{"id":72,"date":"2024-05-17T17:09:04","date_gmt":"2024-05-17T15:09:04","guid":{"rendered":"https:\/\/sis972.fr\/ma-preprod\/\/?page_id=72"},"modified":"2026-05-26T13:46:15","modified_gmt":"2026-05-26T17:46:15","slug":"attestation","status":"publish","type":"page","link":"https:\/\/sis972.fr\/ma-preprod\/attestation\/","title":{"rendered":"Attestation"},"content":{"rendered":"\n[et_pb_section fb_built=\u00a0\u00bb1&Prime; fullwidth=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb collapsed=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_fullwidth_slider _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#2e312f\u00a0\u00bb background_image=\u00a0\u00bbhttps:\/\/sis972.fr\/ma-preprod\/\/wp-content\/uploads\/2024\/11\/Secours_Routier_Ecureuil-scaled.jpg\u00a0\u00bb background_blend=\u00a0\u00bboverlay\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_slide heading=\u00a0\u00bbAttestation d&rsquo;Intervention\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_level=\u00a0\u00bbh1&Prime; header_font=\u00a0\u00bbAkhandsoft Gras||||||||\u00a0\u00bb header_font_size=\u00a0\u00bb45px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_transition=\u00a0\u00bbon\u00a0\u00bb][\/et_pb_slide][\/et_pb_fullwidth_slider][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; admin_label=\u00a0\u00bbSection Form Victime\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_margin=\u00a0\u00bb0px|0px|0px|0px|true|true\u00a0\u00bb custom_padding=\u00a0\u00bb0px|0px|0px|0px|true|true\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb collapsed=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row column_structure=\u00a0\u00bb1_2,1_2&Prime; use_custom_gutter=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb custom_padding=\u00a0\u00bb0px||0px|20px|true|false\u00a0\u00bb sticky_position=\u00a0\u00bbtop\u00a0\u00bb border_radii=\u00a0\u00bboff|||10px|10px\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime; 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_builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_padding=\u00a0\u00bb||0px||false|false\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_heading title=\u00a0\u00bbFormulaire &#8211; Vous \u00eates la victime\u00a0\u00bb module_id=\u00a0\u00bbparticulier\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb title_font=\u00a0\u00bbAkhandsoft Gras||||||||\u00a0\u00bb title_text_align=\u00a0\u00bbleft\u00a0\u00bb title_text_color=\u00a0\u00bb#000000&Prime; title_font_size=\u00a0\u00bb45px\u00a0\u00bb positioning=\u00a0\u00bbnone\u00a0\u00bb position_origin_a=\u00a0\u00bbcenter_center\u00a0\u00bb width=\u00a0\u00bb100%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb max_width_tablet=\u00a0\u00bb50%\u00a0\u00bb max_width_phone=\u00a0\u00bb100%\u00a0\u00bb max_width_last_edited=\u00a0\u00bboff|desktop\u00a0\u00bb module_alignment=\u00a0\u00bbleft\u00a0\u00bb custom_margin=\u00a0\u00bb||0px||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb||||false|false\u00a0\u00bb title_font_size_tablet=\u00a0\u00bb45px\u00a0\u00bb title_font_size_phone=\u00a0\u00bb45px\u00a0\u00bb title_font_size_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb custom_css_main_element_last_edited=\u00a0\u00bboff|desktop\u00a0\u00bb custom_css_main_element_tablet=\u00a0\u00bb\/*empecher le retour \u00e0 la ligne*\/||white-space : nowrap;\u00a0\u00bb custom_css_main_element_phone=\u00a0\u00bb\/*empecher le retour \u00e0 la ligne*\/||white-space : nowrap;\u00a0\u00bb][\/et_pb_heading][et_pb_divider color=\u00a0\u00bb#DD0A14&Prime; divider_position=\u00a0\u00bbcenter\u00a0\u00bb divider_weight=\u00a0\u00bb4px\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb max_width=\u00a0\u00bb130px\u00a0\u00bb module_alignment=\u00a0\u00bbleft\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_divider][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb custom_padding=\u00a0\u00bb0px||||false|false\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font=\u00a0\u00bbLiterata||||||||\u00a0\u00bb text_text_color=\u00a0\u00bb#000000&Prime; text_font_size=\u00a0\u00bb20px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<p>Suite \u00e0 un sinistre, si votre assureur requiert une attestation d\u2019intervention des sapeurs-pompiers, nous vous invitons \u00e0 remplir ce formulaire en y joignant une copie de votre pi\u00e8ce d\u2019identit\u00e9. Une attestation vous sera envoy\u00e9e dans les plus brefs d\u00e9lais apr\u00e8s l\u2019examen de votre demande.<\/p>\n<p style= \"color: red;\">Pour toute question ou information compl\u00e9mentaire, n\u2019h\u00e9sitez pas \u00e0 nous contacter au 0596 59 05 81. <\/p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_code _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bbrgba(0,1,109,0.2)\u00a0\u00bb max_width=\u00a0\u00bb67%\u00a0\u00bb max_width_tablet=\u00a0\u00bb100%\u00a0\u00bb max_width_phone=\u00a0\u00bb100%\u00a0\u00bb max_width_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_padding=\u00a0\u00bb10px|10px|10px|10px|true|true\u00a0\u00bb custom_css_free_form=\u00a0\u00bb.wpcf7-submit{||  background-color: #00016d; ||  color: white; ||  border-radius: 3px; ||  border: none; ||  padding: 10px 20px; ||  font-size: 18px;||}||||.wpcf7 .bt {||margin-top:20px;||margin-left:42%;||}||||.wpcf7 .partie {||\ttext-align: center;||  font-size: 28px;||  line-height: 2;||}||@media (min-width: 800px) {||\/*Contact Form 7 Styles*\/||.wpcf7{||\tfont-family: akhandsoft;||\tfont-size: 20px;||\tcolor: black;||}||.wpcf7-text{||\tfont-family: akhandsoft;||\tfont-size: 18px;||  width: 100%; ||  box-sizing: border-box;||}||||  .wpcf7 .title{||\tfont-family: akhandsoft;||\tfont-size: 35px;||\tcolor: black;||}||  ||.wpcf7 .name-cont {||    display: flex;||  \tgap: 10px;||   ||}||||.wpcf7 .nom {||    flex: 1;\t||}||||\/* Champ de prenom *\/||.wpcf7 .prenom {||    flex: 1;||  ||}||||.wpcf7 .cp-cont {||    display: flex;||    gap: 10px;||}||||.wpcf7 .codepostal {||    flex: 1;||}||||\/* Champ ville *\/||.wpcf7 .ville {||    flex: 1;||}||||.wpcf7 .num-cont {||    display: flex;||    gap: 10px;||}||||.wpcf7 .telephone {||  \tflex: 1;||}||  ||\/* Champ Mail *\/||.wpcf7 .mail {||    flex: 1;||}||}||||||@media (max-width: 700px) {||.wpcf7-submit{||  background-color: #00016d; ||  color: white; ||  border-radius: 3px; ||  border: none; ||  padding: 10px 20px; ||  font-size: 18px;||}||||.wpcf7 .bt {||margin-left:38%;||margin-top:20px;||||  }}\u00a0\u00bb border_radii=\u00a0\u00bbon|3px|3px|3px|3px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1269-o1\" lang=\"fr-FR\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ma-preprod\/wp-json\/wp\/v2\/pages\/72#wpcf7-f1269-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1269\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1269-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"redirect_nonce\" value=\"9ff9c2ef55\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_name\" value=\"formvictime\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_reference\" value=\"21335f5b\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_date\" value=\"27mai2026\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div class=\"partie\">\n\t<p><label> DEMANDEUR<\/label>\n\t<\/p>\n<\/div>\n<div class=\"name-cont\">\n\t<p><label> Nom <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required nom\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Pr\u00e9nom <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required prenom\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label> Adresse Postale <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Compl\u00e9ment d'Adresse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"complementadresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"complementadresse\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complementadresse\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label>Code Postal <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required codepostal\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Ville <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required ville\" aria-required=\"true\" aria-invalid=\"false\" name=\"ville\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse-Pointe\">Basse-Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"num-cont\">\n\t<p><label> T\u00e9l\u00e9phone <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel telephone\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Votre e-mail <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email mail\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"mail\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label> Raison de la demande : <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"raisdem\"><span class=\"wpcf7-form-control wpcf7-radio raisdem\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"raisdem\" value=\"Demande de l&#039;assureur\" \/><span class=\"wpcf7-list-item-label\">Demande de l&#039;assureur<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"raisdem\" value=\"Contentieux en cours\" \/><span class=\"wpcf7-list-item-label\">Contentieux en cours<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label>Demandeur agissant en qualit\u00e9 de : <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"qualDem\"><span class=\"wpcf7-form-control wpcf7-radio qualDem\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"qualDem\" value=\"Sinistr\u00e9(e)\" \/><span class=\"wpcf7-list-item-label\">Sinistr\u00e9(e)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"qualDem\" value=\"Repr\u00e9sentant l\u00e9gal du sinistr\u00e9(e)\" \/><span class=\"wpcf7-list-item-label\">Repr\u00e9sentant l\u00e9gal du sinistr\u00e9(e)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"qualDem\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partie\">\n\t<p><label> DESTINATAIRE(si diff\u00e9rent du demandeur)<\/label>\n\t<\/p>\n<\/div>\n<div class=\"name-cont\">\n\t<p><label> Nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text nom\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Pr\u00e9nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text prenom\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label> Lien avec la victime:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"lien\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text lien\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lien\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Adresse Postale<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale2\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Compl\u00e9ment d'Adresse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"complementadresse2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complementadresse2\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label>Code Postal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text codepostal\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Ville<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville2\"><select class=\"wpcf7-form-control wpcf7-select ville\" aria-invalid=\"false\" name=\"ville2\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse-Pointe\">Basse-Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"num-cont\">\n\t<p><label> T\u00e9l\u00e9phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel telephone\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Votre e-mail<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mail2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email mail\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"mail2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"partie\">\n\t<p><label> SINISTRE<\/label>\n\t<\/p>\n<\/div>\n<div class=\"date-heure\">\n\t<p><label> Date du sinistre : <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"datesin\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date datesin\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datesin\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Heure du sinistre : <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heuresin\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required heuresin\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"heuresin\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label>Nature du sinistre :<span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required nature\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nature\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label> Lieu du sinistre <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale3\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Code Postal <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required codepostal3\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal3\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"cp-cont\">\n\t<p><label>Ville <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville3\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required ville3\" aria-required=\"true\" aria-invalid=\"false\" name=\"ville3\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse-Pointe\">Basse-Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label>D\u00c9G\u00c2TS CONSTAT\u00c9S :<span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"degatcons\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required degatcons\" aria-required=\"true\" aria-invalid=\"false\" name=\"degatcons\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label> TYPE DE V\u00c9HICULE:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"typeveh\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"typeveh\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>IMMATRICULATION:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"immatriculation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text immatriculation\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"immatriculation\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"cp-cont\">\n\t<p><label>Victime casqu\u00e9e :<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"casque\"><span class=\"wpcf7-form-control wpcf7-radio casque\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"casque\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"casque\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p><label>Victime ceintur\u00e9e :<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ceinture\"><span class=\"wpcf7-form-control wpcf7-radio ceinture\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ceinture\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ceinture\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label>Qualit\u00e9 de la (ou des)personne(s) concern\u00e9e(s) par le sinistre <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"perssinistre\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required perssinistre\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Propri\u00e9taire(s)\" \/><span class=\"wpcf7-list-item-label\">Propri\u00e9taire(s)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Locataire\" \/><span class=\"wpcf7-list-item-label\">Locataire<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Conducteur\" \/><span class=\"wpcf7-list-item-label\">Conducteur<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Victime(s)\/Passager\" \/><span class=\"wpcf7-list-item-label\">Victime(s)\/Passager<\/span><\/span><span class=\"wpcf7-list-item last has-free-text\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Autres(\u00e0 pr\u00e9ciser)\" \/><span class=\"wpcf7-list-item-label\">Autres(\u00e0 pr\u00e9ciser)<\/span> <input type=\"text\" name=\"_wpcf7_free_text_perssinistre\" class=\"wpcf7-free-text\" \/><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<p><label><br \/>\nJoindre votre pi\u00e8ce d'identit\u00e9 <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cv\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" id=\"cv\" accept=\".pdf,.jpg,.png,.jpeg\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"cv\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div>\n\t<p><label><br \/>\nPOLITIQUE DE CONFIDENTIALIT\u00c9 <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"politiqueconf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"politiqueconf[]\" value=\"J&#039;accepte que les informations saisies soient exploit\u00e9es dans le cadre de ma demande d&#039;information.\" \/><span class=\"wpcf7-list-item-label\">J&#039;accepte que les informations saisies soient exploit\u00e9es dans le cadre de ma demande d&#039;information.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"font-style: italic;\">Les donn\u00e9es personnelles ainsi collect\u00e9es par le SIS 972 seront trait\u00e9es conform\u00e9ment \u00e0 sa politique de confidentialit\u00e9. Les zones de donn\u00e9es marqu\u00e9es par un ast\u00e9risque doivent \u00eatre obligatoirement fournies ;\n\t<\/p>\n\t<p>La non-fourniture des donn\u00e9es emp\u00eache le traitement de votre demande.\n\t<\/p>\n<\/div>\n<div class=\"bt\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; admin_label=\u00a0\u00bbSection Form Soci\u00e9t\u00e9\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_margin=\u00a0\u00bb0px|0px|0px|0px|true|true\u00a0\u00bb custom_padding=\u00a0\u00bb0px|0px|0px|0px|true|true\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb collapsed=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row use_custom_gutter=\u00a0\u00bbon\u00a0\u00bb gutter_width=\u00a0\u00bb2&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_padding=\u00a0\u00bb||0px||false|false\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_heading title=\u00a0\u00bbFormulaire &#8211; Vous \u00eates une Soci\u00e9t\u00e9\u00a0\u00bb module_id=\u00a0\u00bbsociete\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb title_font=\u00a0\u00bbAkhandsoft Gras||||||||\u00a0\u00bb title_text_align=\u00a0\u00bbleft\u00a0\u00bb title_text_color=\u00a0\u00bb#000000&Prime; title_font_size=\u00a0\u00bb45px\u00a0\u00bb positioning=\u00a0\u00bbnone\u00a0\u00bb position_origin_a=\u00a0\u00bbcenter_center\u00a0\u00bb width=\u00a0\u00bb100%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb max_width_tablet=\u00a0\u00bb50%\u00a0\u00bb max_width_phone=\u00a0\u00bb100%\u00a0\u00bb max_width_last_edited=\u00a0\u00bboff|desktop\u00a0\u00bb module_alignment=\u00a0\u00bbleft\u00a0\u00bb custom_margin=\u00a0\u00bb||0px||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb||||false|false\u00a0\u00bb title_font_size_tablet=\u00a0\u00bb45px\u00a0\u00bb title_font_size_phone=\u00a0\u00bb45px\u00a0\u00bb title_font_size_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb custom_css_main_element_last_edited=\u00a0\u00bboff|desktop\u00a0\u00bb custom_css_main_element_tablet=\u00a0\u00bb\/*empecher le retour \u00e0 la ligne*\/||white-space : nowrap;\u00a0\u00bb custom_css_main_element_phone=\u00a0\u00bb\/*empecher le retour \u00e0 la ligne*\/||white-space : nowrap;\u00a0\u00bb][\/et_pb_heading][et_pb_divider color=\u00a0\u00bb#DD0A14&Prime; divider_position=\u00a0\u00bbcenter\u00a0\u00bb divider_weight=\u00a0\u00bb4px\u00a0\u00bb _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb max_width=\u00a0\u00bb130px\u00a0\u00bb module_alignment=\u00a0\u00bbleft\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_divider][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb custom_padding=\u00a0\u00bb0px||||false|false\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font=\u00a0\u00bbLiterata||||||||\u00a0\u00bb text_text_color=\u00a0\u00bb#000000&Prime; text_font_size=\u00a0\u00bb20px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<p>Suite \u00e0 un sinistre, si votre assureur requiert une attestation d\u2019intervention des sapeurs-pompiers, nous vous invitons \u00e0 remplir ce formulaire en y joignant une copie de votre pi\u00e8ce d\u2019identit\u00e9. Une attestation vous sera envoy\u00e9e dans les plus brefs d\u00e9lais apr\u00e8s l\u2019examen de votre demande.<\/p>\n<p style= \"color: red;\">Pour toute question ou information compl\u00e9mentaire, n\u2019h\u00e9sitez pas \u00e0 nous contacter au 0596 59 05 81. <\/p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_code _builder_version=\u00a0\u00bb4.24.3&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bbrgba(0,1,109,0.2)\u00a0\u00bb text_orientation=\u00a0\u00bbleft\u00a0\u00bb max_width=\u00a0\u00bb67%\u00a0\u00bb max_width_tablet=\u00a0\u00bb100%\u00a0\u00bb max_width_phone=\u00a0\u00bb100%\u00a0\u00bb max_width_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_padding=\u00a0\u00bb10px|10px|10px|10px|true|true\u00a0\u00bb custom_css_free_form=\u00a0\u00bb.wpcf7-submit{||  background-color: #00016d; ||  color: white; ||  border-radius: 3px; ||  border: none; ||  padding: 10px 20px; ||  font-size: 18px;||}||||.wpcf7 .bt {||margin-top:20px;||margin-left:42%;||}||||.wpcf7 .partie {||\ttext-align: center;||  font-size: 28px;||  line-height: 2;||}||@media (min-width: 800px) {||\/*Contact Form 7 Styles*\/||.wpcf7{||\tfont-family: akhandsoft;||\tfont-size: 20px;||\tcolor: black;||}||.wpcf7-text{||\tfont-family: akhandsoft;||\tfont-size: 18px;||  width: 100%; ||  box-sizing: border-box;||}||||  .wpcf7 .title{||\tfont-family: akhandsoft;||\tfont-size: 35px;||\tcolor: black;||}||  ||.wpcf7 .name-cont {||    display: flex;||  \tgap: 10px;||   ||}||||.wpcf7 .nom {||    flex: 1;\t||}||||\/* Champ de prenom *\/||.wpcf7 .prenom {||    flex: 1;||  ||}||||.wpcf7 .cp-cont {||    display: flex;||    gap: 10px;||}||||.wpcf7 .codepostal {||    flex: 1;||}||||\/* Champ ville *\/||.wpcf7 .ville {||    flex: 1;||}||||.wpcf7 .num-cont {||    display: flex;||    gap: 10px;||}||||.wpcf7 .telephone {||  \tflex: 1;||}||  ||\/* Champ Mail *\/||.wpcf7 .mail {||    flex: 1;||}||}||||||@media (max-width: 700px) {||.wpcf7-submit{||  background-color: #00016d; ||  color: white; ||  border-radius: 3px; ||  border: none; ||  padding: 10px 20px; ||  font-size: 18px;||}||||.wpcf7 .bt {||margin-left:38%;||margin-top:20px;||||  }}\u00a0\u00bb border_radii=\u00a0\u00bbon|3px|3px|3px|3px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1485-o2\" lang=\"fr-FR\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ma-preprod\/wp-json\/wp\/v2\/pages\/72#wpcf7-f1485-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1485\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1485-o2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"redirect_nonce\" value=\"9ff9c2ef55\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_name\" value=\"formvictime\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_reference\" value=\"5e631300\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_date\" value=\"27mai2026\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div class=\"partie\">\n\t<p><label > DEMANDEUR<\/label>\n\t<\/p>\n<\/div>\n<div class=\"name-cont\">\n\t<p><label> Raison Sociale<span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required nom\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label> Adresse Postale de l'organisme <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Compl\u00e9ment d'Adresse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"complementadresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complementadresse\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label>Code Postal <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required codepostal\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Ville <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required ville\" aria-required=\"true\" aria-invalid=\"false\" name=\"ville\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse-Pointe\">Basse-Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"num-cont\">\n\t<p><label> T\u00e9l\u00e9phone <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel telephone\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Votre e-mail <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email mail\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"mail\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label> Raison de la demande : <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"raisdem\"><span class=\"wpcf7-form-control wpcf7-radio raisdem\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"raisdem\" value=\"Demande de l&#039;assureur\" \/><span class=\"wpcf7-list-item-label\">Demande de l&#039;assureur<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"raisdem\" value=\"Contentieux en cours\" \/><span class=\"wpcf7-list-item-label\">Contentieux en cours<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label>Demandeur agissant en qualit\u00e9 de : <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"qualDem\"><span class=\"wpcf7-form-control wpcf7-radio qualDem\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"qualDem\" value=\"Sinistr\u00e9(e)\" \/><span class=\"wpcf7-list-item-label\">Sinistr\u00e9(e)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"qualDem\" value=\"Repr\u00e9sentant l\u00e9gal du sinistr\u00e9(e)\" \/><span class=\"wpcf7-list-item-label\">Repr\u00e9sentant l\u00e9gal du sinistr\u00e9(e)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"qualDem\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partie\">\n\t<p><label class=\"partie\"> DESTINATAIRE(si diff\u00e9rent du demandeur)<\/label>\n\t<\/p>\n<\/div>\n<div class=\"name-cont\">\n\t<p><label> Nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text nom\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Pr\u00e9nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text prenom\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label> Lien avec la victime:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"lien\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text lien\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lien\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Adresse Postale<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale2\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label> Compl\u00e9ment d'Adresse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"complementadresse2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complementadresse2\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label>Code Postal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text codepostal\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Ville<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville2\"><select class=\"wpcf7-form-control wpcf7-select ville\" aria-invalid=\"false\" name=\"ville2\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse-Pointe\">Basse-Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"num-cont\">\n\t<p><label> T\u00e9l\u00e9phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel telephone\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Votre e-mail<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mail2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email mail\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"mail2\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"partie\">\n\t<p><label> SINISTRE<\/label>\n\t<\/p>\n<\/div>\n<div class=\"date-heure\">\n\t<p><label> Date du sinistre: <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"datesin\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date datesin\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datesin\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Heure du sinistre: <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heuresin\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required heuresin\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"heuresin\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label>Nature du sinistre:<span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required nature\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nature\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label> Lieu du sinistre <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adressepostale3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adressepostale3\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>Code Postal <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CodePostal3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required codepostal3\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CodePostal3\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div class=\"cp-cont\">\n\t<p><label>Ville <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville3\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required ville3\" aria-required=\"true\" aria-invalid=\"false\" name=\"ville3\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Ajoupa-Bouillon\">Ajoupa-Bouillon<\/option><option value=\"Anses-d&#039;Arlet\">Anses-d&#039;Arlet<\/option><option value=\"Basse Pointe\">Basse Pointe<\/option><option value=\"Bellefontaine\">Bellefontaine<\/option><option value=\"Carbet\">Carbet<\/option><option value=\"Case-Pilote\">Case-Pilote<\/option><option value=\"Diamant\">Diamant<\/option><option value=\"Ducos\">Ducos<\/option><option value=\"Fonds-Saint-Denis\">Fonds-Saint-Denis<\/option><option value=\"Fort-de-France\">Fort-de-France<\/option><option value=\"Fran\u00e7ois\">Fran\u00e7ois<\/option><option value=\"Grand-Rivi\u00e8re\">Grand-Rivi\u00e8re<\/option><option value=\"Gros-Morne\">Gros-Morne<\/option><option value=\"Lamentin\">Lamentin<\/option><option value=\"Lorrain\">Lorrain<\/option><option value=\"Macouba\">Macouba<\/option><option value=\"Marigot\">Marigot<\/option><option value=\"Marin\">Marin<\/option><option value=\"Morne-Rouge\">Morne-Rouge<\/option><option value=\"Morne-Vert\">Morne-Vert<\/option><option value=\"Pr\u00eacheur\">Pr\u00eacheur<\/option><option value=\"Rivi\u00e8re-Pilote\">Rivi\u00e8re-Pilote<\/option><option value=\"Rivi\u00e8re-Sal\u00e9e\">Rivi\u00e8re-Sal\u00e9e<\/option><option value=\"Robert\">Robert<\/option><option value=\"Saint-Esprit\">Saint-Esprit<\/option><option value=\"Saint-Joseph\">Saint-Joseph<\/option><option value=\"Saint-Pierre\">Saint-Pierre<\/option><option value=\"Sainte-Anne\">Sainte-Anne<\/option><option value=\"Sainte-Luce\">Sainte-Luce<\/option><option value=\"Sainte-Marie\">Sainte-Marie<\/option><option value=\"Schoelcher\">Schoelcher<\/option><option value=\"Trinit\u00e9\">Trinit\u00e9<\/option><option value=\"Trois-\u00celets\">Trois-\u00celets<\/option><option value=\"Vauclin\">Vauclin<\/option><\/select><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<p><label>D\u00c9G\u00c2TS CONSTAT\u00c9S :<span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"degatcons\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required degatcons\" aria-required=\"true\" aria-invalid=\"false\" name=\"degatcons\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cp-cont\">\n\t<p><label> TYPE DE V\u00c9HICULE:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"typeveh\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"typeveh\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label>IMMATRICULATION:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"immatriculation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text immatriculation\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"immatriculation\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label>Qualit\u00e9 de la (ou des)personne(s) concern\u00e9e(s) par le sinistre<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"perssinistre\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required perssinistre\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Propri\u00e9taire(s)\" \/><span class=\"wpcf7-list-item-label\">Propri\u00e9taire(s)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Locataire\" \/><span class=\"wpcf7-list-item-label\">Locataire<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Conducteur\" \/><span class=\"wpcf7-list-item-label\">Conducteur<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Victime(s)\/Passager\" \/><span class=\"wpcf7-list-item-label\">Victime(s)\/Passager<\/span><\/span><span class=\"wpcf7-list-item last has-free-text\"><input type=\"checkbox\" name=\"perssinistre[]\" value=\"Autres(\u00e0 pr\u00e9ciser)\" \/><span class=\"wpcf7-list-item-label\">Autres(\u00e0 pr\u00e9ciser)<\/span> <input type=\"text\" name=\"_wpcf7_free_text_perssinistre\" class=\"wpcf7-free-text\" \/><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<p><label> Justificatif d'entreprise <span style=\"color:red;\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cv\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".pdf,.jpg,.png,.jpeg\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"cv\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<div>\n\t<p><label> POLITIQUE DE CONFIDENTIALIT\u00c9 <span style=\"color:red;\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"politiqueconf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"politiqueconf[]\" value=\"J&#039;accepte que les informations saisies soient exploit\u00e9es dans le cadre de ma demande d&#039;information.\" \/><span class=\"wpcf7-list-item-label\">J&#039;accepte que les informations saisies soient exploit\u00e9es dans le cadre de ma demande d&#039;information.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"font-style: italic;\">Les donn\u00e9es personnelles ainsi collect\u00e9es par le SIS 972 seront trait\u00e9es conform\u00e9ment \u00e0 sa politique de confidentialit\u00e9. Les zones de donn\u00e9es marqu\u00e9es par un ast\u00e9risque doivent \u00eatre obligatoirement fournies ;\n\t<\/p>\n\t<p>la non-fourniture des donn\u00e9es conduit \u00e0 ne pas pouvoir donner suite \u00e0 votre demande.\n\t<\/p>\n<\/div>\n<div class=\"bt\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"<p>Suite \u00e0 un sinistre, si votre assureur requiert une attestation d\u2019intervention des sapeurs-pompiers, nous vous invitons \u00e0 remplir ce formulaire en y joignant une copie de votre pi\u00e8ce d\u2019identit\u00e9. Une attestation vous sera envoy\u00e9e dans les plus brefs d\u00e9lais apr\u00e8s l\u2019examen de votre demande. Pour toute question ou information compl\u00e9mentaire, n\u2019h\u00e9sitez pas \u00e0 nous contacter [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-72","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Attestation - SIS 972<\/title>\n<meta name=\"description\" content=\"Formulaire et d\u00e9marches pour obtenir une attestation d&#039;intervention des sapeurs-pompiers du SIS 972 en Martinique (sinistres, assurances).\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Attestation - 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