1_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_33\" class=\"gfield gfield--type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_33'>Kilometerstand<\/label><div class='ginput_container ginput_container_number'><input name='input_33' id='input_1_33' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_35\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'>Erstzulassung<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_35' id='input_1_35' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='tt.mm.jjjj' aria-describedby=\"input_1_35_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_35_date_format' class='screen-reader-text'>TT Punkt MM Punkt JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_35' class='gform_hidden' value='https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_1_37\" class=\"gfield gfield--type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_37'>Listenpreis in \u20ac<\/label><div class='ginput_container ginput_container_number'><input name='input_37' id='input_1_37' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_1_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Sind Sie Halter des Fahrzeugs?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_40'><div class='gchoice gchoice_1_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Ja'  id='choice_1_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Nein'  id='choice_1_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_40_2' id='label_1_40_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_50' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_50' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ist das Fahrzeug geleast oder finanziert?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_39'><div class='gchoice gchoice_1_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='Ja'  id='choice_1_39_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_1' id='label_1_39_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='Nein'  id='choice_1_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_2' id='label_1_39_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_42\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_42'>Leasinggeber \/ Kreditgebende Bank<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_1_42' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_42\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_42'>Geleaste oder finanzierte Fahrzeuge ben\u00f6tigen eine sogenannte Freigabeerkl\u00e4rung der Bank, damit Sie die Anspr\u00fcche geltend machen d\u00fcrfen, da Sie oftmals nicht Eigent\u00fcmer des Fahrzeugs sind.<\/div><\/div><div id=\"field_1_43\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_43'>Finanzierungsnummer<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_1_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_43\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_43'>Bitte geben Sie daher unbedingt die Darlehensnummer an, damit direkt eine solche Freigabeerkl\u00e4rung angefordert werden kann.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_44' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >War der Eigent\u00fcmer der Fahrer?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_41'><div class='gchoice gchoice_1_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Ja'  id='choice_1_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_1' id='label_1_41_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Nein'  id='choice_1_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_2' id='label_1_41_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_45\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Daten des Fahrers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1_45'>\n                            <span id='input_1_45_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_45.2' id='input_1_45_2'   autocomplete=\"honorific-prefix\" aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option><option value='Herr' >Herr<\/option><option value='Frau' >Frau<\/option>\n                      <\/select>\n                                                    <label for='input_1_45_2' class='gform-field-label gform-field-label--type-sub '>Anrede<\/label>\n                                                  <\/span>\n                            <span id='input_1_45_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.3' id='input_1_45_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_1_45_3' class='gform-field-label gform-field-label--type-sub '>Vorname<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_45_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.6' id='input_1_45_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_1_45_6' class='gform-field-label gform-field-label--type-sub '>Nachname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_46\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_46' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_46_1_container' >\n                                        <input type='text' name='input_46.1' id='input_1_46_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_46_1' id='input_1_46_1_label' class='gform-field-label gform-field-label--type-sub '>Anschrift<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_46_3_container' >\n                                    <input type='text' name='input_46.3' id='input_1_46_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_46_3' id='input_1_46_3_label' class='gform-field-label gform-field-label--type-sub '>Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_46.4' id='input_1_46_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_46_5_container' >\n                                    <input type='text' name='input_46.5' id='input_1_46_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_46_5' id='input_1_46_5_label' class='gform-field-label gform-field-label--type-sub '>PLZ<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_46_6_container' >\n                                        <select name='input_46.6' id='input_1_46_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albanien' >Albanien<\/option><option value='Algerien' >Algerien<\/option><option value='Amerikanisch-Samoa' >Amerikanisch-Samoa<\/option><option value='Amerikanische Jungferninseln' >Amerikanische Jungferninseln<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktis' >Antarktis<\/option><option value='Antigua und Barbuda' >Antigua und Barbuda<\/option><option value='Argentinien' >Argentinien<\/option><option value='Armenien' >Armenien<\/option><option value='Aruba' >Aruba<\/option><option value='Aserbaidschan' >Aserbaidschan<\/option><option value='Australien' >Australien<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgien' >Belgien<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosnien und Herzegowina' >Bosnien und Herzegowina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvetinsel' >Bouvetinsel<\/option><option value='Brasilien' >Brasilien<\/option><option value='Britische Jungferninseln' >Britische Jungferninseln<\/option><option value='Britisches Territorium im Indischen Ozean' >Britisches Territorium im Indischen Ozean<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarien' >Bulgarien<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Caymen Inseln' >Caymen Inseln<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Cookinseln' >Cookinseln<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Demokratische Volksrepublik Laos' >Demokratische Volksrepublik Laos<\/option><option value='Deutschland' selected='selected'>Deutschland<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominikanische Republik' >Dominikanische Republik<\/option><option value='D\u00e4nemark' >D\u00e4nemark<\/option><option value='Ecuador' >Ecuador<\/option><option value='El Salvador' >El Salvador<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Falklandinseln' >Falklandinseln<\/option><option value='Fidschi' >Fidschi<\/option><option value='Finnland' >Finnland<\/option><option value='Frankreich' >Frankreich<\/option><option value='Franz\u00f6sisch-Guayana' >Franz\u00f6sisch-Guayana<\/option><option value='Franz\u00f6sisch-Polynesien' >Franz\u00f6sisch-Polynesien<\/option><option value='Franz\u00f6sische S\u00fcd- und Antarktisgebiete' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='Futuna (Wallis und Futuna)' >Futuna (Wallis und Futuna)<\/option><option value='F\u00e4r\u00f6er-Inseln' >F\u00e4r\u00f6er-Inseln<\/option><option value='Gabun' >Gabun<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griechenland' >Griechenland<\/option><option value='Gro\u00dfbritannien' >Gro\u00dfbritannien<\/option><option value='Gr\u00f6nland' >Gr\u00f6nland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard und McDonaldinseln' >Heard und McDonaldinseln<\/option><option value='Heiliger Stuhl' >Heiliger Stuhl<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indien' >Indien<\/option><option value='Indonesien' >Indonesien<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irland' >Irland<\/option><option value='Island' >Island<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italien' >Italien<\/option><option value='Jamaika' >Jamaika<\/option><option value='Japan' >Japan<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kambodscha' >Kambodscha<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Kap Verde' >Kap Verde<\/option><option value='Karibische Niederlande' >Karibische Niederlande<\/option><option value='Kasachstan' >Kasachstan<\/option><option value='Katar' >Katar<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kokosinseln' >Kokosinseln<\/option><option value='Kolumbien' >Kolumbien<\/option><option value='Komoren' >Komoren<\/option><option value='Kongo' >Kongo<\/option><option value='Kongo, Demokratische Republik des' >Kongo, Demokratische Republik des<\/option><option value='Korea. Demokratische Volksrepublik' >Korea. Demokratische Volksrepublik<\/option><option value='Kroatien' >Kroatien<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwait' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettland' >Lettland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litauen' >Litauen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Malediven' >Malediven<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall-Inseln' >Marshall-Inseln<\/option><option value='Martinique' >Martinique<\/option><option value='Mauretanien' >Mauretanien<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexiko' >Mexiko<\/option><option value='Mikronesien' >Mikronesien<\/option><option value='Moldawien' >Moldawien<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolei' >Mongolei<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mosambik' >Mosambik<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Neukaledonien' >Neukaledonien<\/option><option value='Neuseeland' >Neuseeland<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niederlande' >Niederlande<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Nordmazedonien' >Nordmazedonien<\/option><option value='Norfolkinsel' >Norfolkinsel<\/option><option value='Norwegen' >Norwegen<\/option><option value='N\u00f6rdliche Marianen' >N\u00f6rdliche Marianen<\/option><option value='Oman' >Oman<\/option><option value='Osttimor' >Osttimor<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Pal\u00e4stina, Bundesstaat' >Pal\u00e4stina, Bundesstaat<\/option><option value='Panama' >Panama<\/option><option value='Papua Neu Guinea' >Papua Neu Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippinen' >Philippinen<\/option><option value='Pitcairninseln' >Pitcairninseln<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Ruanda' >Ruanda<\/option><option value='Rum\u00e4nien' >Rum\u00e4nien<\/option><option value='Russische F\u00f6deration' >Russische F\u00f6deration<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Pierre und Miquelon' >Saint-Pierre und Miquelon<\/option><option value='Salomonen' >Salomonen<\/option><option value='Sambia' >Sambia<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Saudi-Arabien' >Saudi-Arabien<\/option><option value='Schweden' >Schweden<\/option><option value='Schweiz' >Schweiz<\/option><option value='Senegal' >Senegal<\/option><option value='Serbien' >Serbien<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Simbabwe' >Simbabwe<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovenien' >Slovenien<\/option><option value='Slowakei' >Slowakei<\/option><option value='Somalia' >Somalia<\/option><option value='Spanien' >Spanien<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='St. Helena, Ascension und Tristan da Cunha' >St. Helena, Ascension und Tristan da Cunha<\/option><option value='St. Kitts und Nevis' >St. Kitts und Nevis<\/option><option value='St. Lucia' >St. Lucia<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Vincent und die Grenadinen' >St. Vincent und die Grenadinen<\/option><option value='Sudan' >Sudan<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard und Jan Mayen' >Svalbard und Jan Mayen<\/option><option value='Syrien, Arabische Republik' >Syrien, Arabische Republik<\/option><option value='S\u00e3o Tom\u00e9 und Pr\u00edncipe' >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value='S\u00fcdafrika' >S\u00fcdafrika<\/option><option value='S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln' >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value='S\u00fcdkorea' >S\u00fcdkorea<\/option><option value='S\u00fcdsudan' >S\u00fcdsudan<\/option><option value='Tadschikistan' >Tadschikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tansania, Vereinte Republik' >Tansania, Vereinte Republik<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad und Tobago' >Trinidad und Tobago<\/option><option value='Tschad' >Tschad<\/option><option value='Tschechien' >Tschechien<\/option><option value='Tunesien' >Tunesien<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- und Caicosinseln' >Turks- und Caicosinseln<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkei' >T\u00fcrkei<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='Ungarn' >Ungarn<\/option><option value='Uruguay' >Uruguay<\/option><option value='Usbekistan' >Usbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vereinigte Arabische Emirate' >Vereinigte Arabische Emirate<\/option><option value='Vereinigte Staaten von Amerika' >Vereinigte Staaten von Amerika<\/option><option value='Vietnam' >Vietnam<\/option><option value='Weihnachtsinsel' >Weihnachtsinsel<\/option><option value='Wei\u00dfrussland' >Wei\u00dfrussland<\/option><option value='Westsahara' >Westsahara<\/option><option value='Zentralafrikanische Republik' >Zentralafrikanische Republik<\/option><option value='Zypern' >Zypern<\/option><option value='\u00c4gypten' >\u00c4gypten<\/option><option value='\u00c4quatorial Guinea' >\u00c4quatorial Guinea<\/option><option value='\u00c4thopien' >\u00c4thopien<\/option><option value='\u00c5landinseln' >\u00c5landinseln<\/option><option value='\u00d6sterreich' >\u00d6sterreich<\/option><\/select>\n                                        <label for='input_1_46_6' id='input_1_46_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_115\" class=\"gfield gfield--type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_115'>Telefon<\/label><div class='ginput_container ginput_container_phone'><input name='input_115' id='input_1_115' type='tel' value='+49' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_51' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-51' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_52\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_52'>Tragen Sie hier bitte die Daten Ihrer KfZ-Haftpflichtversicherung ein<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_1_52' class='textarea large'  aria-describedby=\"gfield_description_1_52\"    aria-invalid=\"false\"   rows='10' cols='50'>Unternehmen\nAnschrift\nVersicherungsscheinnummer<\/textarea><\/div><div class='gfield_description' id='gfield_description_1_52'>Beachten Sie bitte, dass Sie ggf. vor Einschaltung eines Anwalts zur Meldung des Schadens bei Ihrer Versicherung verpflichtet sind!<\/div><\/div><fieldset id=\"field_1_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00dcber welche Kaskoversicherung verf\u00fcgt das Auto?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_1_53'><div class='gchoice gchoice_1_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Vollkasko'  id='choice_1_53_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_53_1' id='label_1_53_1' class='gform-field-label gform-field-label--type-inline'>Vollkasko<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Teilkasko'  id='choice_1_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_53_2' id='label_1_53_2' class='gform-field-label gform-field-label--type-inline'>Teilkasko<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_53_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Alle ausw\u00e4hlen\" data-label-deselect=\"Auswahl aufl\u00f6sen\">Alle ausw\u00e4hlen<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_1_55\" class=\"gfield gfield--type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_55'>wie hoch ist die Selbstbeteiligung?<\/label><div class='ginput_container ginput_container_number'><input name='input_55' id='input_1_55' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_1_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Haben Sie eine Rechtsschutzversicherung?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_57'><div class='gchoice gchoice_1_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='Ja'  id='choice_1_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_57_1' id='label_1_57_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_57_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.2' type='checkbox'  value='Nein'  id='choice_1_57_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_57_2' id='label_1_57_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_58\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_58'>Daten Ihrer Rechtsschutzversicherung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_1_58' class='textarea large'  aria-describedby=\"gfield_description_1_58\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'>Unternehmen\nVersicherungsnummer<\/textarea><\/div><div class='gfield_description' id='gfield_description_1_58'>Die Daten Ihrer Rechtsschutzversicherung sind auch bei einer klaren Sach- und Rechtslage n\u00f6tig, falls die Versicherung bestimmte Schadenspositionen nicht bezahlt und sich deshalb doch noch ein Prozess anschlie\u00dft.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_66\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Haben Sie Daten des Unfallgegners?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_66'><div class='gchoice gchoice_1_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='Ja'  id='choice_1_66_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_66_1' id='label_1_66_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_66_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.2' type='checkbox'  value='Nein'  id='choice_1_66_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_66_2' id='label_1_66_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Handelt es sich um Unfallflucht?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_67'><div class='gchoice gchoice_1_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='Ja'  id='choice_1_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_1' id='label_1_67_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='Nein'  id='choice_1_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_2' id='label_1_67_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_61\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Daten des Unfallgegners<\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1_61'>\n                            <span id='input_1_61_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_61.2' id='input_1_61_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Frau' >Frau<\/option><option value='Fr\u00e4ulein' >Fr\u00e4ulein<\/option><option value='Herr' >Herr<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_1_61_2' class='gform-field-label gform-field-label--type-sub '>Anrede<\/label>\n                                                  <\/span>\n                            <span id='input_1_61_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_61.3' id='input_1_61_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_61_3' class='gform-field-label gform-field-label--type-sub '>Vorname<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_61_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_61.6' id='input_1_61_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_61_6' class='gform-field-label gform-field-label--type-sub '>Nachname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_62\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_62' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_62_1_container' >\n                                        <input type='text' name='input_62.1' id='input_1_62_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_62_1' id='input_1_62_1_label' class='gform-field-label gform-field-label--type-sub '>Anschrift<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_62_3_container' >\n                                    <input type='text' name='input_62.3' id='input_1_62_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_62_3' id='input_1_62_3_label' class='gform-field-label gform-field-label--type-sub '>Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_62.4' id='input_1_62_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_62_5_container' >\n                                    <input type='text' name='input_62.5' id='input_1_62_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_62_5' id='input_1_62_5_label' class='gform-field-label gform-field-label--type-sub '>PLZ<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_62_6_container' >\n                                        <select name='input_62.6' id='input_1_62_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albanien' >Albanien<\/option><option value='Algerien' >Algerien<\/option><option value='Amerikanisch-Samoa' >Amerikanisch-Samoa<\/option><option value='Amerikanische Jungferninseln' >Amerikanische Jungferninseln<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktis' >Antarktis<\/option><option value='Antigua und Barbuda' >Antigua und Barbuda<\/option><option value='Argentinien' >Argentinien<\/option><option value='Armenien' >Armenien<\/option><option value='Aruba' >Aruba<\/option><option value='Aserbaidschan' >Aserbaidschan<\/option><option value='Australien' >Australien<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgien' >Belgien<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosnien und Herzegowina' >Bosnien und Herzegowina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvetinsel' >Bouvetinsel<\/option><option value='Brasilien' >Brasilien<\/option><option value='Britische Jungferninseln' >Britische Jungferninseln<\/option><option value='Britisches Territorium im Indischen Ozean' >Britisches Territorium im Indischen Ozean<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarien' >Bulgarien<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Caymen Inseln' >Caymen Inseln<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Cookinseln' >Cookinseln<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Demokratische Volksrepublik Laos' >Demokratische Volksrepublik Laos<\/option><option value='Deutschland' selected='selected'>Deutschland<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominikanische Republik' >Dominikanische Republik<\/option><option value='D\u00e4nemark' >D\u00e4nemark<\/option><option value='Ecuador' >Ecuador<\/option><option value='El Salvador' >El Salvador<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Falklandinseln' >Falklandinseln<\/option><option value='Fidschi' >Fidschi<\/option><option value='Finnland' >Finnland<\/option><option value='Frankreich' >Frankreich<\/option><option value='Franz\u00f6sisch-Guayana' >Franz\u00f6sisch-Guayana<\/option><option value='Franz\u00f6sisch-Polynesien' >Franz\u00f6sisch-Polynesien<\/option><option value='Franz\u00f6sische S\u00fcd- und Antarktisgebiete' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='Futuna (Wallis und Futuna)' >Futuna (Wallis und Futuna)<\/option><option value='F\u00e4r\u00f6er-Inseln' >F\u00e4r\u00f6er-Inseln<\/option><option value='Gabun' >Gabun<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griechenland' >Griechenland<\/option><option value='Gro\u00dfbritannien' >Gro\u00dfbritannien<\/option><option value='Gr\u00f6nland' >Gr\u00f6nland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard und McDonaldinseln' >Heard und McDonaldinseln<\/option><option value='Heiliger Stuhl' >Heiliger Stuhl<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indien' >Indien<\/option><option value='Indonesien' >Indonesien<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irland' >Irland<\/option><option value='Island' >Island<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italien' >Italien<\/option><option value='Jamaika' >Jamaika<\/option><option value='Japan' >Japan<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kambodscha' >Kambodscha<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Kap Verde' >Kap Verde<\/option><option value='Karibische Niederlande' >Karibische Niederlande<\/option><option value='Kasachstan' >Kasachstan<\/option><option value='Katar' >Katar<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kokosinseln' >Kokosinseln<\/option><option value='Kolumbien' >Kolumbien<\/option><option value='Komoren' >Komoren<\/option><option value='Kongo' >Kongo<\/option><option value='Kongo, Demokratische Republik des' >Kongo, Demokratische Republik des<\/option><option value='Korea. Demokratische Volksrepublik' >Korea. Demokratische Volksrepublik<\/option><option value='Kroatien' >Kroatien<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwait' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettland' >Lettland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litauen' >Litauen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Malediven' >Malediven<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall-Inseln' >Marshall-Inseln<\/option><option value='Martinique' >Martinique<\/option><option value='Mauretanien' >Mauretanien<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexiko' >Mexiko<\/option><option value='Mikronesien' >Mikronesien<\/option><option value='Moldawien' >Moldawien<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolei' >Mongolei<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mosambik' >Mosambik<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Neukaledonien' >Neukaledonien<\/option><option value='Neuseeland' >Neuseeland<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niederlande' >Niederlande<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Nordmazedonien' >Nordmazedonien<\/option><option value='Norfolkinsel' >Norfolkinsel<\/option><option value='Norwegen' >Norwegen<\/option><option value='N\u00f6rdliche Marianen' >N\u00f6rdliche Marianen<\/option><option value='Oman' >Oman<\/option><option value='Osttimor' >Osttimor<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Pal\u00e4stina, Bundesstaat' >Pal\u00e4stina, Bundesstaat<\/option><option value='Panama' >Panama<\/option><option value='Papua Neu Guinea' >Papua Neu Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippinen' >Philippinen<\/option><option value='Pitcairninseln' >Pitcairninseln<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Ruanda' >Ruanda<\/option><option value='Rum\u00e4nien' >Rum\u00e4nien<\/option><option value='Russische F\u00f6deration' >Russische F\u00f6deration<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Pierre und Miquelon' >Saint-Pierre und Miquelon<\/option><option value='Salomonen' >Salomonen<\/option><option value='Sambia' >Sambia<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Saudi-Arabien' >Saudi-Arabien<\/option><option value='Schweden' >Schweden<\/option><option value='Schweiz' >Schweiz<\/option><option value='Senegal' >Senegal<\/option><option value='Serbien' >Serbien<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Simbabwe' >Simbabwe<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovenien' >Slovenien<\/option><option value='Slowakei' >Slowakei<\/option><option value='Somalia' >Somalia<\/option><option value='Spanien' >Spanien<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='St. Helena, Ascension und Tristan da Cunha' >St. Helena, Ascension und Tristan da Cunha<\/option><option value='St. Kitts und Nevis' >St. Kitts und Nevis<\/option><option value='St. Lucia' >St. Lucia<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Vincent und die Grenadinen' >St. Vincent und die Grenadinen<\/option><option value='Sudan' >Sudan<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard und Jan Mayen' >Svalbard und Jan Mayen<\/option><option value='Syrien, Arabische Republik' >Syrien, Arabische Republik<\/option><option value='S\u00e3o Tom\u00e9 und Pr\u00edncipe' >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value='S\u00fcdafrika' >S\u00fcdafrika<\/option><option value='S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln' >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value='S\u00fcdkorea' >S\u00fcdkorea<\/option><option value='S\u00fcdsudan' >S\u00fcdsudan<\/option><option value='Tadschikistan' >Tadschikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tansania, Vereinte Republik' >Tansania, Vereinte Republik<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad und Tobago' >Trinidad und Tobago<\/option><option value='Tschad' >Tschad<\/option><option value='Tschechien' >Tschechien<\/option><option value='Tunesien' >Tunesien<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- und Caicosinseln' >Turks- und Caicosinseln<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkei' >T\u00fcrkei<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='Ungarn' >Ungarn<\/option><option value='Uruguay' >Uruguay<\/option><option value='Usbekistan' >Usbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vereinigte Arabische Emirate' >Vereinigte Arabische Emirate<\/option><option value='Vereinigte Staaten von Amerika' >Vereinigte Staaten von Amerika<\/option><option value='Vietnam' >Vietnam<\/option><option value='Weihnachtsinsel' >Weihnachtsinsel<\/option><option value='Wei\u00dfrussland' >Wei\u00dfrussland<\/option><option value='Westsahara' >Westsahara<\/option><option value='Zentralafrikanische Republik' >Zentralafrikanische Republik<\/option><option value='Zypern' >Zypern<\/option><option value='\u00c4gypten' >\u00c4gypten<\/option><option value='\u00c4quatorial Guinea' >\u00c4quatorial Guinea<\/option><option value='\u00c4thopien' >\u00c4thopien<\/option><option value='\u00c5landinseln' >\u00c5landinseln<\/option><option value='\u00d6sterreich' >\u00d6sterreich<\/option><\/select>\n                                        <label for='input_1_62_6' id='input_1_62_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_64\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_64'>amtliches Kennzeichen<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_1_64' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_68\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_68'>Fahrzeug<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_1_68' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_63\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_63'>Versicherung<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_65\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_65'>Versicherungsnummer<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_1_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_69' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_69' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_8' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_70\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_70'>Wie ist der Unfall passiert?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_70' id='input_1_70' class='textarea large'  aria-describedby=\"gfield_description_1_70\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_1_70'>Bitte beschreiben Sie den Unfall so genau wie m\u00f6glich<\/div><\/div><div id=\"field_1_71\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_71'>Hier k\u00f6nnen Sie gerne auch eine Unfallskizze hochladen<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1536000' \/><input name='input_71' id='input_1_71' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_71\" onchange='javascript:gformValidateFileSize( this, 1536000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_71'>Max. Dateigr\u00f6\u00dfe: 1 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_71'><\/div> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_72' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_72' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_9' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_73\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_73'>Welche Sch\u00e4den hat Ihr Auto?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_73' id='input_1_73' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_84\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_84'>Gibt es sonstige Sachsch\u00e4den?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_1_84' class='textarea large'  aria-describedby=\"gfield_description_1_84\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_1_84'>z.B. Brille, Helm, Kleidung, Gegenst\u00e4nde im Auto, Transportgut, etc.<\/div><\/div><fieldset id=\"field_1_74\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ist das Fahrzeug schon repariert?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_74'><div class='gchoice gchoice_1_74_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.1' type='checkbox'  value='Ja'  id='choice_1_74_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_74_1' id='label_1_74_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_74_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.2' type='checkbox'  value='Nein'  id='choice_1_74_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_74_2' id='label_1_74_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_75\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Haben Sie einen Mietwagen genommen?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_75'><div class='gchoice gchoice_1_75_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_75.1' type='checkbox'  value='Ja'  id='choice_1_75_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_75_1' id='label_1_75_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_75_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_75.2' type='checkbox'  value='Nein'  id='choice_1_75_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_75_2' id='label_1_75_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_78\" class=\"gfield gfield--type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_78'>wie viele Tage?<\/label><div class='ginput_container ginput_container_number'><input name='input_78' id='input_1_78' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_1_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wurde bereits ein Gutachter eingeschaltet?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_76'><div class='gchoice gchoice_1_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='Ja'  id='choice_1_76_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_76_1' id='label_1_76_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_76_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.2' type='checkbox'  value='Nein'  id='choice_1_76_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_76_2' id='label_1_76_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_110\" class=\"gfield gfield--type-name gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wer ist der Gutachter?<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_110'>\n                            \n                            <span id='input_1_110_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_110.3' id='input_1_110_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_110_3' class='gform-field-label gform-field-label--type-sub '>Vorname<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_110_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_110.6' id='input_1_110_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_110_6' class='gform-field-label gform-field-label--type-sub '>Nachname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_111\" class=\"gfield gfield--type-address gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse des Gutachters<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_111' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_111_1_container' >\n                                        <input type='text' name='input_111.1' id='input_1_111_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_111_1' id='input_1_111_1_label' class='gform-field-label gform-field-label--type-sub '>Anschrift<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_111_3_container' >\n                                    <input type='text' name='input_111.3' id='input_1_111_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_111_3' id='input_1_111_3_label' class='gform-field-label gform-field-label--type-sub '>Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_111.4' id='input_1_111_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_111_5_container' >\n                                    <input type='text' name='input_111.5' id='input_1_111_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_111_5' id='input_1_111_5_label' class='gform-field-label gform-field-label--type-sub '>PLZ<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_111_6_container' >\n                                        <select name='input_111.6' id='input_1_111_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albanien' >Albanien<\/option><option value='Algerien' >Algerien<\/option><option value='Amerikanisch-Samoa' >Amerikanisch-Samoa<\/option><option value='Amerikanische Jungferninseln' >Amerikanische Jungferninseln<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktis' >Antarktis<\/option><option value='Antigua und Barbuda' >Antigua und Barbuda<\/option><option value='Argentinien' >Argentinien<\/option><option value='Armenien' >Armenien<\/option><option value='Aruba' >Aruba<\/option><option value='Aserbaidschan' >Aserbaidschan<\/option><option value='Australien' >Australien<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgien' >Belgien<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosnien und Herzegowina' >Bosnien und Herzegowina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvetinsel' >Bouvetinsel<\/option><option value='Brasilien' >Brasilien<\/option><option value='Britische Jungferninseln' >Britische Jungferninseln<\/option><option value='Britisches Territorium im Indischen Ozean' >Britisches Territorium im Indischen Ozean<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarien' >Bulgarien<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Caymen Inseln' >Caymen Inseln<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Cookinseln' >Cookinseln<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Demokratische Volksrepublik Laos' >Demokratische Volksrepublik Laos<\/option><option value='Deutschland' >Deutschland<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominikanische Republik' >Dominikanische Republik<\/option><option value='D\u00e4nemark' >D\u00e4nemark<\/option><option value='Ecuador' >Ecuador<\/option><option value='El Salvador' >El Salvador<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Falklandinseln' >Falklandinseln<\/option><option value='Fidschi' >Fidschi<\/option><option value='Finnland' >Finnland<\/option><option value='Frankreich' >Frankreich<\/option><option value='Franz\u00f6sisch-Guayana' >Franz\u00f6sisch-Guayana<\/option><option value='Franz\u00f6sisch-Polynesien' >Franz\u00f6sisch-Polynesien<\/option><option value='Franz\u00f6sische S\u00fcd- und Antarktisgebiete' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='Futuna (Wallis und Futuna)' >Futuna (Wallis und Futuna)<\/option><option value='F\u00e4r\u00f6er-Inseln' >F\u00e4r\u00f6er-Inseln<\/option><option value='Gabun' >Gabun<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griechenland' >Griechenland<\/option><option value='Gro\u00dfbritannien' >Gro\u00dfbritannien<\/option><option value='Gr\u00f6nland' >Gr\u00f6nland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard und McDonaldinseln' >Heard und McDonaldinseln<\/option><option value='Heiliger Stuhl' >Heiliger Stuhl<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indien' >Indien<\/option><option value='Indonesien' >Indonesien<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irland' >Irland<\/option><option value='Island' >Island<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italien' >Italien<\/option><option value='Jamaika' >Jamaika<\/option><option value='Japan' >Japan<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kambodscha' >Kambodscha<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Kap Verde' >Kap Verde<\/option><option value='Karibische Niederlande' >Karibische Niederlande<\/option><option value='Kasachstan' >Kasachstan<\/option><option value='Katar' >Katar<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kokosinseln' >Kokosinseln<\/option><option value='Kolumbien' >Kolumbien<\/option><option value='Komoren' >Komoren<\/option><option value='Kongo' >Kongo<\/option><option value='Kongo, Demokratische Republik des' >Kongo, Demokratische Republik des<\/option><option value='Korea. Demokratische Volksrepublik' >Korea. Demokratische Volksrepublik<\/option><option value='Kroatien' >Kroatien<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwait' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettland' >Lettland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litauen' >Litauen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Malediven' >Malediven<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall-Inseln' >Marshall-Inseln<\/option><option value='Martinique' >Martinique<\/option><option value='Mauretanien' >Mauretanien<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexiko' >Mexiko<\/option><option value='Mikronesien' >Mikronesien<\/option><option value='Moldawien' >Moldawien<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolei' >Mongolei<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mosambik' >Mosambik<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Neukaledonien' >Neukaledonien<\/option><option value='Neuseeland' >Neuseeland<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niederlande' >Niederlande<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Nordmazedonien' >Nordmazedonien<\/option><option value='Norfolkinsel' >Norfolkinsel<\/option><option value='Norwegen' >Norwegen<\/option><option value='N\u00f6rdliche Marianen' >N\u00f6rdliche Marianen<\/option><option value='Oman' >Oman<\/option><option value='Osttimor' >Osttimor<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Pal\u00e4stina, Bundesstaat' >Pal\u00e4stina, Bundesstaat<\/option><option value='Panama' >Panama<\/option><option value='Papua Neu Guinea' >Papua Neu Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippinen' >Philippinen<\/option><option value='Pitcairninseln' >Pitcairninseln<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Ruanda' >Ruanda<\/option><option value='Rum\u00e4nien' >Rum\u00e4nien<\/option><option value='Russische F\u00f6deration' >Russische F\u00f6deration<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Pierre und Miquelon' >Saint-Pierre und Miquelon<\/option><option value='Salomonen' >Salomonen<\/option><option value='Sambia' >Sambia<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Saudi-Arabien' >Saudi-Arabien<\/option><option value='Schweden' >Schweden<\/option><option value='Schweiz' >Schweiz<\/option><option value='Senegal' >Senegal<\/option><option value='Serbien' >Serbien<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Simbabwe' >Simbabwe<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovenien' >Slovenien<\/option><option value='Slowakei' >Slowakei<\/option><option value='Somalia' >Somalia<\/option><option value='Spanien' >Spanien<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='St. Helena, Ascension und Tristan da Cunha' >St. Helena, Ascension und Tristan da Cunha<\/option><option value='St. Kitts und Nevis' >St. Kitts und Nevis<\/option><option value='St. Lucia' >St. Lucia<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Vincent und die Grenadinen' >St. Vincent und die Grenadinen<\/option><option value='Sudan' >Sudan<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard und Jan Mayen' >Svalbard und Jan Mayen<\/option><option value='Syrien, Arabische Republik' >Syrien, Arabische Republik<\/option><option value='S\u00e3o Tom\u00e9 und Pr\u00edncipe' >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value='S\u00fcdafrika' >S\u00fcdafrika<\/option><option value='S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln' >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value='S\u00fcdkorea' >S\u00fcdkorea<\/option><option value='S\u00fcdsudan' >S\u00fcdsudan<\/option><option value='Tadschikistan' >Tadschikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tansania, Vereinte Republik' >Tansania, Vereinte Republik<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad und Tobago' >Trinidad und Tobago<\/option><option value='Tschad' >Tschad<\/option><option value='Tschechien' >Tschechien<\/option><option value='Tunesien' >Tunesien<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- und Caicosinseln' >Turks- und Caicosinseln<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkei' >T\u00fcrkei<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='Ungarn' >Ungarn<\/option><option value='Uruguay' >Uruguay<\/option><option value='Usbekistan' >Usbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vereinigte Arabische Emirate' >Vereinigte Arabische Emirate<\/option><option value='Vereinigte Staaten von Amerika' >Vereinigte Staaten von Amerika<\/option><option value='Vietnam' >Vietnam<\/option><option value='Weihnachtsinsel' >Weihnachtsinsel<\/option><option value='Wei\u00dfrussland' >Wei\u00dfrussland<\/option><option value='Westsahara' >Westsahara<\/option><option value='Zentralafrikanische Republik' >Zentralafrikanische Republik<\/option><option value='Zypern' >Zypern<\/option><option value='\u00c4gypten' >\u00c4gypten<\/option><option value='\u00c4quatorial Guinea' >\u00c4quatorial Guinea<\/option><option value='\u00c4thopien' >\u00c4thopien<\/option><option value='\u00c5landinseln' >\u00c5landinseln<\/option><option value='\u00d6sterreich' >\u00d6sterreich<\/option><\/select>\n                                        <label for='input_1_111_6' id='input_1_111_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_1_81\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Haben Sie das Gutachten schon erhalten?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_81'><div class='gchoice gchoice_1_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='Ja'  id='choice_1_81_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_81_1' id='label_1_81_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_81_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.2' type='checkbox'  value='Nein'  id='choice_1_81_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_81_2' id='label_1_81_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_82\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ist das Gutachten bereits bezahlt?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_82'><div class='gchoice gchoice_1_82_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_82.1' type='checkbox'  value='Ja'  id='choice_1_82_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_82_1' id='label_1_82_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_82_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_82.2' type='checkbox'  value='Nein'  id='choice_1_82_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_82_2' id='label_1_82_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_83\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_83'>Hier k\u00f6nnen Sie entsprechende Rechnungen und Unterlagen hochladen<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_83' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_83&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_83&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_83&quot;,&quot;filelist&quot;:&quot;gform_preview_1_83&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/?gf_page=29e85ccc97ac189&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Erlaubte Dateitypen&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;1536000b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:83,&quot;_gform_file_upload_nonce_1_83&quot;:&quot;72a7aa91e8&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_1_83&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_83' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Ziehe Dateien hier her oder <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_83' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_83\"  >W\u00e4hle Dateien aus<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_83'>Max. Dateigr\u00f6\u00dfe: 1 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_83'><\/ul> <div id='gform_preview_1_83' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_85' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_85' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_10' class='gform_page' data-js='page-field-id-85' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_86\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Liegt ein Personenschaden\/K\u00f6rperverletzung vor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_86'><div class='gchoice gchoice_1_86_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.1' type='checkbox'  value='Ja'  id='choice_1_86_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_1' id='label_1_86_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.2' type='checkbox'  value='Nein'  id='choice_1_86_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_2' id='label_1_86_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_88\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_88'>Daten des\/der Verletzten<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_88' id='input_1_88' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_90\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Krankenversicherung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_90'><div class='gchoice gchoice_1_90_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.1' type='checkbox'  value='Gesetzlich'  id='choice_1_90_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_90_1' id='label_1_90_1' class='gform-field-label gform-field-label--type-inline'>Gesetzlich<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_90_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.2' type='checkbox'  value='Privat'  id='choice_1_90_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_90_2' id='label_1_90_2' class='gform-field-label gform-field-label--type-inline'>Privat<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_89\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Handelt es sich um einen Wegeunfall?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_89'><div class='gchoice gchoice_1_89_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.1' type='checkbox'  value='Ja'  id='choice_1_89_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_89_1' id='label_1_89_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_89_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.2' type='checkbox'  value='Nein'  id='choice_1_89_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_89_2' id='label_1_89_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_91\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_91'>Daten der Berufsgenossenschaft<\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_1_91' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_92\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wurden die Verletzungen im Krankenhaus aufgenommen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_92'><div class='gchoice gchoice_1_92_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.1' type='checkbox'  value='Ja'  id='choice_1_92_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_1' id='label_1_92_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.2' type='checkbox'  value='Nein'  id='choice_1_92_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_2' id='label_1_92_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_93\" class=\"gfield gfield--type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_93'>Welches Krankenhaus?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_93' id='input_1_93' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_94\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Waren\/sind Sie krankgemeldet?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_94'><div class='gchoice gchoice_1_94_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.1' type='checkbox'  value='Ja'  id='choice_1_94_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_94_1' id='label_1_94_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_94_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.2' type='checkbox'  value='Nein'  id='choice_1_94_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_94_2' id='label_1_94_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_95\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_95'>wie lange?<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_1_95' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_96\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wie verl\u00e4uft die Behandlung<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_96'><div class='gchoice gchoice_1_96_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.1' type='checkbox'  value='abgeschlossen'  id='choice_1_96_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_96_1' id='label_1_96_1' class='gform-field-label gform-field-label--type-inline'>abgeschlossen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_96_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.2' type='checkbox'  value='findet noch statt'  id='choice_1_96_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_96_2' id='label_1_96_2' class='gform-field-label gform-field-label--type-inline'>findet noch statt<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_99\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Sind Folgesch\u00e4den zu erwarten?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_99'><div class='gchoice gchoice_1_99_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_99.1' type='checkbox'  value='Ja'  id='choice_1_99_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_99_1' id='label_1_99_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_99_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_99.2' type='checkbox'  value='Nein'  id='choice_1_99_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_99_2' id='label_1_99_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_99_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_99.3' type='checkbox'  value='Unklar\/Wei\u00df ich nicht'  id='choice_1_99_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_99_3' id='label_1_99_3' class='gform-field-label gform-field-label--type-inline'>Unklar\/Wei\u00df ich nicht<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_98\" class=\"gfield gfield--type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_98'>Daten aller behandelnden \u00c4rzte!<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_98' id='input_1_98' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_100\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_100'>F\u00fcgen Sie hier bitte entsprechende Arzt- oder Krankenhausberichte an<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_100' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_100&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_100&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_100&quot;,&quot;filelist&quot;:&quot;gform_preview_1_100&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/?gf_page=29e85ccc97ac189&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Erlaubte Dateitypen&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;1536000b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:100,&quot;_gform_file_upload_nonce_1_100&quot;:&quot;8f289cfe13&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_1_100&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_100' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Ziehe Dateien hier her oder <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_100' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_100\"  >W\u00e4hle Dateien aus<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_100'>Max. Dateigr\u00f6\u00dfe: 1 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_100'><\/ul> <div id='gform_preview_1_100' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_101' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_101' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_11' class='gform_page' data-js='page-field-id-101' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_102\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Gibt es Zeugen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_102'><div class='gchoice gchoice_1_102_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_102.1' type='checkbox'  value='Ja'  id='choice_1_102_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_102_1' id='label_1_102_1' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_102_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_102.2' type='checkbox'  value='Nein'  id='choice_1_102_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_102_2' id='label_1_102_2' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_102_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_102.3' type='checkbox'  value='Unklar\/Wei\u00df ich nicht'  id='choice_1_102_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_102_3' id='label_1_102_3' class='gform-field-label gform-field-label--type-inline'>Unklar\/Wei\u00df ich nicht<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_103\" class=\"gfield gfield--type-textarea gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_103'>Daten der Zeugen<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_103' id='input_1_103' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_104\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_104'>Falls es Fotos des Unfalls gibt, k\u00f6nnen Sie gerne diese hier hochladen<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1536000' \/><input name='input_104' id='input_1_104' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_104\" onchange='javascript:gformValidateFileSize( this, 1536000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_104'>Max. Dateigr\u00f6\u00dfe: 1 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_104'><\/div> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_105' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_105' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_12' class='gform_page' data-js='page-field-id-105' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_123\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_1_127\" class=\"gfield gfield--type-post_title gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_127'>Anliegende Unterlagen sind n\u00f6tig, damit das Mandat bearbeitet werden kann<\/label><div class='ginput_container ginput_container_post_title'>\n\t\t\t\t\t<input name='input_127' id='input_1_127' type='text' value='Bitte Downloaden Sie alle nachfolgenden Dokumente, unterschreiben diese und laden sie anschlie\u00dfend wieder hoch.' class='large'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_116\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/recht-heil.de\/wp-content\/uploads\/2021\/03\/Widerrufsbelehrung.pdf\" target=\"_new\">Download der Widerrufsbelehrung<\/a><\/div><div id=\"field_1_121\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/recht-heil.de\/wp-content\/uploads\/2021\/03\/Mandatsaufnahmebogen.pdf\" target=\"_new\">Download des Mandatsaufnahmebogens<\/a><\/div><div id=\"field_1_107\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/recht-heil.de\/wp-content\/uploads\/2021\/03\/Hinweise-zur-Datenverarbeitung.pdf\" target=\"_new\">Download der Datenschutzerkl\u00e4rung<\/a><\/div><div id=\"field_1_108\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/recht-heil.de\/wp-content\/uploads\/2021\/03\/Vollmacht.pdf\" target=\"_new\">Download der Vollmacht<\/a><\/div><div id=\"field_1_122\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_1_120\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_120'>Upload der unterschriebenen Unterlagen<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_120' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_120&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_120&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_120&quot;,&quot;filelist&quot;:&quot;gform_preview_1_120&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/?gf_page=29e85ccc97ac189&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/form.advobox.com\\\/kanzleiheil-dillingen\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Erlaubte Dateitypen&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;1536000b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:120,&quot;_gform_file_upload_nonce_1_120&quot;:&quot;544c1996c1&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_120&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_120' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Ziehe Dateien hier her oder <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_120' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_120 gfield_description_1_120\"  >W\u00e4hle Dateien aus<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_120'>Max. Dateigr\u00f6\u00dfe: 1 MB, Max. Dateien: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_120'><\/ul> <div id='gform_preview_1_120' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_1_120'>Hier k\u00f6nnen Sie die unterschriebenen Unterlagen direkt wieder hochladen.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_119' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='button' id='gform_next_button_1_119' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Weiter'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_13' class='gform_page' data-js='page-field-id-119' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_128\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/recht-heil.de\/datenschutzerklaerung\/\" target=\"_new\">Link zur Datenschutzerkl&auml;rung<\/a><\/div><fieldset id=\"field_1_106\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Einwilligung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_106.1' id='input_1_106_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_106\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_106_1' >Ich stimme der Datenschutzerkl\u00e4rung zu.<\/label><input type='hidden' name='input_106.2' value='Ich stimme der Datenschutzerkl\u00e4rung zu.' class='gform_hidden' \/><input type='hidden' name='input_106.3' value='4' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_106' tabindex='0'>Mit einem Klick auf dieses K\u00e4stchen best\u00e4tigen Sie, dass Sie die oben verlinkte Datenschutzerkl\u00e4rung zur Kenntnis genommen haben. <\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Zur\u00fcck'  \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Mandatsanfrage abschicken'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='mkq3MzUPPXTOMU0yE1wGhK54RGEcgxXBEV2N\/ggnXkuWXrd52cc2Hp5cMJJg1AQCGOP\/AjsGz5xbdjG\/iLc5JCSvtrPwUJ1WfhMLixO9zXR0eV4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJ7XCIxMDYuMVwiOlwiNjEwMGU5NWYyNGE0MTEzMzliNWU5ZTI0NTYzNTQwODdcIixcIjEwNi4yXCI6XCJjYTBkZmJlODgzMDkzZjM5ZmI2YWJmNDEzOWMyOTVhMVwiLFwiMTA2LjNcIjpcIjBjZjNlYjc5MzQ4ZjkzMGMzMjE1ZWU2ZWZlNWRlNmNjXCJ9IiwiOGFkNjQ0ZWQyNjEwNjU0MGI1MjY4NzUwNmRiMTg3ODYiXQ==' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_1' value='' \/>\n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_1').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1').val();gformInitSpinner( 1, 'https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_1').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_1').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_1').text());}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"1\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_1\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_1\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_1\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 1, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-64","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/pages\/64","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/comments?post=64"}],"version-history":[{"count":8,"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/pages\/64\/revisions"}],"predecessor-version":[{"id":128,"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/pages\/64\/revisions\/128"}],"wp:attachment":[{"href":"https:\/\/form.advobox.com\/kanzleiheil-dillingen\/wp-json\/wp\/v2\/media?parent=64"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}