{"id":269,"date":"2010-02-03T05:59:38","date_gmt":"2010-02-03T05:59:38","guid":{"rendered":"http:\/\/profconsure.co.za\/?page_id=269"},"modified":"2012-06-22T14:02:53","modified_gmt":"2012-06-22T14:02:53","slug":"application","status":"publish","type":"page","link":"http:\/\/profconsure.co.za\/?page_id=269","title":{"rendered":"Application"},"content":{"rendered":"<p><strong>SUPPORTING DOCUMENTS FOR MEMBERSHIP with\u00a0APPLICATION:<\/strong><\/p>\n<p><strong>1. Identification document (Copy) of main member and dependants (ID or birth certificates)<\/strong><\/p>\n<p><strong>2. Cheque or\u00a0bank statement to confirm banking details (Copy)<\/strong><\/p>\n<p><strong>3. Affidavit when registering common law spouse or partner<\/strong><\/p>\n<p><strong>4. Marriage certificate when registering a spouse with diffrent surname on ID<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Please fill in the form below to download the Gap Cover Application Form:<\/strong><\/p>\n\n\t\t<form enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F269#usermessage\" method=\"post\" class=\"cform\" id=\"cformsform\">\n\t\t<fieldset class=\"cf-fs1\">\n\t\t<legend>My personal details:<\/legend>\n\t\t<ol class=\"cf-ol\">\n\t\t\t<li id=\"li--2\"><label for=\"cf_field_2\"><span>Your Name<\/span><\/label><input type=\"text\" name=\"cf_field_2\" id=\"cf_field_2\" class=\"single fldrequired\" value=\"Your Name\" onfocus=\"clearField(this)\" onblur=\"setField(this)\"\/><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t\t<li id=\"li--3\"><label for=\"cf_field_3\"><span>City or Town in which you reside?<\/span><\/label><input type=\"text\" name=\"cf_field_3\" id=\"cf_field_3\" class=\"single fldrequired\" value=\"\" onfocus=\"clearField(this)\" onblur=\"setField(this)\"\/><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t\t<li id=\"li--4\"><label for=\"cf_field_4\"><span>Email<\/span><\/label><input type=\"text\" name=\"cf_field_4\" id=\"cf_field_4\" class=\"single fldemail fldrequired\" value=\"\"\/><span class=\"emailreqtxt\">(valid email required)<\/span><\/li>\n\t\t\t<li id=\"li--5\"><label for=\"cf_field_5\"><span>Contact Number<\/span><\/label><input type=\"text\" name=\"cf_field_5\" id=\"cf_field_5\" class=\"single\" value=\"\"\/><\/li>\n\t\t\t<li id=\"li--6\"><label for=\"cf_field_6\"><span>Who Referred You?<\/span><\/label><select name=\"cf_field_6\" id=\"cf_field_6\" class=\"cformselect\" >\n\t\t\t<\/select><\/li>\n\t\t\t<li id=\"li--7\"><label for=\"cf_field_7\"><span>Are you interested in a new policy?<\/span><\/label><select name=\"cf_field_7\" id=\"cf_field_7\" class=\"cformselect fldrequired\" >\n\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t<\/select><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t\t<li id=\"li--8\"><label for=\"cf_field_8\"><span>Query (include policy no. if you have one)<\/span><\/label><textarea cols=\"30\" rows=\"8\" name=\"cf_field_8\" id=\"cf_field_8\" class=\"area\"><\/textarea><\/li>\n\t\t\t<li id=\"li--9\"><label for=\"cf_field_9\" class=\"cf-before\"><span>I have read and understand the disclaimer as listed at the bottom of this website.<\/span><\/label><input type=\"checkbox\" name=\"cf_field_9\" id=\"cf_field_9\" class=\"cf-box-b fldrequired\"\/><\/li>\n\t\t\t<li id=\"li--10\"><label for=\"cf_field_10\"><span>May we contact you?<\/span><\/label><select name=\"cf_field_10\" id=\"cf_field_10\" class=\"cformselect\" >\n\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t<\/select><\/li>\n\t\t<\/ol>\n\t\t<\/fieldset>\n\t\t<fieldset class=\"cf_hidden\">\n\t\t\t<legend>&nbsp;<\/legend>\n\t\t\t<input type=\"hidden\" name=\"cf_working\" id=\"cf_working\" value=\"One%20moment%20please...\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_failure\" id=\"cf_failure\" value=\"Please%20fill%20in%20all%20the%20required%20fields.\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_codeerr\" id=\"cf_codeerr\" value=\"Please%20double-check%20your%20verification%20code.\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_customerr\" id=\"cf_customerr\" value=\"yyy\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_popup\" id=\"cf_popup\" value=\"yn\"\/>\n\t\t<\/fieldset>\n\t\t<p class=\"cf-sb\"><input type=\"submit\" name=\"resetbutton\" id=\"resetbutton\" class=\"resetbutton\" value=\"Reset Form\" onclick=\"return confirm('Note: This will reset all your input!')\"><input type=\"submit\" name=\"sendbutton\" id=\"sendbutton\" class=\"sendbutton\" value=\"Submit\"\/><\/p>\n\t\t<\/form>\n\t\t<p class=\"linklove\" id=\"ll\"><a href=\"http:\/\/www.deliciousdays.com\/cforms-plugin\"><em>cforms<\/em> contact form by delicious:days<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Please fill in this form in order to download the Application Form:<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>SUPPORTING DOCUMENTS FOR MEMBERSHIP with\u00a0APPLICATION: 1. Identification document (Copy) of main member and dependants (ID or birth certificates) 2. Cheque or\u00a0bank statement to confirm banking details (Copy) 3. Affidavit when registering common law spouse or partner 4. Marriage certificate when registering a spouse with diffrent surname on ID \u00a0 Please fill in the form below [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":267,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/269"}],"collection":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=269"}],"version-history":[{"count":13,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/269\/revisions"}],"predecessor-version":[{"id":2279,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/269\/revisions\/2279"}],"up":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/267"}],"wp:attachment":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}